Medical Speech Pathology

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Functional Neurological Disorder

Functional Neurological Disorder (FND) is a condition that arises from altered functioning of the nervous system, causing individuals to experience neurological symptoms that cannot be explained by structural or biomechanical abnormalities. It is not a diagnosis of exclusion however, but rather a distinct and complex condition recognised for its unique neurological manifestations and underlying mechanisms.  

FND can manifest in various ways which affect communication, cognition and swallowing function, including:

  • Voice changes/difficulty producing voice: This includes dysphonia, aphonia, and mutational falsetto or puberphonia. The loss of voice control is involuntary, but may include excessive muscular tension, which can also be addressed.

  • Swallowing difficulties: Symptoms like globus (a sensation of a lump in the throat) or functional dysphagia (difficulty swallowing) can occur with or without other structural abnormalities, so a comprehensive evaluation of swallowing function is warranted to rule out other contributing factors. 

  • Dysfluency (stuttering): Functional stuttering can emerge suddenly in adulthood without prior speech difficulties and is characterized by extreme variability, unusual patterns, or consistency in dysfluency that defies developmental or neurogenic patterns. 

  • Functional cognitive disorder: This can involve difficulties with memory, attention, or word-finding.

  • Speech and language disorders: Can include issues with articulation, prosody, or language (expressive or receptive).

  • Cough and upper airway disorders: Functional cough and laryngeal hypersensitivity may arise due to altered sensory processing and can significantly impact quality of life.

All Medical Speech Pathology clinicians have additional training in the assessment and management of communication and swallowing issues due to FND and hold membership with the Functional Neurological Disorder Society (FNDS).