Distraction- the key to automatic normal function

Distraction

Recently I had the privilege of attending the 2022 Functional Neurological Society’s international conference. What an inspiration that was! It was so exciting to see hundreds of medical providers eager to learn more about FND.

One frequent topic was the role of attention in FND. Redirecting attention is a cornerstone of FND treatment. One video shared by a speaker showed a woman with FND struggling to walk. Her gait was much like many of us have experienced firsthand- staggering, off-balance, and hesitant. Her difficulty was evident. However, while she was sitting while waiting for her next exercise, her phone rang. She popped out of her chair and walked over to answer it with no gait issues at all. For the uninitiated, it would appear that her mobility problems weren’t real. This is part of why we FND patients have been disbelieved for so long. When a neurologist is able to induce normal movement through distraction maneuvers, there is not much question about the diagnosis. One of the defining characteristics of Functional Neurological Disorder is our ability to function normally when we are distracted.

Another video I saw showed an FND patient whose gait looked fairly normal, but whenever he needed to turn, he began flailing and lost his balance. The physical therapist had him tap his leg as he moved into a turn. Tada! Problem solved! As long as he focused on tapping, his automatic movement through turns returned to normal.

During the early days of my functional neurological disorder, I remember that the inconsistency of my symptoms made me feel crazy. Why could I walk fine sometimes and other times my body refused to cooperate? It wasn’t due to any circumstance that I could figure out.

Now I know that my normal gait depends on automatic movement. I can’t focus on my walking. If I do, the connections go haywire.

Gait Recovery

Only you know what you can do safely! Please don't attempt any exercises that may cause injury.

When you are trying to walk and your legs won’t cooperate, the worst thing that you can do is to focus more on your legs. Success lies in accessing your automatic movements. Think back to when you were walking normally. You didn’t think about what you had to do when you walked, you just got up and did it. That’s the key to recovering your mobility.

Physical therapy can be very helpful with this. If you see a physical therapist who isn’t experienced with FND treatment, be sure to take along Glenn Nielsen’s landmark paper on FND treatment. While other patients who need to relearn to walk might need to focus on their legs, that approach will quickly backfire for those of us with FND.

Sometimes mixing it up a little bit with a movement that gets you moving, but isn’t normal walking, can help your brain avoid the unhelpful FND pattern. Try walking backwards, sidestepping, dancing, marching, changing your speed, sliding your feet as if you’re wearing skis, skipping, walking on tiptoe, or walking on your heels. Walking to the beat of your favorite music or counting out loud as you take steps can also provide distraction. Use any successful attempts at moving as a way to reassure yourself that your muscles are fine, it’s just a brain pathway issue.

Keep your mind off of walking by tapping your legs, singing, counting, or talking. When my legs threaten to give up the normal pattern, it helps me to focus on the spot I’m heading. I keep my gaze up on my target instead of looking at my feet like I used to do when FND was in charge. In my head I’m using words like “glide, smooth movement, easy, calm, relaxed” to remind myself of the feelings I need to stay in the normal automatic pathway.

When my legs feel weak, first I acknowledge the feeling so that I’m not just ignoring what my body is saying. Next up comes reassurance. I remind myself that I’ve had these sensations before, that they’re due to my FND, and that they will pass. It’s very easy to let our FND symptoms lead us into fear. “Why is this happening? Is it permanent? Are the doctors missing something? Surely this isn’t normal!” These thoughts are all understandable. I don’t know any FND patient who hasn’t had them. The problem is that fear causes our nervous system to enter an anxious state, accompanied by the stress hormones that can keep us from the calm, relaxed state that supports our best function.

If it’s been awhile since you’ve walked, don’t expect to just get up and go. Take it in small steps. You might start with a simple exercise moving from sitting to standing. Watch yourself in the mirror as you do this. You might be surprised to see that your form is very different from what you imagine. Watch the position of your feet on the floor and your bottom in the chair. Think about smooth, easy movements. Up, down. Up, down. Don’t overanalyze it.

Another exercise that you can try is weight shifting. Again, look in the mirror, stand up, and slowly shift your weight from side to side. This movement is fundamental to walking and can help your brain reconnect with those automatic patterns.

Tremors

If you have a tremor, you may have noticed that your doctor has performed a test that changes the tremor by initiating movement on the side opposite the tremor. This is called entrainment. For example, if you have an arm tremor on the right side, if you tap your left hand on your knee in a fixed rhythm, your tremor will take on the same rhythm. By slowly decreasing the speed of the tapping, you can slow down and even stop your tremor. Other tricks for distracting your tremor are to make competing movements, like waving your arms in an exaggerated manner like a musical conductor. Tap your toes, move your feet- anything that directs your attention to another body part and away from the part that suffers from a tremor.

Brain Fog

Most of us with FND go through those times when it feels like our brain is composed of sludge and thoughts just can’t get through. This happened to me the day after I returned home from the 2022 FND Society conference. I wasn’t surprised by the brain fatigue (which may have been part of the problem- our expectations play a powerful role in symptom development) after being away from home for several days, a conference with complicated lectures, a crowded conference room, and long flights.

In the past, this symptom has stumped me. I couldn’t figure out how to move out of the fog. This time, I was curious about how my garden was doing after my absence. After spending some time in the garden, I realized that the fog had lifted! I was so excited that my brain was back to processing thoughts normally.

As I thought about it, it made sense that just like my other symptoms, distraction could work to help brain fog too. Sometimes rest is your best option, but at other times, a soothing, calm activity might be just the ticket for clearing the fog.

Experiment!

What symptoms are you struggling with? I hope this post has given you some ideas for using distraction to keep your symptoms at bay. It’s not an all-inclusive list, however. Tools for distraction can be individualized. Experiment with ways to distract yourself from your symptoms and let me know what you find.