Kasia Kozlowska, Nicola Gray, Stephen Scher, Blanche Savage
Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2021 Jan;57(1):73-79. doi: 10.1111/jpc.15122. Epub 2020 Aug 29.
Children and adolescents with functional neurological disorder (FND) present with physical impairment and mental health comorbidities. Specialist physiotherapy programs for treating FND have been developed over the last two decades. This article reports outcome data from three cohorts of children treated with a multidisciplinary rehabilitation intervention - the Mind-Body Program - in which a psychologically informed physiotherapy intervention, known as the wellness approach to physiotherapy, was a key component.
For three cohorts of children (n = 57, n = 60 and n = 25, respectively) treated in the Mind-Body Program, data about functional impairment and mental health concerns were collected at presentation and at follow-up (4 years, 12 months and 18 months, respectively).
Outcome data show that FND symptoms resolved in 54/57 (95%), 51/60 (85%) and 22/25 (88%) of children in the three cohorts, and that 31/57 (61%), 32/60 (53%) and 13/25 (52%) of children returned to full health and to full-time school attendance. Changes in Global Assessment of Function (GAF) were significant (t(54) = 21.60, P < 0.001; t(55) = 9.92, P < 0.001; t(24) = 6.51, P < 0.001). Outcomes were less favourable for children with chronic FND symptoms at presentation; those whose comorbid mental health disorders or other (comorbid) functional somatic symptoms did not resolve; and those who subsequently developed chronic mental health problems.
Implementation of a multidisciplinary rehabilitation intervention - with psychologically informed physiotherapy as one of the key treatment components - resulted in resolution of FND symptoms and return to health and well-being in the large majority of patients.
患有功能性神经障碍（FND）的儿童和青少年存在身体损伤和心理健康合并症。在过去二十年中，已开发出用于治疗FND的专业物理治疗方案。本文报告了三组接受多学科康复干预——身心计划——治疗的儿童的结果数据，在该计划中，一种基于心理学的物理治疗干预措施，即物理治疗的健康方法，是一个关键组成部分。
对于在身心计划中接受治疗的三组儿童（分别为n = 57、n = 60和n = 25），在就诊时和随访时（分别为4年、12个月和18个月）收集有关功能损伤和心理健康问题的数据。
结果数据显示，三组儿童中分别有54/57（95%）、51/60（85%）和22/25（88%）的FND症状得到缓解，并且分别有31/57（61%）、32/60（53%）和13/25（52%）的儿童恢复了完全健康并能全日制上学。功能总体评估（GAF）的变化具有显著性（t(54) = 21.60，P < 0.001；t(55) = 9.92，P < 0.001；t(24) = 6.51，P < 0.001）。对于就诊时患有慢性FND症状的儿童；那些合并的心理健康障碍或其他（合并的）功能性躯体症状未得到缓解的儿童；以及那些随后出现慢性心理健康问题的儿童，结果不太理想。
实施以基于心理学的物理治疗作为关键治疗组成部分之一的多学科康复干预，导致大多数患者的FND症状得到缓解并恢复健康和幸福。
