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Functional Neurological Disorders

Functional Movement Disorders (FMD) / Functional Neurological Disorders (FND)

A Functional Movement Disorder or FMD is a disorder of neurological function rather than of neurological structure.

FMD is a very common problem and symptoms include, but are not limited to, tremor, abnormal postures, jerking movements, weakness, and/or problems with speech or walking.

These symptoms can result in learned patterns of abnormal movement which, with unchecked repetition, become automatic and out of the person’s control.

Our Treatment

It is critical to have the correct diagnosis by a physician with expertise in the area of FMD and FND. Once diagnosed correctly, a multidisciplinary approach is best, including physiotherapy by a therapist familiar with the treatment of these disorders.


We can think of functional movement disorder symptoms as stemming from abnormal motor programming. A computer analogy to contrast structure and function is useful: think of functional neurological symptoms as similar to a brain "software" problem, rather than a “hardware” problem.

We will demonstrate in your assessment that the hardware of your nervous system, i.e. your brain, spinal cord, and nerves, and muscles are all capable of working normally. But just like computers, our brain software programs sometimes malfunction and can create an abnormal motor program.


Over time, and with repeated use, the brain becomes used to using the abnormal motor program, and starts to produce it automatically, without your control. In the same way that a musician or athlete can learn complex normal motor programs, our brains can learn in an abnormal way to perform abnormal motor programs.

The most important part of the treatment of an FMD is the correct diagnosis by a medical expert. Once this diagnosis is established, a combination of physical therapy and psychological therapy can be beneficial.

Physiotherapy & FND

It is important to choose a physiotherapist who is knowledgeable in the best treatment practices for FND. FND-specific physiotherapy, with a prioritization of motor retraining and reinforcement of normal movement, along with principles of rehabilitation have a solid evidence base in Functional Movement Disorders.

These best treatment practices include:

  • Educating the person about FND

  • Demonstrating normal movement

  • Retraining normal movement

  • Applying motor learning principles

  • Changing maladaptive behaviours

Why One Step Ahead Mobility?

Our clinic Co-Owner and Registered Physiotherapist, Jan Goldstein Elman, has an interest in and years of experience working with people with FND.

At One Step Ahead Mobility, we regularly consult with physicians and colleagues specializing in assessing and treating FND, including the team at the Movement Disorders Clinic at Toronto Western Hospital.


Our team regularly reviews the latest research and best practices for FND, and has attended conferences both in Toronto and internationally, including the International Conference on FND in Edinburgh, Scotland.


For more information on our treatment programs for FND or to book an assessment with Physiotherapist Jan Goldstein Elman, please call us at 416-783-7175.

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