FND guide
Menu
Independent information guide — not a medical service.

Movement, strength and walking

Understand the movement presentation group, how assessment works and which questions may help next.

Movement, strength and walking

This page covers functional weakness, walking and balance problems, tremor, dystonia, jerks and functional tic-like symptoms. People experience these in different ways, and FND can happen alongside another condition.

What to do next: Start with the symptom name used in your own diagnosis, and keep anything unresolved visible.

Important limit: This page explains recognised symptom groups. It cannot tell why an individual movement symptom is happening.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

  • WHO ICD-11 2026 — World Health Organization. ICD-11 for Mortality and Morbidity Statistics, 2026-01 release.
  • FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
  • Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
  • Practical review for physicians — Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder for the general physician. Clin Med (Lond). 2021;21(1):28-36.
  • Explanation as treatment — Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol. 2016;139:543-553.
  • Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
  • Epilepsy and functional seizures coexist — Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: systematic review and meta-analysis. Epilepsy Behav. 2018;89:70-78.
  • Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
  • Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
  • Validated weakness techniques — Dolbow J, El-Azzouni S, Zhang Y, Geiger C. A practical guide to assessing functional motor weakness: a review of validated techniques. J Neurol. 2025;272:427.
  • Positive-sign accuracy review — Patwal R, Jolly AJ, Kumar A, Yadav R, Desai G, Thippeswamy H. Diagnostic accuracy of clinical signs and investigations for functional weakness, sensory and movement disorders: a systematic review. J Psychosom Res. 2023;168:111196.
  • Functional tremor — Schwingenschuh P, Espay AJ. Functional tremor. J Neurol Sci. 2022;435:120208.
  • Functional dystonia differentiation — Frucht L, Perez DL, Callahan J, et al. Functional Dystonia: Differentiation From Primary Dystonia and Multidisciplinary Treatments. Front Neurol. 2021;11:605262.
  • Functional tic-like behaviour criteria — Pringsheim T, Ganos C, Nilles C, et al. ESSTS 2022 criteria for clinical diagnosis of functional tic-like behaviours: international consensus. Eur J Neurol. 2023;30:902-910.
  • Functional movement overview — Park JE. Functional Movement Disorders: Updates and Clinical Overview. J Mov Disord. 2024;17(3):251-261.

Last checked: 2026-07-16

Jurisdiction: UK

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Correction route: Report changed or inaccurate information without including personal health information.

Different symptoms need different explanations

These symptoms are grouped together to make them easier to find; they are not one universal movement pattern.

  • Functional limb weakness
  • Functional gait disorder involving walking, stance or balance
  • Functional tremor
  • Functional dystonia
  • Functional jerks, cranial movements and tic-like presentations

What to do next: Use the most specific symptom name already recorded by a clinician when preparing questions or finding further information.

Important limit: Similarity to one of these descriptions does not diagnose FND, and a photograph or short video cannot establish the cause.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

  • Validated weakness techniques — Dolbow J, El-Azzouni S, Zhang Y, Geiger C. A practical guide to assessing functional motor weakness: a review of validated techniques. J Neurol. 2025;272:427.
  • Positive-sign accuracy review — Patwal R, Jolly AJ, Kumar A, Yadav R, Desai G, Thippeswamy H. Diagnostic accuracy of clinical signs and investigations for functional weakness, sensory and movement disorders: a systematic review. J Psychosom Res. 2023;168:111196.
  • Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
  • Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
  • Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
  • Functional tremor — Schwingenschuh P, Espay AJ. Functional tremor. J Neurol Sci. 2022;435:120208.
  • Functional dystonia differentiation — Frucht L, Perez DL, Callahan J, et al. Functional Dystonia: Differentiation From Primary Dystonia and Multidisciplinary Treatments. Front Neurol. 2021;11:605262.
  • Functional tic-like behaviour criteria — Pringsheim T, Ganos C, Nilles C, et al. ESSTS 2022 criteria for clinical diagnosis of functional tic-like behaviours: international consensus. Eur J Neurol. 2023;30:902-910.
  • Functional movement overview — Park JE. Functional Movement Disorders: Updates and Clinical Overview. J Mov Disord. 2024;17(3):251-261.

How clinicians make a positive diagnosis

A functional movement diagnosis should come from recognised positive patterns in the history and neurological examination. It should not be based only on normal tests or the failure to find another cause. The symptoms are involuntary.

  • Weakness is assessed across voluntary movement and movement available in another context.
  • Walking is assessed for positive inconsistency or incongruity during a neurological gait examination.
  • Tremor is assessed for patterns such as variability, distractibility or entrainment that require trained interpretation.
  • Selected movement neurophysiology can support some diagnoses but is not required for every person.

What to do next: Ask which positive pattern supported the diagnosis, which symptoms it explains and whether anything remains uncertain.

Important limit: No single sign proves FND by itself. This page does not teach self-examination or diagnosis from a video.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

  • WHO ICD-11 CDDR — World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: WHO; 2024.
  • Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
  • Practical review for physicians — Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder for the general physician. Clin Med (Lond). 2021;21(1):28-36.
  • Current concepts — Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol. 2018;75(9):1132-1141.
  • Positive-sign accuracy review — Patwal R, Jolly AJ, Kumar A, Yadav R, Desai G, Thippeswamy H. Diagnostic accuracy of clinical signs and investigations for functional weakness, sensory and movement disorders: a systematic review. J Psychosom Res. 2023;168:111196.
  • Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
  • Seizure semiology meta-analysis — Muthusamy S, Seneviratne U, Ding C, Phan TG. Using semiology to classify epileptic seizures vs psychogenic nonepileptic seizures: a meta-analysis. Neurol Clin Pract. 2022;12(3):234-247.
  • Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
  • Explanation as treatment — Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol. 2016;139:543-553.
  • Functional tremor — Schwingenschuh P, Espay AJ. Functional tremor. J Neurol Sci. 2022;435:120208.
  • Functional movement overview — Park JE. Functional Movement Disorders: Updates and Clinical Overview. J Mov Disord. 2024;17(3):251-261.
  • Validated weakness techniques — Dolbow J, El-Azzouni S, Zhang Y, Geiger C. A practical guide to assessing functional motor weakness: a review of validated techniques. J Neurol. 2025;272:427.

FND can sit alongside other conditions

A functional movement diagnosis does not make every present or future symptom functional. Another condition may explain some symptoms while FND explains others.

  • Ask which symptoms the diagnosis is intended to explain.
  • Keep unresolved symptoms and coexisting diagnoses visible.
  • Describe a new, substantially changed or medically concerning symptom rather than automatically placing it under the existing label.

What to do next: Explain what is different, when it began, whether it persists and how it changes function or safety.

Important limit: This is a reassessment boundary, not an emergency-triage result. Ordinary urgent or emergency routes still apply when needed.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

  • FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
  • Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
  • Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
  • Epilepsy and functional seizures coexist — Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: systematic review and meta-analysis. Epilepsy Behav. 2018;89:70-78.
  • Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
  • Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
  • Practical review for physicians — Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder for the general physician. Clin Med (Lond). 2021;21(1):28-36.
  • NICE NG127 referral — National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral (NG127). Updated 2 October 2023.
  • NICE FND quality statement — National Institute for Health and Care Excellence. Quality statement 5: Functional neurological disorders in adults (QS198). 2021.
  • Scotland FND pathway — NHS Scotland Centre for Sustainable Delivery. Functional Neurological Disorder pathway. Current at 14 July 2026.

Treatment should fit the problem and your goal

FND-informed physiotherapy may use education, movement retraining, attention redirection, automatic movement, graded functional goals and self-management. Occupational therapy may focus on everyday activities, roles, routines and participation.

  • The purpose and goal should be clear rather than assuming every movement symptom needs the same approach.
  • Specialist physiotherapy has not proved universally superior or ineffective; trial outcomes need their full context.
  • Falls, injury, pain, fatigue, fixed posture, severe disability or another neurological condition can change what is appropriate.

What to do next: Ask what the proposed treatment is intended to help, who will provide it and how progress will be judged.

Important limit: This page provides no exercises, treatment selection or instruction to push through pain, falls, injury or new deficits.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

  • Physiotherapy consensus — Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86:1113-1119.
  • Physio4FMD phase 3 RCT — Nielsen G, Buszewicz M, Stevenson F, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial. Lancet Neurol. 2024;23:675-686.
  • NHS England FND minimum services — NHS England. Annex A: Specialised Neurology Service Specification—Minimum Services for Neurology Subspecialties. August 2025.
  • Scotland FND pathway — NHS Scotland Centre for Sustainable Delivery. Functional Neurological Disorder pathway. Current at 14 July 2026.
  • Occupational therapy consensus — Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry. 2020;91:1037-1045.

What you can prepare while you wait

Only follow movement or activity guidance already agreed for you. You can still make the next appointment more useful without trying to build your own rehabilitation programme online.

  • Record the movement problem in the words you use and one everyday activity it interrupts.
  • Prepare questions about the positive diagnosis, coexistence and the goal of treatment or rehabilitation.
  • Follow only movement or activity guidance already agreed for you.
  • Seek assessment where falls, injury, a new deficit or another condition could change safety.

What to do next: Use Treatment and living to prepare the next contact, or Find help to understand available routes.

Important limit: Waiting information is not an assessment or an individual rehabilitation plan.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

  • WHO ICD-11 CDDR — World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: WHO; 2024.
  • Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
  • Practical review for physicians — Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder for the general physician. Clin Med (Lond). 2021;21(1):28-36.
  • Current concepts — Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol. 2018;75(9):1132-1141.
  • FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
  • Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
  • Epilepsy and functional seizures coexist — Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: systematic review and meta-analysis. Epilepsy Behav. 2018;89:70-78.
  • Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
  • Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
  • NICE NG127 referral — National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral (NG127). Updated 2 October 2023.
  • NICE FND quality statement — National Institute for Health and Care Excellence. Quality statement 5: Functional neurological disorders in adults (QS198). 2021.
  • Scotland FND pathway — NHS Scotland Centre for Sustainable Delivery. Functional Neurological Disorder pathway. Current at 14 July 2026.
  • Physiotherapy consensus — Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86:1113-1119.
  • NHS England FND minimum services — NHS England. Annex A: Specialised Neurology Service Specification—Minimum Services for Neurology Subspecialties. August 2025.
  • Occupational therapy consensus — Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry. 2020;91:1037-1045.
  • Physio4FMD phase 3 RCT — Nielsen G, Buszewicz M, Stevenson F, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial. Lancet Neurol. 2024;23:675-686.