Re: Conversion Disorder Program

[Guest guest]

You eval and treat them based on the apparent impairments the same way you would

if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

Good luck!

Alan Petrazzi, MPT, MPM

Rehab Director

VEterans Affairs Pittsburgh Healthcare System

[Guest guest]

I agree with Alan - you almost need a systematic approach or clinical protocol

to deal with conversion disorder.

I've only seen one overt case in my 20-year career and she was a 15 year old

girl who manifested a severe kyphotic deformity after exercising on a lumbar

extension machine. She walked around, flexed at the waist for months.

Repeat MRIs, various treatments and several specialists eventually labeled her

with conversion disoder, which I had never heard of before.

Needless to say, before the diagnosis many of the doctors and staff were

skeptical and almost dismissive.

Like Alan said, its important NOT to challenge the patient in a way that arouses

their defenses or humiliates them.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> You eval and treat them based on the apparent impairments the same way you

would if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

>

> Good luck!

>

> Alan Petrazzi, MPT, MPM

> Rehab Director

> VEterans Affairs Pittsburgh Healthcare System

>

>

>

>

[Guest guest]

I agree with Alan - you almost need a systematic approach or clinical protocol

to deal with conversion disorder.

I've only seen one overt case in my 20-year career and she was a 15 year old

girl who manifested a severe kyphotic deformity after exercising on a lumbar

extension machine. She walked around, flexed at the waist for months.

Repeat MRIs, various treatments and several specialists eventually labeled her

with conversion disoder, which I had never heard of before.

Needless to say, before the diagnosis many of the doctors and staff were

skeptical and almost dismissive.

Like Alan said, its important NOT to challenge the patient in a way that arouses

their defenses or humiliates them.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> You eval and treat them based on the apparent impairments the same way you

would if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

>

> Good luck!

>

> Alan Petrazzi, MPT, MPM

> Rehab Director

> VEterans Affairs Pittsburgh Healthcare System

>

>

>

>

[Guest guest]

Tim and Alan,

To play devil's advocate here, while there would be no justification for

humiliating the patient, why would it be important not to challenge the patient

in any way? In an evidence based system, could you cite some evidence that

justifies this treatment approach and demonstrates success with it? I'm

personally not aware of any but you may be able to enlighten me. What I wonder

is, could they not be compassionately " challenged " in a manner of speaking by

bringing them first to a cognitive awareness (to provide a theoretical

framework) and then, progressively, a somatic awareness (to provide a practical

framework) of the origins or roots of their dysfunction by using a concept, very

simply stated, of " joining " and " matching " their system and then " redirecting "

their system back around towards normalcy. In other words, I don't know if I

would treat them as though it were an exclusively physically based impairment

because it's not. That doesn't mean one practices psychotherapy instead of

physical therapy. It simply means one recognizes the primacy of the central

nervous system in the hierarchy of control of the human body and stays honest

and authentic in their interaction with the patient..

Most pathologies occur along a spectrum of severity and while I am by no means

an expert on conversion disorder, the extremely limited number of cases that

I've seen and the more common related types of cases (with elements of, but not

a full blown, conversion disorder) that are skewed more towards the normalcy end

of the spectrum will respond favorably to a treatment methodology of this

philosophical orientation incorporating physically and psychologically

therapeutic elements of disciplines that could include the Feldenkrais Method,

Hanna Somatics, ksonian Hypnosis, Cheng Hsin, etc. Of course, there is

little present day evidence based substantiation for these approaches but

hopefully that will come in time. Just some thoughts, FWIW.

, PT, OCS

Marquette, MI

Re: Conversion Disorder Program

I agree with Alan - you almost need a systematic approach or clinical protocol

to deal with conversion disorder.

I've only seen one overt case in my 20-year career and she was a 15 year old

girl who manifested a severe kyphotic deformity after exercising on a lumbar

extension machine. She walked around, flexed at the waist for months.

Repeat MRIs, various treatments and several specialists eventually labeled her

with conversion disoder, which I had never heard of before.

Needless to say, before the diagnosis many of the doctors and staff were

skeptical and almost dismissive.

Like Alan said, its important NOT to challenge the patient in a way that

arouses their defenses or humiliates them.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> You eval and treat them based on the apparent impairments the same way you

would if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

>

> Good luck!

>

> Alan Petrazzi, MPT, MPM

> Rehab Director

> VEterans Affairs Pittsburgh Healthcare System

>

>

>

>

[Guest guest]

Tim and Alan,

To play devil's advocate here, while there would be no justification for

humiliating the patient, why would it be important not to challenge the patient

in any way? In an evidence based system, could you cite some evidence that

justifies this treatment approach and demonstrates success with it? I'm

personally not aware of any but you may be able to enlighten me. What I wonder

is, could they not be compassionately " challenged " in a manner of speaking by

bringing them first to a cognitive awareness (to provide a theoretical

framework) and then, progressively, a somatic awareness (to provide a practical

framework) of the origins or roots of their dysfunction by using a concept, very

simply stated, of " joining " and " matching " their system and then " redirecting "

their system back around towards normalcy. In other words, I don't know if I

would treat them as though it were an exclusively physically based impairment

because it's not. That doesn't mean one practices psychotherapy instead of

physical therapy. It simply means one recognizes the primacy of the central

nervous system in the hierarchy of control of the human body and stays honest

and authentic in their interaction with the patient..

Most pathologies occur along a spectrum of severity and while I am by no means

an expert on conversion disorder, the extremely limited number of cases that

I've seen and the more common related types of cases (with elements of, but not

a full blown, conversion disorder) that are skewed more towards the normalcy end

of the spectrum will respond favorably to a treatment methodology of this

philosophical orientation incorporating physically and psychologically

therapeutic elements of disciplines that could include the Feldenkrais Method,

Hanna Somatics, ksonian Hypnosis, Cheng Hsin, etc. Of course, there is

little present day evidence based substantiation for these approaches but

hopefully that will come in time. Just some thoughts, FWIW.

, PT, OCS

Marquette, MI

Re: Conversion Disorder Program

I agree with Alan - you almost need a systematic approach or clinical protocol

to deal with conversion disorder.

I've only seen one overt case in my 20-year career and she was a 15 year old

girl who manifested a severe kyphotic deformity after exercising on a lumbar

extension machine. She walked around, flexed at the waist for months.

Repeat MRIs, various treatments and several specialists eventually labeled her

with conversion disoder, which I had never heard of before.

Needless to say, before the diagnosis many of the doctors and staff were

skeptical and almost dismissive.

Like Alan said, its important NOT to challenge the patient in a way that

arouses their defenses or humiliates them.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> You eval and treat them based on the apparent impairments the same way you

would if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

>

> Good luck!

>

> Alan Petrazzi, MPT, MPM

> Rehab Director

> VEterans Affairs Pittsburgh Healthcare System

>

>

>

>

[Guest guest]

Tim and Alan,

To play devil's advocate here, while there would be no justification for

humiliating the patient, why would it be important not to challenge the patient

in any way? In an evidence based system, could you cite some evidence that

justifies this treatment approach and demonstrates success with it? I'm

personally not aware of any but you may be able to enlighten me. What I wonder

is, could they not be compassionately " challenged " in a manner of speaking by

bringing them first to a cognitive awareness (to provide a theoretical

framework) and then, progressively, a somatic awareness (to provide a practical

framework) of the origins or roots of their dysfunction by using a concept, very

simply stated, of " joining " and " matching " their system and then " redirecting "

their system back around towards normalcy. In other words, I don't know if I

would treat them as though it were an exclusively physically based impairment

because it's not. That doesn't mean one practices psychotherapy instead of

physical therapy. It simply means one recognizes the primacy of the central

nervous system in the hierarchy of control of the human body and stays honest

and authentic in their interaction with the patient..

Most pathologies occur along a spectrum of severity and while I am by no means

an expert on conversion disorder, the extremely limited number of cases that

I've seen and the more common related types of cases (with elements of, but not

a full blown, conversion disorder) that are skewed more towards the normalcy end

of the spectrum will respond favorably to a treatment methodology of this

philosophical orientation incorporating physically and psychologically

therapeutic elements of disciplines that could include the Feldenkrais Method,

Hanna Somatics, ksonian Hypnosis, Cheng Hsin, etc. Of course, there is

little present day evidence based substantiation for these approaches but

hopefully that will come in time. Just some thoughts, FWIW.

, PT, OCS

Marquette, MI

Re: Conversion Disorder Program

I agree with Alan - you almost need a systematic approach or clinical protocol

to deal with conversion disorder.

I've only seen one overt case in my 20-year career and she was a 15 year old

girl who manifested a severe kyphotic deformity after exercising on a lumbar

extension machine. She walked around, flexed at the waist for months.

Repeat MRIs, various treatments and several specialists eventually labeled her

with conversion disoder, which I had never heard of before.

Needless to say, before the diagnosis many of the doctors and staff were

skeptical and almost dismissive.

Like Alan said, its important NOT to challenge the patient in a way that

arouses their defenses or humiliates them.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> You eval and treat them based on the apparent impairments the same way you

would if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

>

> Good luck!

>

> Alan Petrazzi, MPT, MPM

> Rehab Director

> VEterans Affairs Pittsburgh Healthcare System

>

>

>

>

[Guest guest]

Not sure if I did the right thing but an old timer helped me with a case where

patient had hysterical paraplegic. We put her on the tilt table and elicited

balance reactions as we loosen the straps and had her do support pulling with

arms. The rational was to point out to the patient that SHE could facilitate

movement in her ankles. We built off that as a treatment method instead of a

got-cha. It was 30 years ago and I think they sent patient from our hospital to

a psych center so not sure how it ended. This seems like treatment 101 with

showing and encouragement.

Steve Passmore

Re: Re: Conversion Disorder Program

Tim and Alan,

To play devil's advocate here, while there would be no justification for

humiliating the patient, why would it be important not to challenge the patient

in any way? In an evidence based system, could you cite some evidence that

justifies this treatment approach and demonstrates success with it? I'm

personally not aware of any but you may be able to enlighten me. What I wonder

is, could they not be compassionately " challenged " in a manner of speaking by

bringing them first to a cognitive awareness (to provide a theoretical

framework) and then, progressively, a somatic awareness (to provide a practical

framework) of the origins or roots of their dysfunction by using a concept, very

simply stated, of " joining " and " matching " their system and then " redirecting "

their system back around towards normalcy. In other words, I don't know if I

would treat them as though it were an exclusively physically based impairment

because it's not. That doesn't mean one practices psychotherapy instead of

physical therapy. It simply means one recognizes the primacy of the central

nervous system in the hierarchy of control of the human body and stays honest

and authentic in their interaction with the patient..

Most pathologies occur along a spectrum of severity and while I am by no means

an expert on conversion disorder, the extremely limited number of cases that

I've seen and the more common related types of cases (with elements of, but not

a full blown, conversion disorder) that are skewed more towards the normalcy end

of the spectrum will respond favorably to a treatment methodology of this

philosophical orientation incorporating physically and psychologically

therapeutic elements of disciplines that could include the Feldenkrais Method,

Hanna Somatics, ksonian Hypnosis, Cheng Hsin, etc. Of course, there is

little present day evidence based substantiation for these approaches but

hopefully that will come in time. Just some thoughts, FWIW.

, PT, OCS

Marquette, MI

Re: Conversion Disorder Program

I agree with Alan - you almost need a systematic approach or clinical protocol

to deal with conversion disorder.

I've only seen one overt case in my 20-year career and she was a 15 year old

girl who manifested a severe kyphotic deformity after exercising on a lumbar

extension machine. She walked around, flexed at the waist for months.

Repeat MRIs, various treatments and several specialists eventually labeled her

with conversion disoder, which I had never heard of before.

Needless to say, before the diagnosis many of the doctors and staff were

skeptical and almost dismissive.

Like Alan said, its important NOT to challenge the patient in a way that

arouses their defenses or humiliates them.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> You eval and treat them based on the apparent impairments the same way you

would if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

>

> Good luck!

>

> Alan Petrazzi, MPT, MPM

> Rehab Director

> VEterans Affairs Pittsburgh Healthcare System

>

>

>

>

[Guest guest]

Not sure if I did the right thing but an old timer helped me with a case where

patient had hysterical paraplegic. We put her on the tilt table and elicited

balance reactions as we loosen the straps and had her do support pulling with

arms. The rational was to point out to the patient that SHE could facilitate

movement in her ankles. We built off that as a treatment method instead of a

got-cha. It was 30 years ago and I think they sent patient from our hospital to

a psych center so not sure how it ended. This seems like treatment 101 with

showing and encouragement.

Steve Passmore

Re: Re: Conversion Disorder Program

Tim and Alan,

To play devil's advocate here, while there would be no justification for

humiliating the patient, why would it be important not to challenge the patient

in any way? In an evidence based system, could you cite some evidence that

justifies this treatment approach and demonstrates success with it? I'm

personally not aware of any but you may be able to enlighten me. What I wonder

is, could they not be compassionately " challenged " in a manner of speaking by

bringing them first to a cognitive awareness (to provide a theoretical

framework) and then, progressively, a somatic awareness (to provide a practical

framework) of the origins or roots of their dysfunction by using a concept, very

simply stated, of " joining " and " matching " their system and then " redirecting "

their system back around towards normalcy. In other words, I don't know if I

would treat them as though it were an exclusively physically based impairment

because it's not. That doesn't mean one practices psychotherapy instead of

physical therapy. It simply means one recognizes the primacy of the central

nervous system in the hierarchy of control of the human body and stays honest

and authentic in their interaction with the patient..

Most pathologies occur along a spectrum of severity and while I am by no means

an expert on conversion disorder, the extremely limited number of cases that

I've seen and the more common related types of cases (with elements of, but not

a full blown, conversion disorder) that are skewed more towards the normalcy end

of the spectrum will respond favorably to a treatment methodology of this

philosophical orientation incorporating physically and psychologically

therapeutic elements of disciplines that could include the Feldenkrais Method,

Hanna Somatics, ksonian Hypnosis, Cheng Hsin, etc. Of course, there is

little present day evidence based substantiation for these approaches but

hopefully that will come in time. Just some thoughts, FWIW.

, PT, OCS

Marquette, MI

Re: Conversion Disorder Program

I agree with Alan - you almost need a systematic approach or clinical protocol

to deal with conversion disorder.

I've only seen one overt case in my 20-year career and she was a 15 year old

girl who manifested a severe kyphotic deformity after exercising on a lumbar

extension machine. She walked around, flexed at the waist for months.

Repeat MRIs, various treatments and several specialists eventually labeled her

with conversion disoder, which I had never heard of before.

Needless to say, before the diagnosis many of the doctors and staff were

skeptical and almost dismissive.

Like Alan said, its important NOT to challenge the patient in a way that

arouses their defenses or humiliates them.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

> You eval and treat them based on the apparent impairments the same way you

would if it were a true physical deficit -- never insinuating or calling out the

physical inconsistencies. I worked with a lady who presented like a classic R

hemiplegia in all physical ways. Subtely and infrequently, she would use the R

& #39;flaccid & #39; hand/arm to skillfully retrieve an item out of her pocket,

etc. Quite fascinating but you have to demonstrate self control so not to

humiliate them which can be counterproductive. Same goes for the support staff

who may & #39;call out & #39; inconsistencies. Positive reinforcement. Start with

easily achievable goals to build confidence and proceed.

>

> Good luck!

>

> Alan Petrazzi, MPT, MPM

> Rehab Director

> VEterans Affairs Pittsburgh Healthcare System

>

>

>

>

[Guest guest]

http://journals.lww.com/jnpt/Fulltext/2007/03000/Physical_Therapy_Management_for\

_Conversion.8.aspx

Good article. I suspect you & #39;ll get more input as people return to their

emails on Monday.

Alan Petrazzi

Rehab Director

VA Pittsburgh

[Guest guest]

I really like Mr. 's reply. If only the hospital I worked for could

provide something so comprehensive. I work in-patient. I have dealt with quite

a few patients who fall in this category. One who has been a frequent flyer for

over 10 years, that I have been following. Yes 10!

We are seeing more patient's labeled with conversion disorder (sometimes its

just slapped on) who take a lot of resources and time. We have wondered if it is

the economy or lack of out patient mental health resources?. These patients are

ALWAYS referred to PT and sometimes OT. Then we begin a back and forth. Yes we

treat them based them on the impairments they present with, and resulting

disability. Challenging them, especially by PT NEVER WORKS. But for PT to what

end? If they do not respond to PT treatment and no rehab will take them because

no test is showing that they have a cause for what they present with then we go

back and forth. What is needed is a real team approach and some hospitals don't

have time for that. But MD, SW, NSG, Psych, PT, OT and any others involved with

the patient need to meet and come up with a comprehensive plan and figure out

how to approach the patient as a UNITED front to assist them to whatever goals

this team feels is appropriate for the patient. I have seen this work really

well one time.

I feel we will see more of this diagnosis (label?).

Just my thoughts.

Katesel strimbeck PT, MS

PT Supervisor

St. 's Hospital

Albany, New York

katesels@...

[Guest guest]

Interesting article Alan, thanks. I agree with the concept of using a learning

theory based approach rather than a purely physical approach. It'd be

illuminating to know further details of the rapport building stage (or what I

referred to as " joining " and " matching " ) and how specifically the patient was

educated about their disorder. Also, rather than avoiding abnormal behavior, I

suspect selectively utilizing the principle of paradoxical intention may work

faster in some cases. At 3-5 hours per day of physical therapy, that's a lot of

physical therapy.

, PT, OCS

Marquette, MI

Re: Re: Conversion Disorder Program

http://journals.lww.com/jnpt/Fulltext/2007/03000/Physical_Therapy_Management_for\

_Conversion.8.aspx

Good article. I suspect you & #39;ll get more input as people return to their

emails on Monday.

Alan Petrazzi

Rehab Director

VA Pittsburgh

[Guest guest]

Interesting article Alan, thanks. I agree with the concept of using a learning

theory based approach rather than a purely physical approach. It'd be

illuminating to know further details of the rapport building stage (or what I

referred to as " joining " and " matching " ) and how specifically the patient was

educated about their disorder. Also, rather than avoiding abnormal behavior, I

suspect selectively utilizing the principle of paradoxical intention may work

faster in some cases. At 3-5 hours per day of physical therapy, that's a lot of

physical therapy.

, PT, OCS

Marquette, MI

Re: Re: Conversion Disorder Program

http://journals.lww.com/jnpt/Fulltext/2007/03000/Physical_Therapy_Management_for\

_Conversion.8.aspx

Good article. I suspect you & #39;ll get more input as people return to their

emails on Monday.

Alan Petrazzi

Rehab Director

VA Pittsburgh

[Guest guest]

I agree. Having worked with a few patients with this diagnosis over the years,

a team approach is really important. Psych and MD involvement is key, since

sometimes the underlying root cause is psychological in nature that can manifest

itself in physical impairments.

a Eppenstein, PT, MS

Supervisor for Clinical Development

njoy Hospital

Wheaton, IL

Sent from my iPad

> I really like Mr. 's reply. If only the hospital I worked for could

provide something so comprehensive. I work in-patient. I have dealt with quite a

few patients who fall in this category. One who has been a frequent flyer for

over 10 years, that I have been following. Yes 10!

> We are seeing more patient's labeled with conversion disorder (sometimes its

just slapped on) who take a lot of resources and time. We have wondered if it is

the economy or lack of out patient mental health resources?. These patients are

ALWAYS referred to PT and sometimes OT. Then we begin a back and forth. Yes we

treat them based them on the impairments they present with, and resulting

disability. Challenging them, especially by PT NEVER WORKS. But for PT to what

end? If they do not respond to PT treatment and no rehab will take them because

no test is showing that they have a cause for what they present with then we go

back and forth. What is needed is a real team approach and some hospitals don't

have time for that. But MD, SW, NSG, Psych, PT, OT and any others involved with

the patient need to meet and come up with a comprehensive plan and figure out

how to approach the patient as a UNITED front to assist them to whatever goals

this team feels is appropriate for the patient. I have seen this really well

one time.

> I feel we will see more of this diagnosis (label?).

> Just my thoughts.

>

> Katesel strimbeck PT, MS

> PT Supervisor

> St. 's Hospital

> Albany, New York

> katesels@...

>

>

[Guest guest]

I agree. Having worked with a few patients with this diagnosis over the years,

a team approach is really important. Psych and MD involvement is key, since

sometimes the underlying root cause is psychological in nature that can manifest

itself in physical impairments.

a Eppenstein, PT, MS

Supervisor for Clinical Development

njoy Hospital

Wheaton, IL

Sent from my iPad

> I really like Mr. 's reply. If only the hospital I worked for could

provide something so comprehensive. I work in-patient. I have dealt with quite a

few patients who fall in this category. One who has been a frequent flyer for

over 10 years, that I have been following. Yes 10!

> We are seeing more patient's labeled with conversion disorder (sometimes its

just slapped on) who take a lot of resources and time. We have wondered if it is

the economy or lack of out patient mental health resources?. These patients are

ALWAYS referred to PT and sometimes OT. Then we begin a back and forth. Yes we

treat them based them on the impairments they present with, and resulting

disability. Challenging them, especially by PT NEVER WORKS. But for PT to what

end? If they do not respond to PT treatment and no rehab will take them because

no test is showing that they have a cause for what they present with then we go

back and forth. What is needed is a real team approach and some hospitals don't

have time for that. But MD, SW, NSG, Psych, PT, OT and any others involved with

the patient need to meet and come up with a comprehensive plan and figure out

how to approach the patient as a UNITED front to assist them to whatever goals

this team feels is appropriate for the patient. I have seen this really well

one time.

> I feel we will see more of this diagnosis (label?).

> Just my thoughts.

>

> Katesel strimbeck PT, MS

> PT Supervisor

> St. 's Hospital

> Albany, New York

> katesels@...

>

>

[Guest guest]

For what it is worth.... I recently had a 15 year old with what appeared to be

conversion disorder respond dramatically -with complete resolution in six visits

of dry needling myofascial release. She presented five weeks following a single

episode of bilateral knee pain, followed by lower back pain which within five

days presented as severe weakness, complete loss of single leg standing balance

and inability to ambulate. She was first seen for PT five weeks after initial

onset after having seen four physicians and full diagnostic testing. I agree

that taking a non confrontational approach may be the best approach in this type

of situation. The patient And her parents did not care if i utilized an

" evidenced based approach " . it appears that placebo has a place in all areas

of medicine. This patient went from wheelchair to playing volleyball and running

within four weeks. br

Sent from my iPad

[Guest guest]

For what it is worth.... I recently had a 15 year old with what appeared to be

conversion disorder respond dramatically -with complete resolution in six visits

of dry needling myofascial release. She presented five weeks following a single

episode of bilateral knee pain, followed by lower back pain which within five

days presented as severe weakness, complete loss of single leg standing balance

and inability to ambulate. She was first seen for PT five weeks after initial

onset after having seen four physicians and full diagnostic testing. I agree

that taking a non confrontational approach may be the best approach in this type

of situation. The patient And her parents did not care if i utilized an

" evidenced based approach " . it appears that placebo has a place in all areas

of medicine. This patient went from wheelchair to playing volleyball and running

within four weeks. br

Sent from my iPad

[Guest guest]

I think an important point is that the type of intervention may not necessarily

be the key but rather the interactive nature of the intervention and the

INTENTION behind the intervention. Think first of why these problems develop.

There is almost always a psychological conflict involved. " Sickness " allows one

to withdraw from conflict in a socially acceptable manner and brings attention,

caring, and a " time out " period to regroup which is needed to bring about

resolution, whether the level of perception of this need is conscious or

sub-conscious (the latter usually being the case rather than the former). I

would bet that given the right approach, either a physical contact OR a

non-physical contact (i.e. verbal) approach could be successful. Consider for

example the well known story of Milton kson's intervention with the

delusional mental patient who thought he was Jesus and how kson skillfully

used the emotional impact of a hammer, nails, and lumber (i.e. the components

leading to a cross and the ultimate consequence of that) to phase into the

utilization of carpentry skills to bring the patient back around to a productive

life. I would also venture that a variety of manual interventions of varying

philosophical orientations and physical characteristics could be employed by

individuals skilled in each and each of the practitioners could be successful

(or unsuccessful) depending upon HOW they employed their interventions. Ditto

for a variety of movement interventions. And an integrated combination of

manual, movement, and verbal therapy, again applied with the proper intention,

could also be successful. The " communication " with the subconscious mind,

whether through the cybernetic linkage established through the hands and

movement or via dry needling or through the verbal connection and rapport

established by talk, would appear to be the common element.

, PT, OCS

Re: Conversion Disorder Program

For what it is worth.... I recently had a 15 year old with what appeared to be

conversion disorder respond dramatically -with complete resolution in six visits

of dry needling myofascial release. She presented five weeks following a single

episode of bilateral knee pain, followed by lower back pain which within five

days presented as severe weakness, complete loss of single leg standing balance

and inability to ambulate. She was first seen for PT five weeks after initial

onset after having seen four physicians and full diagnostic testing. I agree

that taking a non confrontational approach may be the best approach in this type

of situation. The patient And her parents did not care if i utilized an

" evidenced based approach " . it appears that placebo has a place in all areas of

medicine. This patient went from wheelchair to playing volleyball and running

within four weeks. br

Sent from my iPad

[Guest guest]

I think an important point is that the type of intervention may not necessarily

be the key but rather the interactive nature of the intervention and the

INTENTION behind the intervention. Think first of why these problems develop.

There is almost always a psychological conflict involved. " Sickness " allows one

to withdraw from conflict in a socially acceptable manner and brings attention,

caring, and a " time out " period to regroup which is needed to bring about

resolution, whether the level of perception of this need is conscious or

sub-conscious (the latter usually being the case rather than the former). I

would bet that given the right approach, either a physical contact OR a

non-physical contact (i.e. verbal) approach could be successful. Consider for

example the well known story of Milton kson's intervention with the

delusional mental patient who thought he was Jesus and how kson skillfully

used the emotional impact of a hammer, nails, and lumber (i.e. the components

leading to a cross and the ultimate consequence of that) to phase into the

utilization of carpentry skills to bring the patient back around to a productive

life. I would also venture that a variety of manual interventions of varying

philosophical orientations and physical characteristics could be employed by

individuals skilled in each and each of the practitioners could be successful

(or unsuccessful) depending upon HOW they employed their interventions. Ditto

for a variety of movement interventions. And an integrated combination of

manual, movement, and verbal therapy, again applied with the proper intention,

could also be successful. The " communication " with the subconscious mind,

whether through the cybernetic linkage established through the hands and

movement or via dry needling or through the verbal connection and rapport

established by talk, would appear to be the common element.

, PT, OCS

Re: Conversion Disorder Program

For what it is worth.... I recently had a 15 year old with what appeared to be

conversion disorder respond dramatically -with complete resolution in six visits

of dry needling myofascial release. She presented five weeks following a single

episode of bilateral knee pain, followed by lower back pain which within five

days presented as severe weakness, complete loss of single leg standing balance

and inability to ambulate. She was first seen for PT five weeks after initial

onset after having seen four physicians and full diagnostic testing. I agree

that taking a non confrontational approach may be the best approach in this type

of situation. The patient And her parents did not care if i utilized an

" evidenced based approach " . it appears that placebo has a place in all areas of

medicine. This patient went from wheelchair to playing volleyball and running

within four weeks. br

Sent from my iPad