Functional Parkinsonism

Functional (Psychogenic) Parkinsonism describes Parkinson-like symptoms—such as slowness, stiffness, tremor and walking difficulties—that arise as part of a Functional Neurological Disorder (FND). In FND, the problem is with how the brain controls movement, not with structural nerve damage. Symptoms are real, often disabling, and can improve with the right explanation and rehabilitation.

At The Royal Buckinghamshire Hospital, we offer consultant-led inpatient neurorehabilitation for adults with functional movement disorders, including functional parkinsonism. Our approach is compassionate, evidence-informed and focused on restoring function, confidence and independence.

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How Functional Parkinsonism Presents

People may experience:

• Bradykinesia-like slowness that varies with distraction or attention
• Rigidity or stiffness that changes during tasks or with dual-tasking
• Tremor that is variable, entrainable or inconsistent across tasks
• Gait disturbance: hesitant starts, freezing episodes, wide-based or irregular step pattern
• Functional overlays such as weakness, sensory change, fatigue, pain or dizziness
• Anxiety or low mood, often secondary to symptoms and reduced activity

Functional features often include internal inconsistency (better with distraction, worse when observed) and improvement with explanation and retraining.

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Why It Happens

Functional parkinsonism can follow or be triggered by:

• Injury, illness or high stress (even without structural brain damage)
• A frightening fall or near-fall, leading to movement avoidance
• Coexisting functional symptoms (e.g. functional tremor, functional gait disorder)
• Long periods of inactivity and deconditioning
• Health anxiety or uncertainty about unexplained symptoms

See: Functional Neurological Disorder

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Diagnosis

Diagnosis is positive, based on characteristic exam findings made by a clinician experienced in FND. Tests such as MRI or DaTscan may be used to exclude neurodegenerative parkinsonism when indicated. Clear explanation of the diagnosis is a critical first step in recovery.

Related pages:
Idiopathic Parkinsonism
Vascular Parkinsonism

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Our Inpatient Rehabilitation Approach

We combine movement retraining with psychological and behavioural strategies that help the brain relearn automatic control.

Your Programme May Include

• Neurophysiotherapy: graded exposure to movement, cueing for gait initiation and turning, step-length practice, dual-task tolerance, balance and falls-prevention.
• Occupational Therapy: energy conservation and pacing, task-specific practice for transfers and self-care, confidence rebuilding, home/environment adaptations.
• Neuropsychology: education about FND, strategies for attention and movement focus, anxiety and avoidance reduction, mood support, relapse-prevention planning.
• Speech And Language Therapy (when needed): voice projection, articulation, and cognitive-communication strategies.
• Education & Self-Management: personalised home exercises, flare-management and return-to-activity plans; carer/family coaching.

Explore Our Rehabilitation Centre

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When To Consider Inpatient Rehab

• Walking is unsafe or severely limited by slowness, freezing or fear of falling
• Marked variability and functional overlays (pain, fatigue, sensory symptoms)
• Daily activities are restricted despite outpatient therapy
• You need co-ordinated input from physiotherapy, OT and psychology with carer education

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Living Well With Functional Parkinsonism

• Build a regular activity routine with short, frequent practices
• Use external cues (counting, rhythmic beats, floor markers) to start and maintain steps
• Practice dual-task training gradually (e.g., walk + talk) to normalise automatic control
• Reduce safety behaviours that maintain avoidance (over-reliance on furniture, excessive checking) with therapist guidance
• Address sleep, stress and mood, which strongly influence symptoms