Background/Purpose: Conversion disorder is a poorly understood diagnosis that is frequently demonized and often misinterpreted as malingering. Conversion disorder is not malingering. Instead it is a coping mechanism of the brain in response to stress. Patients with conversion disorder will present with neurologic-like symptoms, but demonstrate no organic neurological explaination. The purpose of this study is to examine the available literature assessing operant behavioral management of conversion disorder, by physical therapists, in patients presenting with positive motor findings referencing a case study from a personal clinical experience. Case Description: The case report describes a 34-year-old male with an initial presentation of symptoms and diagnosis of Multiple Sclerosis. Mr. E, as he shall henceforth be referenced, was diagnosed with an MS flare, as well as a urinary tract infection (UTI), prior to admission to the hospital for this episode of care. Due to impairments in mobility and self-care, along with medical complexity, which include the UTI, hypertension, and bipolar fisorder, the patient was admitted to inpatient rehabilitation. During his hospitalization, Mr. E was seen by a neurologist and repeat studies were conducted to confirm the MS diagnosis. However, the repeat studies revealed that Mr. E had no spinal cord or brain lesions to suggest a true MS diagnosis, at which point his diagnosis was changed to possible conversion disorder. At the time of discharge the patients symptoms continued to wax and wane, as he was prematurely discharged due to current insurance policies. Outcomes: The literature highlights many different treatment options for conversion disorder, which can be grouped as psychiatrically oriented, modality-oriented, or behaviorally oriented1. However, the pertinent evidence is considered to be relatively low ranking and includes: expert opinion, case series, and case reports. Evidence suggests that treatment of conversion disorder is best suited for physical rehabilitation, in conjunction with psychological treatment, in an inpatient setting. The environment can be effectively controlled for relational and circumstantial stressors, as well as facilitate a socially acceptable treatment setting by allied health professionals. Key elements of treatment highlighted are positive and negative behavioral modification techniques, both of which have proven to have astounding functional outcomes. However, in situations where behavioral modification techniques are either not practical or effective at resolving the patients' symptoms, a variety of other treatments are available. Discussion/Conclusion: Despite the low levels of evidence, the relevant research does demonstrate that physical therapy using behavioral modification techniques can provide effective short-term symptom resolution in patients with positive motor findings, when combined with psychological treatment in an inpatient setting, in a fairly short period of time.
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Conversion Disorder, behavior management, physical therapy, Multiple Scierosis, positive motor symptoms
Frangos, Vanessa. "The Effects of Operant Behavior Manaement of Movement Patterns in Individual Diagnosed with Conversion Disorder." (2014). http://digitalrepository.unm.edu/dpt/27
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