Clinical Research Directory

Feasibility and Usability of a Mobile App for Monitoring and Managing Functional Movement Disorders

People with FMD may experience symptoms such as tremor, jerks, spasms, or difficulty walking. These symptoms are not caused by damage to the brain or nerves. Instead, they happen because the brain is not sending or processing signals in the usual way. Symptoms can change from day to day, and stress, emotions, or certain situations may make them better or worse. Right now, patients are often asked to remember how their symptoms have been since their last clinic visit or to write things down in a notebook. This can be hard to do and may not give an accurate picture of what is happening. Because of this, doctors and patients may miss important patterns or triggers, and it can be harder to know which coping strategies are helpful. To improve this, our team has created a mobile app that allows people with FMD to easily record their symptoms, stress level, and mood, in real time. The app also includes simple self-help tools that may support symptom management. Before using this app more widely, we want to find out (1) whether patients can use it as intended and (2) whether they find it easy and helpful to use. This study will help us understand if the app is practical for use in an FMD clinic and how it could be improved.

Action Outcome Latencies as a Measure of Sense of Agency in Functional Movement Disorders.

Functional movement disorders (FMD) are among the most common neurological conditions seen in clinical practice, yet they are poorly understood and often misdiagnosed. Impaired self-agency, the sense of controlling one's actions, is a key feature of FMD. Studies using functional MRI have shown reduced activation and connectivity in the right inferior parietal lobule, a region associated with agency. The sense of agency consists of two components: the feeling of agency, which is an implicit, low-level sense of control over voluntary actions, and the judgment of agency, which is the conscious attribution of actions to oneself. While the feeling of agency is often measured using intentional binding tasks, judgment of agency is assessed using self-reported scales. While studies have explored intentional binding as a measure of implicit agency in FMD, few have systematically investigated judgment of agency. This study aims to fill this gap by introducing a novel approach that quantitatively evaluates judgment of agency in FMD patients using action-outcome latencies as an objective metric.

Virtual Reality in Functional Movement Disorder

This study investigates the effect of virtual reality (VR) motor tasks on functional movement disorders.

Additive Effects of Interoceptive Training to Physiotherapy in Functional Movement Disorders (interoPTfmd)

Functional movement disorder (FMD) is a common source of neurological disability that imposes a significant financial burden on healthcare systems. However, the heterogeneous manifestations of FMD and numerous associated non-motor symptoms, often fluctuating over time, present a challenge for developing effective treatment pathways. Although increasing evidence supports the efficacy of physiotherapy for FMD, the lack of predictors of treatment outcomes remains a significant obstacle to effectively managing FMD. The main hypothesis of this project is that abnormalities in interoceptive processing are responsible for variability in motor and non-motor symptoms and response to physiotherapy. Interoception describes the afferent signalling, central processing, and mental representation of internal bodily signals. We hypothesize that worse performance on interoceptive tests will be associated with greater severity of motor and non-motor symptoms and worse quality of life. We also expect that patients with worse interoceptive performance and associated non-motor symptoms such as pain will particularly benefit from treatment techniques modulating interoception, such as specific breathing techniques. Therefore, to test our hypotheses, in this project, we will study interoceptive and attentional abnormalities of FMD and identify predictors of the effect of physiotherapy and interoceptive respiratory training.

Non-invasive Intermittent Theta Burst Stimulation of the Dorsolateral Prefrontal Cortex in Functional Movement Disorders

Background: Functional movement disorders (FMD) involve involuntary movements that are not due to a recognized neurological or medical cause. FMD can cause major disability. Researchers want to learn more to create better treatments for FMD. Objective: To test whether non-invasive brain stimulation using transcranial magnetic stimulation (TMS) improves FMD symptoms. Eligibility: People between the ages of 18 and 80 who have been diagnosed with FMD by a neurologist. Design: Participants will be randomly assigned to one of two groups. One group is an active brain stimulation group and the other is a sham brain stimulation group. Participants will have a baseline visit. This will include: Neurological exam Questionnaires Urine test Brain MRI: Participants will lie in a machine that takes pictures of the body. They will be asked to respond to images on a screen while in the scanner. Within 2 weeks of the baseline visit, participants will begin 5 daily sessions of TMS. The active group will have stimulation delivered to the brain via a coil. In the sham group, a dummy coil will be used that will not deliver stimulation. A total of three 3-minute cycles will be done in one visit. There will be 20-minute breaks between the cycles. Participants will have visits 1 month, 2 months, and 6 months after their last day of TMS. Their FMD symptoms will be evaluated. They will complete health questionnaires. These visits can be in person or virtual.

Study of Sensory Attenuation in Functional Movement Disorders

Functional movement disorders (FMD) are conditions where people experience unusual movements or difficulties with walking, not caused by a specific brain or nerve injury but related to how the brain controls movements. Functional movement disorders are common in clinical practice and can lead to significant disability and healthcare costs. A key feature of FMD is a problem with self-agency-the feeling that we are in control of our own movements. Many patients with FMD feel that their abnormal movements happen without their control. Sensory attenuation is closely linked to self-agency. It's the brain's way of reducing the intensity of sensations caused by our own movements. For example, you can't tickle yourself because your brain knows it's your own action. In people with FMD, this process doesn't work properly. As a result, they might feel their movements are involuntary. Previous research shows that sensory attenuation is reduced in FMD, but the studies so far have been small. This study will investigate sensory attenuation in a larger group of FMD patients and compare it with healthy individuals. The goal is to see if reduced sensory attenuation could be used as a marker to measure the severity of FMD.

Passive Thoughts in Functional Movement Disorders

Passive thoughts also known as mind-wandering are the thoughts that are not produced from the current task. When we aren't focused on a task that needs our full attention, our minds tend to drift from one thought to another. It is believed that mind wandering is the baseline or natural state of the mind, and we shift our focus only when needed for a task. Many areas of the brain are active during mind-wandering, and these areas together are called the brain's default network. An important part of this network is the right temporoparietal junction. Functional movement disorder (FMD) is characterized by unusual movements or walking difficulties that are not caused by a specific brain or nerve injury. Functional movement disorders are believed to be caused due to loss of sense of agency. The sense of agency is the awareness that one is responsible for their own actions. The brain network involved in the sense of agency is mainly located in the right side of the brain, especially in the right temporoparietal junction. In FMD patients, there is decreased connectivity between the right temporoparietal junction and other brain areas that control movement. Since both passive thoughts (mind wandering) and the sense of agency involve the temporoparietal junction, and because the sense of agency is abnormal in functional movement disorders (FMD), we plan to study passive thoughts in individuals with FMD. The study aims to find out how passive thoughts differ between individuals with FMD and healthy individuals. Passive thoughts will be measured using Mind Excessively Wandering Scale (MEWS).

Effect of a Dual-task Intervention Program on Physical and Cognitive Function

Aim: to compare the effects of single-task (ST) and dual-task (DT) training on physical and cognitive function in institutionalized older adults in 1 month. Methods: Participants were assigned randomly into two groups, ST (multicomponent physical exercise) and DT training (multicomponent physical exercise + cognitive tasks). Both groups performed the exercise three times per week for 1 month. Short Physical Performance Battery (SPPB), handgrip strength, Barthel Index and Montreal Cognitive Assessment (MoCA) were used to assess physical and cognitive performance, respectively. Variables were measured at the beginning (V1),at the end of the exercise (V2), as well as one month later (V3). Paired Student's t-test and lineal logistic regressions models were used to explore the effect of the exercise interventions.

Tremor Retrainer Software Application for Functional Tremor

The purpose of this clinical trial is to learn about the Tremor Retrainer smartphone application and Simplified Functional Movement Disorder Rating Scale in patients with functional tremor. The main questions the study aims to answer are: 1. Is the Tremor Retrainer application usable for patients and are there signs that it can help functional tremor? 2. Can a televideo administration of the Simplified Functional Movement Disorder Rating Scale give enough information to use this scale via televideo in future studies?