FROM MY PT SCHOOL NOTES · NEUROLOGY · UNIT 6 · CHAPTER 23
How should PT adapt for dementia, cerebral palsy and FND?
Dementia, cerebral palsy (CP) and functional neurological disorder (FND) differ in cause and course. They belong together here only to teach how communication, context and individual presentation change the rehabilitation plan.
Build the clinical picture
Dementia: support meaningful action and safety
Dementia describes cognitive decline affecting independence, with multiple possible causes. Alzheimer’s disease is one cause. In PT, assess gait and falls, task sequence, instruction processing, caregiver support, pain and environmental risks. Use respectful concise cues, predictable routines, demonstrations and meaningful activities.
A patient’s difficulty following a multistep instruction is not proof that exercise is impossible. Focus on task performance, safe assistance, caregiver training and preserving participation, while recognizing changing needs over time.
Cerebral palsy: a nonprogressive brain disturbance with changing lifelong needs
CP arises from a nonprogressive disturbance of the developing brain, but its functional consequences can change with growth and aging. Movement patterns can be spastic, dyskinetic, ataxic or mixed; associated pain, fatigue, communication, orthopedic and participation factors vary. Adolescents and adults may need new equipment, endurance management and lifelong access planning.
Avoid assuming every adult with CP has the same capacity or should be treated as a pediatric patient. Build goals around work, family, self-care, mobility, pain and personal preferences.
Functional neurological disorder: positive diagnosis, real symptoms
FND is a genuine neurological condition involving altered functioning of motor/sensory networks, not a synonym for pretending or ‘symptoms with no cause.’ Diagnosis rests on appropriate positive clinical features and medical assessment, not merely on normal imaging or the absence of another diagnosis. Symptoms may include functional weakness, gait changes, tremor or episodes resembling seizures.
Evidence-informed rehabilitation uses a clear shared explanation, collaborative goals, movement retraining, attention-shifting where appropriate, task normalization and multidisciplinary care. Avoid suggesting that all FND is caused by an unresolved psychological conflict; the uploaded lecture’s older ‘conversion disorder’ model should be labeled historical. See recent FND rehabilitation evidence.
At a glance
| Dementia | Make cues accessible and routines predictable; incorporate caregiver/environment |
| Cerebral palsy | Adapt lifelong mobility and participation goals to the individual |
| FND | Validate symptoms; use positive clinical findings and collaborative retraining |
Clinical reasoning
An adult with CP works full-time and reports new shoulder pain from mobility aids, while another patient with FND shows improved automatic stepping during a distracted task. Would you prescribe the same program because both have abnormal gait?
Answer: No. The first requires person-specific orthopedic/equipment and participation assessment; the second requires collaborative, appropriately diagnosed functional-movement retraining and a supportive explanation.
Check your understanding
How do diagnosis, functional goals, environment and communication needs change the intervention choices across these three conditions?
Source notes: Alzheimer’s Dementia – Diagnosis Updated.pdf; CP.pdf; Conversion Disorder.pdf (historical terminology and theory). Historical note: The older ‘conversion disorder’ lecture proposes a single psychological mechanism that is not established for all FND. Compare your notes with current multidisciplinary FND research. Educational content; not an individual diagnosis or medical protocol.
