Movement - uncoordinated

Answer 1

Definition

Jerky body movements is a condition in which uncontrolled, purposeless, rapid motions interrupt normal movement or posture.

Alternative Names

Jerky body movements; Chorea; Muscle - jerky movements (uncontrolled); Hyperkinetic movements

Considerations

Typical movements of chorea (called tics) include facial grimacing, raising and lowering the shoulders, bending and extending the fingers and toes. The condition can affect one or both sides of the body.

These involuntary movements are generally not repetitive and can appear purposeful even though they are involuntary and uncontrollable. A person with chorea may be viewed as jittery or restless.

Common Causes

There are many possible causes of unpredictable, jerky movements, including Sydenham's chorea, Huntington's disease, Wilson's disease, and other rare disorders. Some medical illnesses that can cause chorea include anti-cardiolipin antibody syndrome, systemic lupus erythematosus, polycythemia rubra vera, stroke, thyroid disease, and disorders of calcium, glucose or sodium metabolism.

Some medications such as anti-psychotic drugs, may cause tardive dyskinesia, a movement disorder which may include choreic movements. Rarely, it is inherited in the syndrome called benign hereditary chorea. Some women may develop chorea when pregnant. This is called chorea gravidarum.

Home Care

Therapy is aimed at identifying and treating the underlying cause. If it is due to medication, the drug should be discontinued if possible. If it is due to medical disease, the disorder should be treated. If the movements are severe and disruptive, medications such as amantadine or tetrabenazine may help control the movements.

Rest helps improve chorea, which can be aggravated by excitement or fatigue. Emotional stress should be minimized.

Safety measures should also be taken to decrease the likelihood of injury from the involuntary movements.

Call your health care provider if

Call your provider if there is any persistent, unexplained, and unpredictable bodily motions.

What to expect at your health care provider's office

The medical history will be obtained and a physical examination performed.

Medical history questions documenting this symptom in detail may include:

• What kind of movement occurs?
• What part of the body is affected?
• What other symptoms are also present?
• Is there irritability?
• Is there weakness or paralysis?
• Is there restlessness?
• Is there emotional instability?
• Are there facial tics?

The physical exam may include detailed examination of both the nervous and the muscular systems. It will be performed with emphasis on the neurological exam. A careful eye examination is also needed to look for some kinds of disease that can affect the eye and movements. Diagnostic tests that may be performed include:

• Blood work such as a complete blood count (CBC) or blood differential
• CT scan or MRI of the head or affected area
• EEG (rarely)
• Lumbar puncture
• Urinalysis

Unpredictable movements may be treated with various medications. This will be decided by your health care provider based on your symptoms and signs.

References

Fahn S. Hypokinesia and hyperkinesia. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 16.

Lang A. Other movement disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 434.

Answer 2

Definition

Uncoordinated movement is muscle control problem or an inability to finely coordinate movements, which results in a jerky, unsteady, to-and-fro motion of the middle of the body (trunk) and unsteady gait (walking style). The condition is called ataxia.

Alternative Names

Lack of coordination; Loss of coordination; Coordination impairment; Ataxia; Clumsiness; Uncoordinated movement

Considerations

Smooth graceful movement results from a fine balance between opposing muscle groups. This balance is coordinated by a portion of the brain called the cerebellum.

Diseases that damage the cerebellum, spinal cord, and peripheral nerves can interfere with normal muscle movement and result in coarse, jerky, uncoordinated movement, called ataxia.

Ataxia may be the result of a defect that is present from birth (congenital) or a viral infection such as the chicken pox. It may also develop after encephalitis, head trauma, and diseases that affect the central nervous system or spinal cord. In adults, the most common causes are stroke, toxic reactions to medications or alcohol, problems with the nerves in the legs.

Common Causes

• Transient ischemic attack (TIA)
• Stroke
• Multiple sclerosis
• Problems with the vertebrae in the spine (such as compression fractures of the spine)
• Poisoning by heavy metals such as Mercury, thallium, and lead, or solvents such as toluene or carbon tetrachloride
• Alcohol or other drug intoxication
• Drugs such as aminoglutethimide, anticholinergics, phenytoin (in high doses), carbamazepine, phenobarbital and tricyclic antidepressants, although any sedative can cause uncoordinated movement
• Paraneoplastic syndromes (ataxia may appear months or years before cancer is diagnosed -- an affected person produces antibodies against the neurons in the cerebellum)
• Post-infectious condition (typically following chickenpox)
• Hereditary conditions (such as congenital cerebellar ataxia, Friedreich's ataxia, ataxia telangiectasia, Wilson's disease)

Home Care

Take safety measures around the home to compensate for difficulties in mobility that are inherent with this problem. For example, avoid clutter, leave wide walkways, and avoid throw rugs or other objects that might cause slipping or falling.

Other family members should encourage the affected person to participate in normal activities. Family members need to have extreme patience with people who suffer from poor coordination. Take time to demonstrate ways of performing tasks more simply, and taking advantage of the afflicted person's strengths while avoiding weaknesses.

Call your health care provider if

• There is unexplained incoordination.
• Incoordination lasts longer than a few minutes.

What to expect at your health care provider's office

In emergency situations, the patient will be stabilized first.

The health care provider will perform a physical exam and ask questions about the person's symptoms and medical history.

The patient will be asked to stand up with the feet together and the eyes closed. This is called the Romberg test. If the patient loses balance, this is a sign of a loss of the sense of position and the test is considered positive.

The physical exam will also include a detailed neurological and muscular examination, paying careful attention to walking, balance, and coordination of pointing with fingers and toes.

Medical history questions may include:

• When did the symptoms begin?
• Is the uncoordinate movement continuous or does it come and go?
• Is it getting worse?
• What medications do you take?
• Do you drink alcohol?
• Do you use recreational/illicit drugs?
• Has you been exposed to something that may have caused poisoning?
• What other symptoms do you have? For example:
  • Weakness or paralysis
  • Numbness, tingling, or loss of sensation
  • Confusion or disorientation
  • Seizures

Diagnostic tests that may be performed include:

• Blood tests (such as a CBC or blood differential)
• CT scan of the head
• Genetic testing
• Antibody testing to rule out paraneoplastic syndromes
• MRI of the head

Referral to a specialist for diagnosis and management may be needed. A home safety evaluation by a physical therapist may be helpful.

References

Griggs R, Jozefowicz R, Aminoff M. Approach to the patient with neurologic disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 418.

Timmann D, Diener H. Coordination and ataxia. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 17.

Answer 3

Definition

Jerky body movements is a condition in which people make fast movements that they cannot control and that have no purpose. These movements interrupt their normal movement or posture.

Alternative Names

Jerky body movements; Chorea; Muscle - jerky movements (uncontrolled); Hyperkinetic movements

Considerations

Typical movements of chorea include:

• Bending and straightening the fingers and toes
• Grimacing in the face
• Raising and lowering the shoulders

This condition can affect one or both sides of the body.

These movements do not usually repeat. They can look like they are being done on purpose, although they are not under the person's control. A person with chorea may look jittery or restless.

Common Causes

There are many possible causes of unpredictable, jerky movements, including:

• Huntington's disease
• Sydenham chorea
• Wilson's disease
• Other rare disorders

Some medical illnesses that can cause chorea include:

• Anti-cardiolipin antibody syndrome
• Disorders of calcium, glucose, or sodium metabolism
• Polycythemia rubra vera
• Stroke
• Systemic lupus erythematosus
• Thyroid disease

Other possible causes of chorea include:

• Benign hereditary chorea (an inherited condition) -- rarely
• Pregnancy (chorea gravidarum)
• Tardive dyskinesia (a condition that can be caused by medications such as antipsychotic drugs)

Home Care

Treatment is aimed at the cause of the movements.

• If the movements are due to medication, the drug should be stopped, if possible.
• If the movements are due to a medical disease, the disorder should be treated.
• If the movements are severe and affect the person's life, medications such as amantadine or tetrabenazine may help control them.

Excitement and fatigue can make chorea worse. Rest improves chorea. Try to reduce emotional stress.

Safety measures should also be taken to prevent injury from the involuntary movements.

Call your health care provider if

Call your health care provider if you have unexplained body motions that are unpredictable and do not go away.

What to expect at your health care provider's office

The health care provider will take a medical history and perform a physical examination.

Medical history questions may include:

• What kind of movement occurs?
• What part of the body is affected?
• What other symptoms are present?
• Is there irritability?
• Is there weakness or paralysis?
• Is there restlessness?
• Is there emotional instability?
• Are there facial tics?

The health care provider may do a detailed examination of both the nervous and the muscle systems. Tests that may be performed include:

• Blood work such as a complete blood count (CBC) or blood differential
• CT scan of the head or affected area
• EEG(rarely)
• Lumbar puncture
• MRI of the heador affected area
• Urinalysis

Unpredictable movements may be treated with different medications. Your health care provider will decide which medicine to use based on your symptoms and signs.

References

Jankovic J, Lang AE. Movement disorders: diagnosis and assessment. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 23.

Lang A. Other movement disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 434.

Subramony SH. Ataxic disorders. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 22.

Reviewed By

Review Date: 02/05/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 4

Definition

Uncoordinated movement is a muscle control problem or an inability to finely coordinate movements. This condition is called ataxia.

It leads to a jerky, unsteady, to-and-fro motion of the middle of the body (trunk) and an unsteady gait (walking style).

Alternative Names

Lack of coordination; Loss of coordination; Coordination impairment; Ataxia; Clumsiness; Uncoordinated movement

Considerations

Smooth graceful movement requires a fine balance between different muscle groups. A part of the brain called the cerebellum manages this balance.

Common Causes

Diseases that damage the cerebellum, spinal cord, or peripheral nerves can interfere with normal muscle movement and result in coarse, jerky, uncoordinated movements.

Brain injuries or diseases that can cause uncoordinated movements include:

• Brain injury or head trauma
• Chickenpox or certain other brain infections
• Conditions that are passed through families (such as congenital cerebellar ataxia, Friedreich's ataxia, ataxia - telangiectasia, or Wilson's disease
• Multiple sclerosis
• Strokeortransient ischemic attack (TIA)

Poisoning or toxic effects caused by:

• Alcohol
• Drugs including aminoglutethimide, anticholinergics, phenytoin, carbamazepine, phenobarbital, tricyclic antidepressants, and any sedative
• Heavy metals such as mercury, thallium, and lead
• Solvents such as toluene or carbon tetrachloride

Other causes include:

• Certain cancers, in which symptoms may appear months or years before the cancer is diagnosed (called paraneoplastic syndrome)
• Problems with the nerves in the legs (neuropathy)
• Spine injury or damage (such as compression fractures of the spine)

Home Care

Use safety measures around the home to make it easier to get around. For example, avoid clutter, leave wide walkways, and avoid throw rugs or other objects that might cause slipping or falling.

People with this condition should be encouraged to take part in normal activities. Family members need to be very patient with a person who has poor coordination. Take time to show the person ways to do tasks more easily. Take advantage of the person's strengths while avoiding his or her weaknesses.

Walking aids, such as a cane or walker, may be helpful.

Call your health care provider if

Call your health care provider if:

• A person has unexplained problems with coordination
• Lack of coordination lasts longer than a few minutes

What to expect at your health care provider's office

In emergency situations, the patient will first be stabilized.

The health care provider will perform a physical exam and ask questions about the person's symptoms and medical history.

The physical exam will also include a detailed examination of the nervous system and muscles, paying careful attention to walking, balance, and coordination of pointing with fingers and toes. The patient will be asked to stand up with the feet together and the eyes closed. This is called the Romberg test. If the patient loses balance, this is a sign that the sense of position has been lost and the test is considered positive.

Medical history questions may include:

• When did the symptoms begin?
• Does the uncoordinated movement happen all the time or does it come and go?
• Is it getting worse?
• What medications do you take?
• Do you drink alcohol?
• Do you use recreational drugs?
• Have you been exposed to something that may have caused poisoning?
• What other symptoms do you have? For example:
  • Weakness or paralysis
  • Numbness, tingling, or loss of sensation
  • Confusion or disorientation
  • Seizures

Tests that may be performed include:

• Antibody testing to rule out paraneoplastic syndromes
• Blood tests (such as a CBC or blood differential)
• CT scan of the head
• Genetic testing
• MRI of the head

You may need to be referred to a specialist for diagnosis and treatment. A home safety evaluation by a physical therapist may be helpful.

References

Griggs R, Jozefowicz R, Aminoff M. Approach to the patient with neurologic disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 418.

Subramony SH. Ataxic disorders. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 22.

Reviewed By

Review Date: 02/05/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.