The Challenge

Jessica came to us through an unusual referral pathway – her local NHS Commissioner reached out because there were no specialist physiotherapy services available in her area for people with Functional Neurological Disorder (FND). This highlighted a significant gap in specialist neurological services across different regions.

Jessica’s journey had been particularly challenging. Following a fall, she had spent a considerable period in hospital and had become wheelchair dependent. Her situation was further complicated by the fact that during her hospital admission, her family had relocated to a different geographical area, meaning she was dealing with both her physical challenges and the stress of adapting to an entirely new environment.

When we first began working with Jessica, she was struggling significantly with engagement. Traditional physiotherapy approaches and formal exercise programmes were met with resistance, and she appeared low in mood and withdrawn. This lack of engagement is not uncommon in FND cases, where the relationship between physical symptoms and psychological factors can make conventional rehabilitation approaches challenging.

Jessica’s isolation was compounded by her dependence on a hoist for all transfers, which significantly limited her independence and contributed to her low mood and withdrawal from activities she had previously enjoyed.

Our Approach

The breakthrough in Jessica’s case came through careful observation and a willingness to think creatively about therapeutic interventions. Our physiotherapist noticed Jessica’s strong bond with her cat and recognised this as a potential pathway to engagement.

Creative, Person-Centred Therapy: Rather than persisting with traditional exercise approaches that weren’t working, we developed an innovative intervention using cat toys to engage Jessica therapeutically. This approach cleverly disguised therapeutic activities as play with her beloved pet.

Building Through Success: We used the cat toy activities to challenge Jessica’s balance and confidence, encouraging her to reach beyond her usual comfort zone and return safely in her wheelchair. This approach allowed her to experience success and build confidence without the pressure associated with formal physiotherapy exercises.

Trust-Building: As Jessica’s confidence in her movement abilities grew, so did her relationship with her physiotherapist. This improved therapeutic alliance became the foundation for progressing to more conventional therapeutic activities.

Functional Goal Setting: Once trust and confidence were established, we began working on practical, meaningful goals. We focused on seated transfers to and from her bed, aiming to reduce her dependence on the hoist and increase her independence.

Community Integration: As Jessica’s confidence and abilities improved, her physiotherapist supported her to engage with community-based activities, including swimming and gym sessions at an adapted fitness facility.

The Outcomes

Jessica’s transformation has been remarkable, demonstrating the power of person-centred, creative therapeutic approaches in FND recovery:

Physical Improvements:

• Progressed from complete wheelchair dependence to improved mobility and transfer abilities
• Developed the ability to perform seated transfers independently, eliminating the need for hoist assistance in many situations
• Improved balance and confidence in wheelchair mobility
• Enhanced upper body strength and coordination through creative therapeutic activities

Psychological and Social Benefits:

• Significant improvement in mood and engagement
• Transformed from withdrawn and resistant to actively participating in therapy
• Increased confidence in her physical abilities
• Renewed interest in community activities and social engagement

Independence and Empowerment:

• Reduced dependence on assistive equipment (hoist) for daily activities
• Successfully engaging in independent community activities (swimming and gym)
• Taking ownership of her own health and wellbeing journey
• Developing self-efficacy in managing her condition

Therapeutic Relationship:

• Strong, trusting relationship established with physiotherapist
• Successful transition from creative, disguised therapy to conventional approaches
• Ongoing support facilitating community integration and independence

Key Outcomes

• Successful engagement despite initial resistance to traditional therapy approaches
• Progression from hoist-dependent transfers to independent seated transfers
• Integration into community fitness and swimming activities
• Significant improvement in mood, confidence, and self-efficacy
• Development of strong therapeutic alliance enabling ongoing progress
• Creative, person-centred approach proving effective where conventional methods had failed
• Taking active ownership of health and wellbeing journey

Addressing Service Gaps

This case highlights an important aspect of our work – our ability to provide specialist neurological physiotherapy services to areas where such expertise is not readily available. By working with NHS Commissioners, we can help bridge geographical gaps in specialist services, ensuring that people with complex neurological conditions like FND can access the expert care they need, regardless of their location.

The Power of Creative, Person-Centred Care

Jessica’s story demonstrates that sometimes the most effective therapeutic interventions are those that connect with what truly matters to the individual. By recognising and incorporating Jessica’s love for her cat into the therapeutic process, we were able to overcome initial barriers to engagement and create a pathway to recovery that might not have been possible through conventional approaches alone.

The success of this creative approach, combined with the supportive home environment, enabled Jessica to rebuild her confidence, develop her physical abilities, and ultimately take control of her own recovery journey.

Get in Touch