STEP 2: Concussion Live Course - October 21-22, 2025, in Salt Lake City, UT-Risk Factors for Delayed Recovery and Beyond

Pdf Summary

This comprehensive document by Dr. Ginger Polich explores functional neurological disorders (FND) in the context of concussion and post-concussion syndrome (PCS), emphasizing shared mechanisms, diagnosis, phenotypes, and treatment implications. FND involves genuine, involuntary neurological symptoms without structural pathology, distinguished from malingering by lack of intentional symptom fabrication for secondary gain. Predisposing factors for FND include stress, medical illness, neuroticism, anxiety, and genetics; precipitating events include injury (like concussion), and perpetuating factors include diagnostic uncertainty and secondary gain.<br /><br />Up to 12% of neurological cases may have functional overlays, complicating diagnosis especially when symptoms straddle organic and functional boundaries. FND symptoms after concussion can manifest as functional motor symptoms such as gait disorders, functional dizziness, cognitive impairments, speech disturbances like functional stuttering, and seizures. Yellow flags for FND include atypical symptom patterns, fluctuating course, incongruent exam findings, and history of trauma or psychiatric comorbidities.<br /><br />Diagnosis relies on clinical assessment demonstrating incongruency, inconsistency, distractibility, and suggestibility of symptoms, supported by exclusion of organic pathology. Diagnosis is challenging but critical, as mislabeling symptoms solely as concussion-related may lead to unnecessary tests, treatment resistance, and patient distress.<br /><br />Treatment requires a multidisciplinary approach integrating neurologists, physical, occupational, and speech therapists, and mental health professionals. Interventions focus on motor relearning, cognitive-behavioral strategies, psychoeducation, and addressing psychological comorbidities. Delivering the diagnosis with validation, positive rule-in signs, and clear explanatory models improves acceptance and engagement.<br /><br />Challenges include patient resistance due to fixed beliefs about brain injury, stigma, and financial or social factors. Addressing personality traits and maladaptive behaviors is important in treatment. Emerging evidence suggests that recognizing and treating FND within PCS may reduce overestimation of chronic concussion effects and improve patient outcomes.<br /><br />In summary, Dr. Polich advocates for awareness of FND after concussion, positive diagnosis based on clinical signs, and tailored multidisciplinary therapy to optimize recovery beyond delayed concussion recovery.

Asset Subtitle

Ginger R. Polich, MD

Keywords

Functional Neurological Disorders

Concussion

Post-Concussion Syndrome

Diagnosis of FND

Functional Motor Symptoms

Multidisciplinary Treatment

Psychological Comorbidities

Clinical Assessment

Patient Engagement

Recovery Optimization