Sensory Processing Difficulties and Occupational Therapy Outcomes for Functional Neurological Disorder 2024 McCombs, Perez et al

Abstract

Background and Objectives
Occupational therapy (OT) consensus recommendations and articles outlining a sensory-based OT intervention for functional neurological disorder (FND) have been published. However, limited research has been conducted to examine the efficacy of OT interventions for FND. We performed a retrospective cohort study aimed at independently replicating preliminarily characterized sensory processing difficulties in patients with FND and reporting on clinical outcomes of a sensory-based OT treatment in this population. We hypothesized that (1) a history of functional seizures, anxiety, and/or post-traumatic stress disorder would be associated with increased sensory processing difficulties and (2) the number of OT treatment sessions received would positively relate to clinical improvement.

Methods
Medical records were reviewed for 77 consecutive adults with FND who received outpatient, sensory-based OT care. Data from the Adolescent/Adult Sensory Profile characterized self-reported sensory processing patterns across 4 quadrants (low registration, sensory sensitivity, sensory seeking, and sensory avoidance) in this population. Following univariate screenings, multivariate linear regression analyses were performed to identify neuropsychiatric characteristics associated with discrete sensory processing patterns. Clinical improvement was quantified using an estimated, clinician-determined improvement rating (“improved” vs “not improved”), and relationships between clinical participation, baseline neuropsychiatric factors, and outcomes were investigated.

Results
Patients with FND reported sensory processing patterns with elevated scores in low registration, sensory sensitivity, and sensation avoidance compared with normative values; differences in sensory processing scores were not observed across FND subtypes (i.e., motor, seizure, and speech variants). In linear regression analyses, lifetime history of an anxiety disorder, history of migraine headaches, current cognitive complaints, and a comorbid major neurologic condition independently predicted individual differences in sensory processing scores. Following a sensory-based OT intervention, 62% of individuals with FND were clinician determined as “improved.” In a multivariate logistic regression analysis controlling for baseline characteristics associated with improvement ratings, number of treatment sessions positively correlated with clinical improvement.

Discussion
These findings support the presence of sensory processing difficulties in patients with FND and provide Class IV evidence for the efficacy of an outpatient, sensory-based OT intervention in this population. Controlled prospective trials are warranted.

Paywall, https://www.neurology.org/doi/10.1212/CPJ.0000000000200286

 

So, recommendations published without evidence. And not actual consensus either, although this is the dominant school of thought, it's not a full consensus since there is a lot of disagreement over pretty much everything here.

Given the huge number of people with LC misdiagnosed with FND, and the significant % of natural recoveries over time, widely reported by patients as being simply time, not anything particular they did, this is simply the natural course of those illnesses. This is simply not valid research. It's basically the kind of investment prospectus you see from companies that don't have a real product, instead are selling the idea that if they had a working product, it would be a worthy investment.

But as usual they are oblivious, indifferent or worse, to pushing out unevidenced pseudoscience, even worse under the banner of "evidence-based medicine". By their own admission they don't have evidence for this. This is what this 'study' is about: "hey, we have 'consensus', but no evidence, so I guess we should, I don't know, make some?". And of course all they can show is that those patients are ill, and a significant % of them improve with time, which is not evidence of anything other than a natural course invalidating any of their claims about their unevidenced treatments being any effective.

This also obviously doesn't "support the presence of sensory processing difficulties in patients with FND". This is what patients report and have done so for, well, centuries and more. There is no other form of evidence here. It's valid evidence, but this study adds nothing to it, symptoms being, by definition, self-reported. Utter nonsense as usual.