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Rory Higgins

@roryhigginsphysio.bsky.social
19 followers 50 following 20 posts

Physiotherapist, Integrated Movement Disorders Program, Toronto Rehabilitation Institute

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Reposted by Rory Higgins
gnielsenphysio.bsky.social @gnielsenphysio.bsky.social · 13/06/2026
Our new paper on Falls in motor FND has been published. This is work completed by Zahra Mohammadi and Rory Higgins doi.org/10.1111/ene....
doi.org
Falls in Functional Neurological Disorder: Prevalence, Risk Factors and Clinical Implications
Background Functional neurological disorder (FND) is a disabling condition often presenting with motor impairments, including gait disturbance and postural instability. Data on the prevalence and pr.....
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Bottom line: Sensory symptoms in FND are: ✅ Highly prevalent ✅ Diverse ✅ Often disabling ✅ Frequently persistent ✅ Poorly captured by traditional sensory testing They should be routinely asked about and addressed. They are a core feature of FND - not an afterthought.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
8. Disturbed sense of limb ownership Some report limbs feeling “dead”, absent, or not belonging to them. This mirrors disturbances seen in stroke and CRPS involving higher-level sensory integration networks.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
7. Altered interoception Reduced accuracy or confidence in sensing internal bodily signals may amplify or distort sensory experiences.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
6. Sensory processing differences High rates of sensory hypersensitivity (sound/light/touch) overlap with migraine and autism-related sensory traits, which point to potential shared predictive processing mechanisms.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
5. Peripheral vasomotor dysregulation Cold extremities, swelling, and colour changes are not uncommon in motor-FND (e.g. functional dystonia), suggesting altered peripheral circulation (consistent with previous descriptions of overlap with complex regional pain syndrome #CRPS).
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
4. Co-existing pathophysiology FND often co-occurs with conditions that cause sensory symptoms (e.g. radiculopathy, carpal tunnel syndrome, etc) which often act as predisposing or perpetuating factors for FND.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
3. Anxiety, panic & autonomic arousal Many people experience sensory symptoms associated with panic (e.g. tingling, dizziness, hot/cold) without feeling anxious (“panic without panic”). Autonomic arousal may be misinterpreted in some individuals.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
2. Dissociation & compartmentalisation Experiences of depersonalisation/derealisation are common in motor-FND. Reports of insensate limbs or unnoticed injuries suggest impaired integration of sensory signals, consistent with the concept of compartmentalisation.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
1. Dual processing of motor & sensory signals Sensory and motor symptoms may be mutually consequential - two sides of the same coin. These two processes are intrinsically linked and processed together within the brain. Improving one may result in improvement in the other.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
The large variation in sensory experiences documented in this study implies multifactorial mechanisms contribute to sensory symptoms in motor-FND. Potential mechanistic explanations:
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Concept conflation: 50% of patients struggled to distinguish the concepts of "weakness" from "numbness." Exploring what patients mean by their words is crucial in assessment.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Sensory symptoms were often perceived as severe and were statistically associated with higher disability and depression. Only one-third of motor-FND reported improvement in sensory symptoms at 12 months.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
The motor-FND group experienced pain more frequently than the stroke group (88% vs 41%) and more frequently endorsed having a high pain tolerance (70% vs 49%). Self-reported hypersensitivity was more common in FND (to light 63% FND vs 20% stroke; sound 65% FND vs 15% stroke).
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Classic sensory FND signs (midline splitting of light touch and vibration) were uncommon and had poor diagnostic specificity when compared with stroke. These signs may still hold value as part of the accumulation of evidence in making a diagnosis. Clinical context is important.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Quantitative sensory testing (QST)? Added little information to assessment. Often detected abnormalities patients didn’t report.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
The distribution of symptoms in motor-FND is complex. Complete sensory loss in an area? • 27% of motor-FND vs 11% stroke Classic “glove and stocking” patterns? • 20% of motor-FND vs 3% of stroke
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
"It feels like my limb is dead." While both groups reported numbness, people with motor-FND described a broader spectrum including: “dead” or an absent limb (19% motor-FND vs 1% stroke). This is not a rare phenomenon for people with motor-FND.
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Prevalence: Sensory symptoms are extremely common (96% of motor-FND and 67% of stroke). When asked to list symptoms... 70% of motor-FND reported sensory symptoms without prompting. 96% endorsed them after prompting. That’s higher than stroke (31% unprompted, 67% prompted).
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Sensory symptoms (e.g. numbness, pins and needles) in Functional Neurological Disorder (#FND) are common, but often overlooked. Our new prospective case-control study compares sensory symptoms of 102 people with motor-FND vs 75 people with recent #stroke. Here’s what we found 🧵
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Rory Higgins @roryhigginsphysio.bsky.social · 17/02/2026
Delighted to report our study on sensory symptoms has been published in @braincomms.bsky.social - @jonstoneneuro.bsky.social, Prof. Mark Edwards, Dr. Jan Coebergh, @roryhigginsphysio.bsky.social, @gnielsenphysio.bsky.social academic.oup.com/braincomms/a...
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