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Movement - uncoordinated

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.