Wolfson FND assessment clinic letter

Date of assessment: 1 November 2024 Hospital MRN: 123456789 Dear Mrs. Smith, Thank you for taking the time to meet with me on 1 November 2024. As you are aware, you were referred for neurorehabilitation for Functional Neurological Disorder (FND) by Dr. Jones on 1st October 2024. I am sorry that we have such long waiting lists to triage referrals and that this was the first available appointment we could offer you. Our meeting was a 90-minute initial assessment appointment, which provided you with information about our rehabilitation pathway and allowed us to briefly discuss your current symptoms and situation. The overall aim of this appointment is to identify whether we are the most suitable service for your current needs and to agree appropriate treatment options available to you. Due to the nature of this appointment, I have only briefly described the background to the FND-onset. This is described more fully in previous correspondence, including Dr. Jones' clinic letters, and much of our discussion today focused on your current symptoms and difficulties. Brief Background to FND-Onset Mrs. Smith reported that her symptoms began approximately six months ago following a viral infection. She initially experienced fatigue and weakness, which gradually progressed to include speech difficulties, such as slurring and word-finding problems. She reports that she was told by her GP that she had a functional neurological disorder. Current Diagnoses * Functional Neurological Disorder (FND) Current Medications * Sertraline 50mg daily (for low mood) Description of Current Situation & Symptoms Mrs. Smith reports significant difficulties with speech, including slurring of words and difficulty finding the right words, particularly when tired or stressed. She also experiences fatigue, weakness in her arms and legs, and occasional tremors. These symptoms significantly impact her ability to communicate effectively, participate in social activities, and perform daily tasks. Mrs. Smith is currently able to walk short distances with the aid of a walking stick. She requires assistance with shopping and other activities outside the home. She reports that a typical day involves waking up feeling fatigued, attempting to complete some household chores, resting in the afternoon, and struggling to communicate with her family in the evening. Mrs. Smith reports that her speech difficulties have the biggest impact on her life, as they make it difficult for her to express herself and connect with others. Mrs. Smith manages her symptoms by pacing herself, taking regular breaks, and using communication strategies such as writing things down and using gestures. Mental Health, Well-Being & Risk Mrs. Smith reports a history of low mood and anxiety, for which she is currently taking Sertraline. She has previously attended counselling, which she found helpful. She denies any current suicidal ideation or self-harm. Goals * To improve speech clarity and fluency. * To reduce fatigue and improve physical function. * To regain independence in daily activities. Opinion & Plan Mrs. Smith presents with a complex presentation of FND, with prominent speech and motor symptoms. Her symptoms are significantly impacting her quality of life. I believe that she would benefit from our FND rehabilitation pathway. In terms of the FND rehabilitation pathway that we offer, we have agreed that we will invite you to our group programme, which is run via video-conferencing. The programme consists of four group sessions, lasting between 60 to 90 minutes, which helps participants to understand how and why FND symptoms occur and what rehabilitation entails. I will send you the details for this. We require everyone to attend all group sessions, before offering further assessment or treatment. Yours sincerely, [Clinician Name] Speech and Language Therapist