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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Woordenschat en spreektips bij deze les
Deze spreekles op niveau C1 is gebaseerd op de video “Breaking down functional movement disorders • 2025 MDS Congress”. Deze woorden komen het vaakst terug: patient, functional, disorder, neurologist, symptom. Deze video bevat 123 zinnen en 1585 woorden om na te spreken. Het gesproken deel duurt 11:00. De spreker praat in een gelijkmatig tempo van ongeveer 144 woorden per minuut, prettig om te shadowen. 82% van de woorden hoort bij de 3.000 meest gebruikte Engelse woorden; de rest kun je beter vooraf bekijken.
Belangrijke woorden in deze video
De 15 moeilijkste woorden uit de video, met uitspraak en betekenis:
| Woord | Uitspraak | Betekenis |
|---|---|---|
| neurologist zelfstandig naamwoord | neuroloog, neurologe | |
| symptom zelfstandig naamwoord | /ˈsɪm(p)təm/ | symptoom |
| neurological bijvoeglijk naamwoord | /nɝəˈlɑd͡ʒɪkəl/ | neurologisch |
| diagnose werkwoord | /ˈdaɪ.əɡˌnoʊs/ | diagnosticeren |
| interdisciplinary bijvoeglijk naamwoord | interdisciplinair | |
| prognosis zelfstandig naamwoord | /pɹɑɡˈnoʊsɪs/ | prognose, vooruitblik |
| psychiatrist zelfstandig naamwoord | /ˌsaɪˈkaɪ.ə.tɹɪst/ | psychiater |
| abnormal bijvoeglijk naamwoord | /ˌæbˈnɔɹ.ml̩/ | abnormaal |
| amplitude zelfstandig naamwoord | /ˈæm.plɪ.tud/ | omvang |
| coexist werkwoord | /ˌkoʊ.ɪɡˈzɪst/ | co-existeren, samengaan |
| dizziness zelfstandig naamwoord | duizeligheid | |
| fascinate werkwoord | /ˈfæsɪneɪt/ | fascineren |
| fascination zelfstandig naamwoord | /fæsɪˈneɪʃən/ | fascinatie |
| outpatient zelfstandig naamwoord | /ˈaʊtˌpeɪʃ(ə)nt/ | poliklinische patiënt |
| physiotherapist zelfstandig naamwoord | fysiotherapeut, fysiotherapeute |
Phrasal verbs die je zult horen
| Woord | Uitspraak | Betekenis |
|---|---|---|
| come out werkwoord | /ˌkʌm ˈaʊt/ | uitkomen |
| go out werkwoord | naar buiten gaan |
Grammatica in deze video
De structuren die de spreker het meest gebruikt, met de exacte woorden uit de video:
| Structuur | In de video |
|---|---|
| Present perfect continuous have/has been + -ing — iets dat eerder begon en nog bezig is | has been coming · I've been trying |
| Lijdende vorm be + voltooid deelwoord — het gaat om wat er gebeurt, niet om wie het doet | be seen · has been shown · been estimated |
| Present perfect have/has + voltooid deelwoord — iets uit het verleden dat nu nog telt | you've been · you've done · has been shown |
Uitspraak om op te letten
De spreker gebruikt 17 samentrekkingen en verkorte vormen, zoals don't, we're, I've. Spreek ze kort uit, zoals je ze hoort.
- De “th”-klanken: thankful /ˈθæŋkfəl/, therapist /ˈθɛɹəpɪst/
- De klanken “sh” en “zh”: fascination /fæsɪˈneɪʃən/, outpatient /ˈaʊtˌpeɪʃ(ə)nt/, reassure /ˌɹi.əˈʃʊɹ/, impatient /ɪmˈpeɪʃənt/, occupational /ɑkjuˈpeɪʃənəl/
- Lange woorden — let op de klemtoon: neurological /nɝəˈlɑd͡ʒɪkəl/, psychiatrist /ˌsaɪˈkaɪ.ə.tɹɪst/, epileptic /ˌɛpɪˈlɛptɪk/, fascination /fæsɪˈneɪʃən/, perceptual /pə(ɹ)ˈsɛp.tʃ(u)əl/
Klanken die Nederlandstaligen lastig vinden:
- Stemhebbende eindmedeklinker — /b/, /d/, /g/, /z/, /v/ niet verscherpen: amplitude /ˈæm.plɪ.tud/, descriptive /dəˈskɹɪptɪv/, discourage /dɪsˈkɝɪd͡ʒ/, oppose /əˈpoʊz/, colleague /ˈkɒliːɡ/
- /æ/ — opener dan de Nederlandse “e”: abnormal /ˌæbˈnɔɹ.ml̩/, amplitude /ˈæm.plɪ.tud/, fascinate /ˈfæsɪneɪt/, fascination /fæsɪˈneɪʃən/, postgraduate /ˌpəʊstˈɡɹædju.ət/
- /g/ — een harde plofklank, geen Nederlandse “g”: diagnose /ˈdaɪ.əɡˌnoʊs/, prognosis /pɹɑɡˈnoʊsɪs/, coexist /ˌkoʊ.ɪɡˈzɪst/, postgraduate /ˌpəʊstˈɡɹædju.ət/, subgroup /ˈsʌbˌɡɹuːp/
Zo oefen je met deze video
- Luister de hele video één keer zonder te spreken en noteer de woorden die je niet kent.
- Spreek zin voor zin na op normale snelheid en herhaal elke zin tot je ritme gelijk is aan dat van de spreker.
- Neem jezelf op en vergelijk met het origineel; let daarbij op woorden als neurologist, symptom, neurological.
Wat is de Shadowing-techniek?
Shadowing is een wetenschappelijk onderbouwde taalleermethode die oorspronkelijk is ontwikkeld voor professionele tolkentraining en gepopulariseerd door polyglot Dr. Alexander Arguelles. De methode is eenvoudig maar krachtig: je luistert naar native Engelse audio en herhaalt het onmiddellijk hardop — als een schaduw die de spreker volgt met slechts 1–2 seconden vertraging. In tegenstelling tot passief luisteren of grammaticadrills, dwingt shadowing je hersenen en mondspieren om echte spraakpatronen tegelijkertijd te verwerken en te reproduceren. Onderzoek toont aan dat het de uitspraaknauwkeurigheid, intonatie, ritme, verbonden spraak, luisterbegrip en spreekvaardigheid aanzienlijk verbetert — waardoor het een van de meest effectieve methoden is voor IELTS Speaking-voorbereiding en echte Engelse communicatie.