CONVERSION DISORDER.

Conversion disorder is a mental condition in which a person can have blindness, paralysis, or any nervous system symptoms that cannot be explained by medical evaluations. It may occur because of psychological conflict. Symptoms usually begin suddenly after a stressful experience. It can be dissociation disorder( escape from reality, that is not on purpose).

FES Machine

A forty-year-old lady was brought to our Neurology OPD with a history of sudden paralysis. She was admitted and investigations started. There can be numerous causes for paralysis. Therefore investigations were one after another and all showed normal results. Nothing could be revealed in ten days. It is the prestige of our research institute, to diagnose a disease. Many neurological diseases cannot be fully cured but the progress of the disease may be retarded by treatment if correctly diagnosed. But in her case, no investigation showed any abnormality. It was an embarrassing situation among neurologists. In many such cases, neurologists advise physiotherapy as a placebo. Here also physiotherapy was advised. She was not cooperative for any active or passive exercises. So, being a lady, I had limitations for a compulsion. In fact, she did not have any loss of physical power. But her strong conviction was that her hands and legs had no power. So she did not do any movement on command. This was beyond her control. It was a typical Conversion disorder, which is a psychiatric problem.

There was a history of the onset of her paralysis. She was a NCC instructress who was posted to a distant remote area, while she had a lot of domestic problems for a movement. She was upset for a few days with that. Then slowly she developed a loss of body power. It was not a concious acting to evade transfer. So she was brought to the hospital. She was not prepared to believe that she had no loss of power after investigation. I realized that she needed treatment for her mind. The psychiatrist gave his opinion that it would take a longer time to cure that state of mind. I told my strategy of treatment management for her and requested one week for my plan and he gladly agreed.

I gave an explanation to the patient about Functional Electrical Stimulation(FES), which we use to function the innervated paralysed muscles. I did a counselling on her that her limbs will certainly work with FES. I was very sure that the electricity will make movements of her hands and legs as she had no conductivity problem. I applied the electrodes in both hands and started the machine. The hands did many actions like Flexion, Extension, Abduction, Adduction, etc. involuntarily. Even I could make her hold a cup of water and sip. Then I applied the electrodes on both the legs and the legs also did many actions involuntarily with electrical stimulation with the application of a suitable dosage. She was wonderstruck to see her own movements, which she couldn't do voluntarily. Her blushing face revealed her thrill in her. I had earlier agreed with her of her conviction of some ailment, which was although disproved by the investigations. Therefore I made use of her ardent faith in the machine and thrill. I told her that this is a magic machine which is going to cure you. Fortunately, Google and social media were not developed at that time. At times "ignorance is bliss". The involuntary movement by the machine, which she could not do by herself filled hope in her for cure. This electrical stimulation was continued every day. I encouraged her to make the test of her power in all affected joints with my assistance slowly. I always took care to adhere to my consensus to her conviction on virtual disease. Then I watched her frequently testing her power which was a self-motivated active exercise. She was very well convinced that she was improving. No more stimulation was needed. She joyfully continued her exercises with her background of being an NCC instructress, as if she has taken a rebirth. She became fully powerful in seven days. Meanwhile, her posting to a remote distant area was cancelled on compassionate grounds. That was a blessing in disguise. She was allowed to remain in Trivandrum for many years. The Authorities were convinced that she was not a malingerer, but the victim of a mental disorder.

In fact the Functional Electrical Stimulation is used to strengthen innervated paralysed muscles to perform a function. But here, I used to treat her mind, on which she lost her control. This case report was presented by me, with the comment of the psychiatrist in a scientific session of All India Association of Physiotherapists.