Rehabilitation of functional neurological disorder with lower limb powered robotic exoskeleton: A case report

Rationale: Functional neurological disorder (FND) is a disabling and challenging condition that straddles Neurology and Psychiatry. Prolonged symptoms in FND are associated with poor functional outcome. Multidisciplinary management often involves physiotherapy in assisting with rehabilitation of the motor dysfunction associated with this condition. Despite many motor training approaches and strategies being described and trialed, successful outcome remains challenging. Patient concerns: Impaired ambulatory function (i.e., short-distance walking with rollator frame and ankle-foot-orthoses on level ground) despite 2 years of physical therapy. Diagnoses: FND with prolonged lower limb weakness and sensory loss following a road traffic accident. Interventions: Lower limb powered robotic exoskeleton (PRE) followed by conventional physiotherapy in ambulatory training. Outcomes: Three sessions of physical therapy training with lower limb PRE resulted in significant functional improvements. The patient achieved independence in walking without any gait-aid. Progress was made in walking tolerance, balance and lower limb strength. Six-minute and 10-m walk tests improved approximately 3- and 4-fold, respectively. Consequent conventional physiotherapy treatment saw to further improvements. Ambulatory and functional gains were maintained and bettered 9 months on. Lessons: PRE can be beneficial as an adjunctive training device for motor training in patients with FND.