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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Vocabulary and speaking notes for this lesson
This C1 speaking lesson is built on the video “Breaking down functional movement disorders • 2025 MDS Congress”. The speaker keeps coming back to these words: patient, functional, disorder, neurologist, symptom. This video has 123 sentences and 1585 words to shadow. The speech runs for 11:00. The speaker talks at a steady 144 words per minute, a comfortable pace for shadowing. 82% of the words are among the 3,000 most common in English; the rest is worth studying before you start.
Key vocabulary in this video
The 15 most advanced words in the video, with pronunciation and meaning:
| Word | Pronunciation | Meaning |
|---|---|---|
| neurologist noun | A doctor or scientist who practices or specializes in neurology. | |
| symptom noun | /ˈsɪm(p)təm/ | A perceived change in some function, sensation or appearance of a person that indicates a disease or disorder, such as fever, headache or rash; strictly, a… |
| neurological adjective | /nɝəˈlɑd͡ʒɪkəl/ | Of or pertaining to neurology. |
| diagnose verb | /ˈdaɪ.əɡˌnoʊs/ | To determine which disease is causing a sick person's signs and symptoms; to find the diagnosis. |
| interdisciplinary adjective | Of or pertaining to multiple distinct academic disciplines or fields of study. | |
| prognosis noun | /pɹɑɡˈnoʊsɪs/ | A forecast of the future course or outcome of a situation based on what is presently known; a prediction. |
| tremor noun | /ˈtɹɛmɚ/ | A shake, quiver, or vibration. |
| psychiatrist noun | /ˌsaɪˈkaɪ.ə.tɹɪst/ | A medical doctor specializing in psychiatry. |
| abnormal adjective | /ˌæbˈnɔɹ.ml̩/ | Not conforming to rule or system; deviating from the usual or normal type. |
| amplitude noun | /ˈæm.plɪ.tud/ | The measure of the size of something, especially its width or breadth; largeness, magnitude. |
| bradykinesia noun | Slowness of movement. | |
| certify verb | /ˈsɜː.tɪ.faɪ/ | To attest to (a fact) as the truth. |
| coexist verb | /ˌkoʊ.ɪɡˈzɪst/ | To exist contemporaneously or in the same area. |
| dizziness noun | The state of being dizzy; the sensation of instability. | |
| epileptic adjective | /ˌɛpɪˈlɛptɪk/ | Of or relating to epilepsy. |
Phrasal verbs you will hear
| Word | Pronunciation | Meaning |
|---|---|---|
| come out verb | /ˌkʌm ˈaʊt/ | To be discovered; to be revealed. |
| go back to verb | To stem from; to originate in. | |
| go out verb | To leave, especially a building. | |
| work together verb | To be coworkers with someone; to share a workspace with someone. |
Grammar in this video
The structures the speaker uses most, with the exact words from the video:
| Structure | In the video |
|---|---|
| Present perfect continuous have/has been + -ing — an action that started earlier and is still going on | has been coming · I've been trying · that's been listening |
| Present perfect have/has + past participle — a past action that still matters now | you've been · you've done · has been shown |
| Passive voice be + past participle — the focus is on what happens, not who does it | be seen · has been shown · been estimated |
Pronunciation to watch
The speaker uses 17 contractions and reduced forms, such as don't, we're, I've. Say them the short way, as you hear them.
- The “th” sounds: thankful /ˈθæŋkfəl/, therapist /ˈθɛɹəpɪst/
- The “sh” and “zh” sounds: fascination /fæsɪˈneɪʃən/, outpatient /ˈaʊtˌpeɪʃ(ə)nt/, reassure /ˌɹi.əˈʃʊɹ/, impatient /ɪmˈpeɪʃənt/, occupational /ɑkjuˈpeɪʃənəl/
- Long words — get the stress right: neurological /nɝəˈlɑd͡ʒɪkəl/, psychiatrist /ˌsaɪˈkaɪ.ə.tɹɪst/, epileptic /ˌɛpɪˈlɛptɪk/, fascination /fæsɪˈneɪʃən/, perceptual /pə(ɹ)ˈsɛp.tʃ(u)əl/
How to practise with this video
- Listen to the whole video once without speaking and note the words you do not know.
- Shadow it sentence by sentence at normal speed, repeating each one until your rhythm matches the speaker.
- Record yourself and compare with the original, paying attention to words like neurologist, symptom, neurological.
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.