Kathryn E McCombs, Julie MacLean, Sara A Finkelstein, Susan Goedeken, David L Perez, Jessica Ranford
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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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. 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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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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). 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引用次数: 0
摘要
背景和目的:职业疗法(OT)共识建议和概述对功能性神经紊乱(FND)进行基于感官的职业疗法干预的文章已经发表。然而,针对功能性神经障碍的 OT 干预疗效的研究却十分有限。我们进行了一项回顾性队列研究,旨在独立复制 FND 患者感官加工困难的初步特征,并报告在该人群中基于感官的 OT 治疗的临床结果。我们假设:(1) 功能性癫痫发作、焦虑和/或创伤后应激障碍的病史与感觉处理障碍的增加有关;(2) 接受的定向行走治疗次数与临床改善呈正相关:研究人员查阅了 77 名连续接受门诊感官加时治疗的 FND 成人患者的医疗记录。来自青少年/成人感官档案的数据描述了这一人群自我报告的感官处理模式的四个象限(低登记、感官敏感、感官寻求和感官回避)。在进行单变量筛选后,我们进行了多变量线性回归分析,以确定与离散感觉处理模式相关的神经精神特征。临床改善情况采用临床医生确定的估计改善评级("改善 "与 "未改善")进行量化,并调查临床参与、基线神经精神因素和结果之间的关系:结果:与常模值相比,FND患者的感觉处理模式在低登记、感觉灵敏度和感觉回避方面得分较高;在不同的FND亚型(即运动型、癫痫发作型和语言变异型)中未观察到感觉处理得分的差异。在线性回归分析中,终生焦虑症病史、偏头痛病史、当前认知症状以及合并主要神经系统疾病可独立预测感觉处理得分的个体差异。经过以感官为基础的 OT 干预后,62% 的 FND 患者被临床医生认定为 "有所改善"。在控制与改善评分相关的基线特征的多变量逻辑回归分析中,治疗次数与临床改善呈正相关:讨论:这些研究结果证实了 FND 患者存在感觉处理障碍,并提供了 IV 级证据,证明以感官为基础的门诊 OT 干预对这一人群具有疗效。有必要进行前瞻性对照试验。
Sensory Processing Difficulties and Occupational Therapy Outcomes for Functional Neurological Disorder: A Retrospective Cohort Study.
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.
期刊介绍:
Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.