Conceptual Overlap Between OPTIMAL Theory Constructs and Motor Presentations in Functional Neurological Disorder Rehabilitation.

Abstract

Background and purpose: Functional neurological disorder (FND) is increasingly recognized as a disorder of brain network dysfunction with neuroimaging studies demonstrating altered communication among neural circuits involved in movement, attention, and self-agency. The Optimizing Performance Through Intrinsic Motivation and Attention for Learning (OPTIMAL) theory of motor learning is centered on the three constructs: external focus of attention, enhanced expectancies, and autonomy. This article explores the potential alignment between the pathophysiology underlying FND and the constructs proposed by the OPTIMAL theory and hypothesizes that OPTIMAL offers a promising, pathophysiology-informed framework for the physical therapy management of FND across varied practice settings.

Summary of key points: • FND is characterized by disrupted brain network communication, particularly in circuits related to motor learning, attention, and self-agency.• Physical therapy is supported by evidence as a first-line treatment for motor symptoms in FND; however, existing consensus guidelines do not identify an explicit motor learning framework to guide PT intervention• The OPTIMAL theory of motor learning emphasizes external focus of attention, enhanced expectancies, and autonomy, constructs that align with the neural networks implicated in FND and have demonstrated efficacy to improve motor learning when applied to healthy and neurological populations.

Recommendations for clinical practice: • Applying motor learning constructs from OPTIMAL offers a practical and evidence-aligned approach to treating motor learning deficits in FND across care settings and age groups.• Therapists may improve motor outcomes in FND by incorporating external cueing, success-oriented feedback, and patient choice.