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There have been several studies investigating the difference in hand strength between the dominant and non-dominant hands (Petersen et al 1989, Crosby et al 1994, Armstrong and Oldham 1999, Amousun et al 1995). However, there is a lack of literature investigating hand function, which may be a more useful measure of daily hand use. Differences in dominant and non-dominant hand function are important, as clinically, bilateral functional comparison is recommended to the therapist (Boscheinen-Morrin et al 1992). This preliminary research study aimed to: • investigate the difference in grip manipulation between the dominant and non-dominant hands in a sample of 24 healthy participants using the Southampton Hand Assessment Procedure (SHAP) • explore the difference in use of the hands between right- and left-hand dominant individuals by means of a short questionnaire. The results demonstrated that right-handers preferred to use their dominant hand for all skilled activities whereas left-handers showed some preference for their non-dominant hand. Only the light tripod grip task for right-handers showed a statistically significant difference (p=0.009) between the speed of manipulation between dominant and non-dominant hands; all other light and heavy handgrips demonstrated no statistical difference. However, there was a general trend for the dominant hand to be faster in manipulating objects than the non-dominant hand in both right- and left-handed individuals.

BackgroundBackground: Some patients with FND and FEVD cannot re-establish walking ability with standard treatment alone. Cases Cases: Novel invasive treatment of FEVD trialed in three females, aged 19, 30 and 33 years with >18 month history of FND. None could walk and all were wheelchair-dependent needing home carers. Standard treatment plus novel step-wise escalation of invasive "intervention+" was individually tailored to correct FEVD; functional electrical stimulation, botulinum toxin injections, tibial nerve block, serial casting, and for Case 3, manipulation under anesthetic and surgical tendon lengthening. All regained walking ability and discontinued carers. Case 1 resumed dancing and Case 3 returned to employment. Improvements were largely maintained at 3 and 6 month follow-up. Conclusions Conclusions: As a last resort, invasive adjuncts may be considered in a very small proportion of FND patients who fail to regain walking ability with standard treatment alone and reach a "dead end" where no further progress is feasible.

Objective/Aims Functional Neurological Disorder (FND) affects 10-30% of neurology outpatients. Symptoms commonly include sensory, motor and cognitive changes without structural nervous system damage. Fixed equinovarus dystonia (FEVD) of the foot and ankle is a common feature of FND characterised by plantar flexion and inversion of the foot which cannot be corrected passively. This prevents weightbearing often causing permanent wheelchair dependence. FEVD correction is necessary for patients to walk again. Consensus opinion is that invasive treatments are ill-advised and potentially detrimental in patients with FND. However, we have developed a novel approach that may challenge this opinion for a specific patient group, combining invasive treatments and neuropsychiatry interventions. Methods A patient-led, goal oriented, multidisciplinary approach guided treatment. Treatments included functional electrical stimulation, botulinum toxin, tibial nerve block, serial casting and surgical intervention as an adjunct to specialist physiotherapy, occupational therapy, psychology. Standardised outcome measures of gait and mobility, balance, anxiety and depression were performed on admission and discharge. Patient consent was obtained for photo and video recording.Abstract 30 Table 1 Functional Electrical Stimulation to common peroneal nerve (FES). Botulinum Toxin to posterior tibial muscles (BoNT). Tibial Nerve Block (TNB)