Shadowing Practice: Breaking down functional movement disorders • 2025 MDS Congress - Learn English Speaking with Video
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Good afternoon, everyone, and welcome to a special episode of the MDS podcast coming from the Movement Disorder Congress 2025.
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We are so privileged to have Professor Ibeck with us to discuss today's topic, Functional Movement Disorders.
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Professor Ibeck is a neurologist working at the University of Freiburg.
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To say Professor Ibeck is a specialist in FND is an understatement.
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We are very thankful to have you here today with us.
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I just listened to your talk on functional movement disorders, diagnosis and management.
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Before we dive into the content of functional movement disorders, can you maybe tell us a little bit about what got you interested in this topic?
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Sure.
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Thank you so much, first, for inviting me to take part in this podcast.
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It's a pleasure.
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And to talk about FND, my passion.
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So about how I got into FND, it was actually the fascination for these clinical presentations that I saw during my training.
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I had a mentor who was a movement disorder specialist, and he showed me these unusual cases because back then the diagnosis
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but he started showing me that there are actually positive signs.
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And I got so fascinated because we did not understand the pathophysiology.
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Mainly that was my interest.
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Why do these patients do these symptoms?
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And I wanted to know more.
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And I think that over the years, you've been such an amazing contributor to telling all of us about how that happens.
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And so thank you for the amazing work you've done.
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Yes, so FMD, functional movement disorder,
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is actually a group of symptoms where people present with abnormal movements or abnormal motor patterns such as weakness.
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And it's actually a subgroup of what we call FND,
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functional neurological disorder, because the same disorder can also express in different ways and be seen by other neurologists,
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like non -epileptic or functional seizures, for example, or speech disorder would be part of FMD but sometimes diagnosed by other specialists,
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or sensory problems, vision, hearing, so all the senses.
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And now more recently, we also defined two groups that belong to that, that are functional cognitive disorder and functional vertigo.
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That has also this name of triple PD, PPPD for postural, persistent, perceptual dizziness.
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So this is a whole group.
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But we're focusing today on FMD, right, movement and motor problems.
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Brilliant.
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Thank you.
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That gives us a great overview of where everything sits.
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would you say FMD is?
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FMD, again, in general has been shown to be one of the commonest cause to see a neurologist in different studies.
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So it's very common.
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It's been estimated also to represent up to a third of consultation in a general neurologist setting.
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Now that said, it can also be
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just FND or FND plus neurological disorder because it's not rare to see patients who can have both, right, coexisting.
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And FMD is the commonest subtype.
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So you mentioned that it can also be seen with a neurological condition.
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Are there specific neurological conditions that it's often seen with, or can it be seen with any neurological condition?
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So it can be seen with any.
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So you can have any
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symptom but there are some specific patterns that we now recognize
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and one that is of particular interest I think
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that we discussed in the session is the association of functional Parkinsonism with actually Parkinson's disease
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and it's very interesting because first the clinical presentation is not
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that easy we need to really carefully look for signs one of the signs we discussed in the video is
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that the slowness of movement that you can see in functional
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bit different in the sense that patient will be slow
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when you do the finger tapping but they won't show this loss of amplitude
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that is typical of the bradykinesia that we see in Parkinson's.
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So these help you make the diagnosis of functional Parkinsonism.
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And it's been shown now in a few case series that patients can have both, but when they have both, it tends to be that they start with the functional Parkinsonism,
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sometimes years before we actually find or develop the signs and symptoms of Parkinson.
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but they might develop the disease.
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This is an example where the role of the neurologist is really very important.
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So over the last few years, there's so much research that has been coming out around FND.
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How do you feel that the medical community has responded to this research?
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Do you feel there are still some controversies around it?
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Yeah, so thank you indeed for raising this point
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because we see big lag between what's shown in science and the literature and then the clinical application.
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And here I'm referring to this whole evidence from the literature that now we can make the diagnosis with positive signs,
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that there are a lot of positive signs that have been validated in studies showing a good specificity, showing a good inter -rater reliability,
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and yet In clinical practice, it takes years before neurologists actually know these signs or use them.
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And yeah, but I guess it's normal in the field, right?
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But it takes years until clinical research comes into clinical practice.
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And we need then to bridge that gap.
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A lot of conferences teaching, postgraduate teaching, pregraduate teaching.
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I think if we teach the young medical doctors early how to make the diagnosis, we won't have this issue anymore.
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So to everyone listening, if you understand the ins and outs of diagnosis, go out and share with your colleagues.
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So when making the diagnosis, do you ever discuss the prognosis with the patient?
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Not necessarily.
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I really wait for the patient to ask.
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And we often have patients who ask.
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And then my answer is that for an individual person, we cannot predict, we're not good at it.
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But then I cite studies and I say that roughly 40 % of patients will still have symptoms, but that it really depends.
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And I then tailor my explanation to what I see, because if I see a patient with acute symptoms,
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I tend to be more encouraging and positive because from experience, not really from literature, but from experience, we know that they tend to get better quicker.
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When we see patients with very chronic symptoms, I also want them to have realistic expectations, so I tell them that it will take months or years.
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And again, it's not to discourage them, it's to make a good treatment plan with them that is realistic.
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Thank you.
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And again, when explaining the diagnosis to your patients, are there any big no -nos that you would say,
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"Stay away from everyone, please." Yes, I think there are two words that we should stay away from.
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It's to refer to a functional disorder on one hand and oppose it to a real disorder.
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So the term real disorder should not be used.
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Or genion is the other one to say this is a genion tremor, whereas this is a functional tremor.
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This is really not helpful because it conveys really a sort of hierarchy of symptoms and that FND would be less important.
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And we're talking to people who suffer on a daily basis with the symptoms.
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And other than that, I think we can use term.
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Of course functional is the most appropriate to me
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because it's very descriptive but what matters more is our attitude
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and our behavior and the respect we show to our patient
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and we show them that we not only believe them
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but we have seen many other patients like them
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and it's not rare and we know what we're talking about and this reassures the patients a lot.
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Brilliant, thank you.
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So then moving towards management, how beneficial is it to see or to refer a patient for treatment as early as possible?
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It's very important.
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Going back to the prognosis, if we diagnose patients early and they can get into treatment early, they will get better.
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So this is really the big effort that I've been trying to do in my country, in the different hospitals I've been working for, but also to advocate internationally.
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These patients should be diagnosed really early so that we can influence the prognosis.
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And then in terms of management, how important is an interdisciplinary team?
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It's key.
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To have an interdisciplinary team is key.
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And we still see a lot of centers around the globe where neurologists feel very isolated
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because they're able to make the diagnosis, but then they don't know where to refer.
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They don't have a good physio around.
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They don't have a psychiatrist or psychologist.
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We see the other side where it's the psychiatrist that say, we don't have any neurologists interested in the team.
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Or I've also talked to some OT, occupational therapists, that said, but I need a neurologist to certify it.
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So it's really key that we all work together and that we develop then this teamwork.
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Also because now there are studies that show
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that we can really improve the patient's outcome with interdisciplinary treatment being outpatient setting or inpatient setting.
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Both have now come in studies.
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Thank you.
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I really appreciate your time today and for sharing your knowledge with our listeners.
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Thank you also for your amazing presentation at the Congress.
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And to everyone that's been listening, thank you for opening your mind.
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Thank you.
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clinical practice.
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Any disclosures of the participants can be found within the episode description located on the MDS website.
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אוצר מילים והערות הגייה לשיעור הזה
שיעור הדיבור הזה ברמה C1 מבוסס על הסרטון “Breaking down functional movement disorders • 2025 MDS Congress”. המילים שחוזרות הכי הרבה: patient, functional, disorder, neurologist, symptom. בסרטון הזה יש 123 משפטים ו-1585 מילים לתרגול Shadowing. הדיבור נמשך 11:00. הדובר שומר על קצב יציב של כ-144 מילים בדקה, קצב נוח לתרגול Shadowing. 82% מהמילים נמצאות בין 3,000 המילים הנפוצות ביותר באנגלית; כדאי ללמוד את השאר לפני שמתחילים.
אוצר מילים מרכזי בסרטון הזה
15 המילים המתקדמות ביותר בסרטון, עם ההגייה והמשמעות שלהן:
| מילה | הגייה | משמעות |
|---|---|---|
| symptom שם עצם | /ˈsɪm(p)təm/ | תַּסְמִין, סִימְפּטוֹם |
| diagnose פועל | /ˈdaɪ.əɡˌnoʊs/ | אבחן |
| psychiatrist שם עצם | /ˌsaɪˈkaɪ.ə.tɹɪst/ | פְּסִיכִיאָטֶר |
| certify פועל | /ˈsɜː.tɪ.faɪ/ | וידא |
| coexist פועל | /ˌkoʊ.ɪɡˈzɪst/ | התקיים בצוותא |
| slowness שם עצם | איטיות | |
| specificity שם עצם | /spɛsɪˈfɪsɪti/ | ייחודיות \ יִחוּדִיּוּת |
| understatement שם עצם | /ˌʌndɚˈsteɪtmənt/ | לְשׁוֹן הַמְעָטָה |
| listener שם עצם | /ˈlɪs(ə)nɚ/ | מַאֲזִין |
| tailor שם עצם | /ˈteɪlɚ/ | חַיָּט |
| contributor שם עצם | /kənˈtɹɪb.jə.tɚ/ | תורם, תורמת |
| participant שם עצם | /pɑːɹˈtɪsəpənt/ | מִשׁתַתֵף |
| hierarchy שם עצם | /ˈhaɪ.ə.ɹɑː(ɹ).ki/ | הִיֵרַרכִיָה \ הייררכיה |
| psychologist שם עצם | /ˌsaɪˈkɑl.ə.d͡ʒɪst/ | פְּסִיכוֹלוֹג, פסיכולוגית |
| convey פועל | /kənˈveɪ/ | הוביל, העביר |
Phrasal verbs שתשמעו
| מילה | הגייה | משמעות |
|---|---|---|
| come out פועל | /ˌkʌm ˈaʊt/ | יָצָא |
| go out פועל | יָצָא |
דקדוק בסרטון הזה
המבנים שהדובר משתמש בהם הכי הרבה, עם המילים המדויקות מהסרטון:
| מבנה | בסרטון |
|---|---|
| הווה מושלם ממושך (Present perfect continuous) have/has been + -ing — פעולה שהתחילה בעבר ועדיין נמשכת עכשיו | has been coming · I've been trying · that's been listening |
| הווה מושלם (Present perfect) have/has + past participle — פעולה שקרתה בעבר ועדיין יש לה חשיבות או השפעה עכשיו | you've been · you've done · has been shown |
| סביל (Passive voice) be + past participle — הדגש הוא על מה שקורה, לא על מי שעושה את הפעולה | be seen · has been shown · been estimated |
| משפטי זיקה (Relative clauses) who / which + clause — מידע נוסף על אדם או דבר | one that is · people who suffer |
הגייה ששווה לשים לב אליה
הדובר משתמש ב-17 קיצורים וצורות מקוצרות, כמו don't, we're, I've. אמרו אותם בצורה הקצרה, כפי שאתם שומעים אותם.
- הצלילים של “th”: thankful /ˈθæŋkfəl/, therapist /ˈθɛɹəpɪst/
- הצלילים של “sh” ו-“zh”: fascination /fæsɪˈneɪʃən/, outpatient /ˈaʊtˌpeɪʃ(ə)nt/, reassure /ˌɹi.əˈʃʊɹ/, impatient /ɪmˈpeɪʃənt/, occupational /ɑkjuˈpeɪʃənəl/
- מילים ארוכות — שימו לב להטעמה: neurological /nɝəˈlɑd͡ʒɪkəl/, psychiatrist /ˌsaɪˈkaɪ.ə.tɹɪst/, epileptic /ˌɛpɪˈlɛptɪk/, fascination /fæsɪˈneɪʃən/, perceptual /pə(ɹ)ˈsɛp.tʃ(u)əl/
צלילים שדוברי עברית מתקשים בהם:
- /æ/ — פתוח יותר מה-“אֶ” העברית, לא כמו “a” ב-“cup”: abnormal /ˌæbˈnɔɹ.ml̩/, amplitude /ˈæm.plɪ.tud/, fascinate /ˈfæsɪneɪt/, fascination /fæsɪˈneɪʃən/, postgraduate /ˌpəʊstˈɡɹædju.ət/
- /r/ — הלשון לא נוגעת בשום מקום, לא ה-“ר” הגרונית: prognosis /pɹɑɡˈnoʊsɪs/, tremor /ˈtɹɛmɚ/, psychiatrist /ˌsaɪˈkaɪ.ə.tɹɪst/, abnormal /ˌæbˈnɔɹ.ml̩/, perceptual /pə(ɹ)ˈsɛp.tʃ(u)əl/
- עיצור קולי בסוף מילה — /b/, /d/, /g/, /z/, /v/ בלי להפוך אותם לאטומים: amplitude /ˈæm.plɪ.tud/, descriptive /dəˈskɹɪptɪv/, discourage /dɪsˈkɝɪd͡ʒ/, oppose /əˈpoʊz/, colleague /ˈkɒliːɡ/
איך לתרגל עם הסרטון הזה
- הקשיבו לכל הסרטון פעם אחת בלי לדבר, ורשמו את המילים שאתם לא מכירים.
- תרגלו Shadowing משפט אחר משפט במהירות רגילה, וחזרו על כל משפט עד שהקצב שלכם תואם את הדובר.
- הקליטו את עצמכם והשוו למקור, תוך תשומת לב למילים כמו symptom, diagnose, psychiatrist.
מהי טכניקת השאדואינג?
שאדואינג היא טכניקת למידת שפה מבוססת מדע שפותחה במקור להכשרת מתורגמנים מקצועיים ופופולרית על ידי הפוליגלוט ד"ר אלכסנדר ארגואלס. השיטה פשוטה אך עוצמתית: אתה מקשיב לאודיו באנגלית ילידית וחוזר עליו בקול רם מיד — כמו צל העוקב אחרי הדובר עם עיכוב של 1–2 שניות בלבד. בניגוד להאזנה פסיבית או תרגילי דקדוק, שאדואינג מכריח את המוח והשרירים בפה לעבד ולשחזר דפוסי דיבור אמיתיים בו זמנית. מחקרים מראים שזה משפר משמעותית את דיוק ההגייה, האינטונציה, הקצב, הדיבור המחובר, הבנת השמיעה ושטף הדיבור — מה שהופך אותו לאחת השיטות היעילות ביותר להכנה לIELTS Speaking ולתקשורת באנגלית בעולם האמיתי.