At George Ide we are seeing increasing numbers of cases involving Functional Neurological Disorder (FND) following a mild traumatic brain injury and/or post-concussion syndrome. Such cases are complex and can be challenging for everyone involved. Until FND is diagnosed, it can often appear that there is nothing wrong with the claimant or that they are inventing or exaggerating their condition, which in turn can result in a reluctance on the part of insurers to engage in rehabilitation.
A diagnosis of FND involves several aspects, for example a patient may have more than one symptom of altered voluntary motor or sensory function; clinical findings provide evidence of incompatibility between the symptom and recognised neurological or medical conditions. Often the symptom or deficit is not better explained by another medical or mental disorder, and the symptom or deficit can cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, or warrants medical evaluation.
We have in the past had clients who have failed effort tests intended to catch out anyone ‘faking’ FND. These tests include the Waddell test, designed to establish whether downward pressure on the head causes low back pain, and the Hoover test, designed to establish an involuntary extension of an affected leg when flexing the contralateral leg against resistance. However, it is not uncommon for patients who genuinely have FND to fail such tests; indeed their poor levels of engagement and lack of effort while taking part in the testing process can be an indicator of FND.
Treating FND is complex and insurers are often reluctant to engage in rehabilitation during the litigation process. However, multi-disciplinary therapy including, but not limited to, psycho-education, neuro-physiotherapy, specialist occupational therapy, and pharmacological therapy can be effective. The goal, even if a complete recovery is unlikely, is to get the client functioning to the point where they can engage more in normal life and, hopefully, work again.
In terms of valuation of the claim the difference can be significant between identifying FND in a client and missing the signs. It is essential, therefore, to have a legal team sufficiently open-minded to the possibility of such a diagnosis and who can put together the right medico-legal and rehabilitation programme to assist the client properly.
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