A new model of care for patients with movement disorders
It was a chance encounter during Dr. Sarah Lidstone’s final year of residency that planted the seed for what would become a groundbreaking movement disorders program.
Dr. Lidstone completed her residency in neurology and a fellowship in movement disorders at the University of Toronto (U of T). Prior to this, she completed her PhD in Neuroscience at the University of British Columbia, studying the placebo effect in Parkinson's Disease. During her training, she also spent time in the United Kingdom, Switzerland and The Netherlands learning about diverse models used in the care of movement disorders.
The idea for such a program began to take shape when she encountered a challenging case: a patient who had been admitted to the hospital with functional neurological disorder (FND). Since FND is a neuropsychiatric disorder that displays neurologic symptoms inconsistent with an established medical illness, it lies at the intersection between neurology and psychiatry, and can often be challenging to treat.
“I asked my good friend, Dr. Lindsey MacGillivray, who was a psychiatry resident at the time if she wanted to work with me to try to do a rehabilitation program with this patient for five days,” says Dr. Lidstone.
“She was up for it, so we convinced the ward physiotherapist, occupational therapist and nursing staff to get on board with this crazy idea, treated this patient and she got a lot better over the course of five days. At that point, we knew we were onto something.”
Dr. Lidstone continued exploring her multidisciplinary approach throughout her fellowship. She recalls treating another patient – a young nurse in her 20s who had a functional movement disorder characterized by jerky movements and difficulty walking. The woman loved to dance ballet and one of the rare times when her body exhibited fluid movement was when she was dancing.
Dr. Lidstone and her team decided to turn their clinic room into a replica ballet studio and utilize the patient's motor functions when dancing to rehabilitate her walking ability, while also addressing the underlying anxiety and personality traits that contributed to her symptoms.
The patient's complete recovery within three months further fueled Dr. Lidstone's belief in the profound connection between mind and body, and she sought to find concrete ways to bridge these gaps in neurology and rehabilitation.
“Our movement is largely affected by how we think and feel,” says Dr. Lidstone. “If you look at somebody who’s feeling down and depressed, their body, facial expressions and movement patterns are completely different than someone who is anxious or even happy, and this isn’t generally noticed or accounted for in the field of rehab, neurology or psychiatry.”
In 2019, Dr. Lidstone was recruited to become a faculty member in the Department of Medicine at U of T after the university received a philanthropic donation dedicated to building a program for the multidisciplinary care of movement disorders. The opportunity perfectly coincided with her desire to expand her novel approach to therapy and the Integrated Movement Disorders Program (IMDP) was born at the Toronto Rehab Institute.
While the program has seen a number of successful outcomes over the years, one in particular that stands out to Dr. Lidstone is the few patients she’s seen arrive in a wheelchair and later walk out.
“You simply do not get those outcomes in any other area of neurology,” she says.
Another hallmark of the program is empowering patients to actively engage in their therapy. Dr. Lidstone and her team aim to prioritize patients' unique needs and goals. To do so, they begin their assessments by asking a patient what their top three concerns are to ensure that their goals align with what the team can target.
“If we have a patient who identifies they're feeling lonely and isolated, sure, they have a problem with their walking and balance, but to that person, what really matters is social connection,” says Dr. Lidstone. “So we will target that as our outcome and find ways to blend that into the treatment plan, for example, through the use of group therapy.”
Dr. Lidstone has also established a Patient Advisory Board consisting of individuals from diverse backgrounds who participate in co-designing treatment and creating resources, including a newsletter for the movement disorders community. Board members take on various responsibilities such as generating story concepts, crafting content, supplying photographs and copy editing – producing the type of resources they personally find useful.
With the IMDP's commitment to individualized care and a patient-centered approach, Dr. Lidstone’s patients are not just improving their physical mobility but also finding the emotional and social connections they cherish.