Could Functional Neurologic Disorder Be the "Surprise Topic" on the 2027 NCS Exam?

One of the most common questions from therapists preparing for the Neurologic Clinical Specialist (NCS) examination is whether it is worth spending valuable study time on less common neurologic conditions. It is tempting to focus almost exclusively on "high-yield" diagnoses such as Parkinson disease, stroke, MS, and TBI, while giving minimal attention to diagnoses like amyotrophic lateral sclerosis (ALS) or other conditions that you would expect to generate only a handful of questions.

While this strategy seems logical, it has repeatedly proven to be a mistake.

Over the years, the NCS exam has demonstrated a consistent pattern: seemingly minor topics are occasionally elevated and become disproportionately represented on the exam. This helps ensure that candidates develop broad clinical knowledge rather than selectively studying only the most common diagnoses. The leadership in the neurology section of the APTA wants neurologic specialists to be well-rounded and able to treat even those patients with disorders which do not occur often. Whether or not you agree with the test creator's strategy to achieve this, we still have to be prepared.

For example, Spinal Muscular Atrophy (SMA), which, Based on its incidence alone, you might expect it to receive only a single question (or perhaps none at all). After all, SMA affects approximately 0.1–0.3 people per 100,000 each year, compared with stroke, which affects roughly 140–240 people per 100,000 annually. If you were allocating study time purely based on clinical prevalence, it would seem reasonable to devote nearly all of your attention to stroke, TBI, Parkinson disease, and other common neurologic conditions.

However, previous NCS exams have caught many candidates by surprise when SMA received far more attention than expected. This isn't an isolated occurrence. Throughout the exam's history, smaller topics have periodically become major areas of emphasis, rewarding candidates who prepared broadly rather than narrowly.

The lesson is clear: your study time should generally be proportional to the clinical importance and prevalence of each diagnosis, but no topic listed in the exam content outline should be completely ignored. Any "minor" diagnosis has the potential to become a featured topic on a given year's exam.

These shifts in emphasis may seem random, however, there are recognizable patterns that can help predict which topics are more likely to receive increased attention on next year's exam.

Why FND Should Be on Your Radar

Looking ahead to the 2027 examination cycle, Functional Neurologic Disorder (FND), also referred to as Functional Movement Disorder (FMD), appears to be a strong candidate for increased emphasis.

Although no one outside the examination committee knows what will appear on the exam, several trends make FND/FMD difficult to ignore:

• A growing body of high-quality peer-reviewed research

• Increasing discussion within the neurologic physical therapy community

• Greater recognition of FND as a common and treatable neurologic condition

• Development of rehabilitation-specific clinical recommendations that provide evidence-based guidance for physical therapists

  
  

Whether or not FND becomes the featured topic on the exam, it has clearly transitioned from a niche diagnosis to one that every neurologic physical therapist should understand.

What Should You Study?

If FND/FMD does receive greater emphasis, expect questions to focus less on diagnosis alone and more on evidence-based rehabilitation.

You should be familiar with:

• Clinical presentation and positive diagnostic signs

• Differentiating FND from structural neurologic disorders

• Principles of physical therapy management

• Communication and patient education

• Motor retraining strategies

• Prognostic factors and interdisciplinary management

  
  

Among the available resources, the Consensus Recommendations for Functional Neurologic Disorder / Functional Movement Disorder (Baker et al., 2021) is arguably the most important reference for rehabilitation professionals and should be considered essential reading.

Additional recommended references include:

• Park JE. Functional Movement Disorders: Updates and Clinical Overview.

• Kelmanson AN. Physical Rehabilitation of Motor Functional Neurological Disorders: A Narrative Review.

The Bottom Line

The biggest mistake NCS candidates make is assuming they can safely skip "minor" topics. History suggests otherwise. Every testing cycle has the potential to spotlight an unexpected diagnosis, and candidates who prepared broadly are rewarded.

Whether the highlighted topic in 2027 turns out to be Functional Neurologic Disorder or something else entirely, the safest strategy remains the same: study each topic in the content outline. You don't need to devote equal time to every diagnosis, but you should be prepared for the possibility that any one of them could receive far more attention than expected.

Don't fear surprise topics - be prepared!