Movement disorders / Motor problems

 

Short descriptions of movement disorders, problems with motor skills or coordination
and links to pages with more information.


Follow the link to your topic.
A - B - C - D - E - F-  H - I - J - M - P - R - S - T - V - Y

 

There are various types of movement disorders and motor problems that may result from the brain injury.

 

Motor problems
Motor problems include paralysis and difficulty with purposeful actions (apraxia). Difficulty speaking (Broca's aphasia) and dysarthria. Difficulty writing (agraphia). Difficulty swallowing and chewing.
This can be caused by:

  • Damage to the motor cortex of the left or right hemisphere. This cortex controls
    voluntary movements and the sequence of movements in large muscle groups.

(In the image below, the pink strip at the top of the head)

 

  • Upper motor neuron damage. This nerve cell extends from the motor cortex and brainstem and sends signals to the lower motor neurons, which in turn send signals to the muscles. This causes decreased strength, problems with fine motor skills, and spasticity. This is a persistent, abnormally high level of muscle tension/hypertonia, with overactive reflexes or hyperreflexia.
    It can also affect speaking, chewing, and swallowing. It can range from minor muscle control disorders to complete paralysis.

 

 

People may have difficulty controlling muscles/motor skills and/or coordination due to an overstimulated brain.

 

Movement Disorders
A movement disorder means an 'abnormal form of movement'.

This refers to diseases of the nervous system involving:

  • excessive movement
  • insufficient movement
  • a disturbance in the execution of movements.

In these cases, the person is conscious.

 

It may be caused by:

 

A thorough neurological examination is necessary to be able to distinguish these conditions.

Movement disorders are classified into:

  • Hypokinetic disorders - Decreased or slowed movement, such as in Parkinson's disease and parkinsonisms. Hypokinetic syndromes include: rigidity, akinesia, bradykinesia, and hypoknesia. (see the alphabetical order for more information about these conditions)
  • Hyperkinetic disorders - Increased movement. Hyperkinetic syndromes include: chorea, hemiballism, tics, myoclonus, and dystonia. (see the alphabetical order for more information about these conditions)
  • Tremor - shaking with a fixed rhythm; can be classified as either a hyperkinetic or hypokinetic disorder
  • Coordination disorder of involuntary movements (ataxia)

 

The hyperkinetic movement disorders are as follows:

Glossary:
Proximal (Latin 'proximus') means 'close by', the location of a body part that is closer to the center of the body than another body part
Distal is the opposite, further away

 

Movement disorders in alphabetical order

 

A

  • ADCA/SCA
    SCA stands for Spinocerebellar Ataxia Type 1. Spino refers to the spinal cord and Cerebellar to the cerebellum. Ataxia refers to the uncoordinated gait. SCA1 is a hereditary disease. A child of a parent with the condition has a 50% chance of developing the disease.

 

  • Absence of a fidgety movement pattern in preterm infants. This pattern is normally characterized in healthy preterm infants by continuous, small, circular movements of the head, trunk, and limbs, which stop with crying or exertion. The absence of this pattern, or abnormal fidgety movements, is considered a predictor of neurological disorders.
    Studying the fidgety movement pattern is performed to detect a potential neurological disorder at an early stage, enabling early treatment.

 

  • Apraxia is characterized by a person's inability to perform everyday tasks purposefully, even though instructions are understood. See the link for information on ideational apraxia, ideomotor apraxia, constructional apraxia, limb-kinetic apraxia, and buccofacial or orofacial apraxia. Apraxia is not a movement disorder, but a functional disorder; a disrupted action plan that prevents meaningful movement patterns.

 

  • Ataxia / Coordination disorder is a balance and coordination disorder, a movement disorder. Balance and coordination of movement are affected. Someone with ataxia has an unsteady gait and moves arms, legs, and trunk jerkily and uncontrollably. This can be caused by damage to multiple brain areas, but the basal ganglia and the cerebellum are most often involved. When ataxia is caused by the cerebellum, it is called cerebellar ataxia. See the video.

     

    • Athetosis, or athetoid movements, are characterized by continuous, slow, involuntary movements of the fingers, hands, feet, and toes, and sometimes the arms, legs, neck, and tongue. The fingers are often hyperextended. The joints twist or writhe continuously or slowly, rolling. When the facial muscles move along, the face appears to be grimacing. The neck muscles appear thickened (hypertrophied) due to frequent contractions, which then cause the head to turn. Note: Athetoid and choreic movements can be caused not only by damage to the red nuclei in the midbrain
      (part of the brainstem), but also by damage to the basal ganglia or by Huntington's disease.

     

     

    B

     

    • Ballismus (proximal chorea) is characterized by involuntary, swinging, irregular, coarse movements. It is related to chorea, but ballismus is slower than chorea and often, as the name "proximal chorea" suggests, involves proximal body parts. Proximal means closer to the center of the body than another body part. In the case of ballismus, it involves the hip, thighs, upper arms, and shoulders. The hip joint is proximal to the knee joint. The upper arms are proximal to the forearms. The opposite of proximal is distal.

     

    Ballism is often caused by damage to the subthalamic nucleus, a part of the basal ganglia. The globus pallidus, putamen, or caudate nucleus and other parts of the basal ganglia, may also be disrupted.
    During sleep, the movements may subside, but they become more intense with arousal. Causes of ballism include hemorrhage, a stroke, a tumor, a metastasis, or an infection.
    If it occurs on one side of the body, it is called hemiballism.

     

    • Bradykinesia is characterized by a general slowness of movement and is the most common form of impaired movement (hypokinesia). For example, a person might sway back and forth in a chair several times before standing up. Automatic movements, such as blinking, become less rapid and smooth.
      It occurs in Parkinson's disease, but also in parkinsonism disorders and due to aging.

     

     

    C

    • Cerebellar ataxia is a balance and coordination disorder (ataxia) caused by damage to the cerebellum (little brain). Persons with ataxia have an unsteady gait and move their arms, legs, and trunk in a jerky, uncontrolled manner.

     

     

    • Chorea is the Greek word for dance. It is characterized by sudden, irregular, involuntary, undirected (aimless), continuous, "dance-like," and sometimes graceful movements of the face, hands, arms, neck, or torso. The movements may last for seconds to minutes and are not rhythmic in nature. They cannot be suppressed. The respiratory and throat muscles participate in coughing, snorting, or grunting. This can increase with tension or emotion. It is caused by caused by damage in the red nucleus or in the basal ganglia. The caudate nucleus and putamen of the basal ganglia do not sufficiently inhibit movement (inhibitory dysfunction).

       

      There are several conditions that are characterized by chorea, but the most characteristic condition is Huntington's disease. In Huntington's disease, degeneration of striatal GABA neurons occurs, causing the head of the caudate nucleus to shrink (atrophy). Other conditions with chorea include: pregnancy chorea, systemic lupus erythematosus (SLE), but also side effects of neuroleptics.

     

    • Sydenham's chorea, also known as chorea minor or St. Vitus's dance, is characterized by rapid, short, uncoordinated, jerky movements. It primarily affects the face, hands, and feet. It can be a reaction to a streptococcal infection. It can also cause inflammation of the heart muscle in approximately 30% of patients. It can also be a consequence of acute rheumatic fever.

     

     

    D

    • Dysarthria is characterized by difficulty speaking. There is little control over speech due to problems using the muscles of the lips, tongue, palate, and vocal cords.
      It causes problems with speech production, often with good language comprehension.

     

    • Dystonia literally means decreased muscle tone, resulting in excessive muscle activity. It is characterized by involuntary, sustained muscle contractions, spasms in muscles or muscle groups. This can cause repetitive or twisting movements or an unnatural position of the body part.

    The often painful movements are often accompanied by a tremor.
    Dystonia can be classified by cause, age of onset and distribution across the body.

     

    It may affect single muscle groups (focal dystonia), for example spasmodic torticollis, or multiple muscle groups (generalized dystonia).
    In generalized dystonia, one or both legs, the trunk, and at least one other body part are involved.
    In spasmodic torticollis (cervical dystonia), dystonia affects the neck and cervical muscles. When the head is tilted, it is called laterocollis. When the neck is turned to one side, it is called rotational torticollis. When the head is turned backward, it is called retrocollis.
    The eyelids may remain closed in spasm.

    This is called blepharospasm, literally "eyelid contraction."
    Furthermore, dystonia can be classified as:

    - segmental, when the dystonia affects two adjacent body parts

    - hemidystonia, when the dystonia affects one half of the body (usually due to brain injury)

    - multifocal (affecting several body parts that are not adjacent).

     

    Symptoms of dystonia may include:

    - Abnormal posture of the neck, toes, hands, or other parts of the body

    - Involuntary turning of the neck due to fatigue or stress

    - Involuntary rapid blinking of the eyes

    - Eyelid spasms, causing the eyelids to remain closed

    - Foot cramps or a tendency for one foot to twist after walking

    - Writing problems, causing handwriting to deteriorate after writing a few lines

     

    Dystonia is one of the conditions that may be caused by damage to the basal ganglia. It may also have a genetic cause.
    Detailed information on dystonia can be found at the website of the  Dystonia Association.

     

    E

    • Early-Onset Parkinsonism (EOPD) is a type of parkinsonism that develops before the age of approximately 40-45. A more specific term is young-onset parkinsonism (YOPD), which officially means that parkinsonism symptoms develop between the ages of 21 and 45. When parkinsonism symptoms develop before the age of 21, it is called juvenile parkinsonism (JPD).

     

    • Essential tremor is a common form of rhythmic tremor. It primarily affects the hands and forearms. Sometimes the head, voice, and legs are also affected. This occurs primarily while assuming a position with the arms, such as extending the hands, writing, shaving, or pouring a drink. It is essentially a combination of a movement tremor and a postural tremor. It is not the same as Parkinson's disease. Essential means without an identifiable cause.

     

     

    F

    Fidgety movements are healthy movements. The absence of fidgety movements or abnormal fidgety movements is considered a predictor of neurological disorders; see under A for the absence of a fidgety movement pattern. See here for the information about the origin of the word 'fidgety'.

     

    H

     

    • Hemiballism is characterized by involuntary movements of the limbs on one side (hemi) of the body. It is unilateral ballism. See under ballism. Hemiballism and ballism can be caused by damage to the subthalamic nucleus.
      This is part of the basal ganglia. The globus pallidus, the putamen, or the caudate nucleus — other parts of the basal ganglia — may also be affected.
      The involuntary movements become more intense during movement. They may disappear during rest or during sleep.
      Ninety percent of acute movement disorders resolve within six months.

     

    • Hemiballismus-hemichorea (HBHC) syndrome is a rare hyperkinetic movement disorder. It is characterized by involuntary, irregular, continuous, unilateral body movements. The cause is damage to the basal ganglia due to a stroke or an autoimmune disease. Although rare, high blood sugar (hyperglycemia) is another possible cause of HBHC syndrome, also known as chorea-hyperglycemia-basal ganglia syndrome in this context.
      The diagnosis can be made if a triad of abnormalities is present: chorea, high blood sugar (hyperglycemia), and radiological abnormalities in a specific part of the basal ganglia, the striatum.

     

    • Hemichorea is chorea on one side of the body. It is caused by damage to the basal ganglia. The damage is on the opposite side from where the movements occur (contralateral side).

       

       

    • High muscle tension is caused by damage to the upper motor neuron.

     

    • Hyperkinetic movement disorders are characterized by excessive and unwanted, increased muscle activity, similar to that seen in Huntington's disease. These are involuntary, excessive, normal, and abnormal movements, sometimes accompanied by athetosis, ballism, tremor, and/or chorea. Hyperkinetic means: with excessive energy.

     

    • Hypokinesia is a decrease in movement; slow movement (bradykinesia) or no movement (akinesia). Along with bradykinesia and akinesia (initiating and stopping movement becomes more difficult), it is one of the hallmarks of Parkinson's disease and of atypical parkinsonism. It is caused by decreased dopamine production due to the death of dopamine-producing nerve cells.

     

    I

    • Intention tremor is the shaking of the limbs during purposeful movement. It is most easily observed in the hands, for example, when grasping an object. This may be caused by damage to the red core corenucleus.

     

     

    J

    Juvenile Parkinsonism (JPD) Symptoms of parkinsonism that develop before the age of 21. Muscle stiffness combined with slow movement and some or all of the hand tremors. Causes can be diverse: metabolic disorders, genetic and autoimmune disorders, oxygen deficiency in the brain, brain infection, brain tumor, hydrocephalus, parathyroid problems, or medication side effects. Early-onset parkinsonism (EOPD) is a type of parkinsonism that develops before the age of approximately 40-45. A more specific classification is young-onset parkinsonism (YOPD), which officially means that symptoms of parkinsonism develop between the ages of 21 and 45.

     

    M

    Myoclonus / myoclonia is a very rapid, jerky, involuntary, and usually arrhythmic (sometimes rhythmic) movement with a consistent motion. There is no urge to move. Myoclonia cannot be suppressed voluntarily.
    Myo means muscle and clonus means jerk. The most common myoclonus is hiccups.

     

    When the muscle twitches are caused by damage to the cerebral cortex, they are called cortical myoclonus.

    When they are caused by subcortical (located beneath the cerebral cortex) brain areas such as the basal ganglia they are called subcortical myoclonus.
    Myoclonus can also originate in the cerebellum or the spinal cord (myelum).

     

    Myoclonus may be present at rest. This is called rest myoclonus. Action myoclonus, as the name suggests, is a muscle twitch when the muscles are moving. If it occurs in only one area of the body, it is called focal (local) myoclonus.

    Multifocal myoclonus affects multiple areas. If the myoclonus is spread throughout the body, it is called generalized myoclonus. If it occurs on one side of the body, it is called segmental myoclonus.

     

    Causes may be harmless, such as sleep myoclonus or hiccups. Myoclonus may also occur in epilepsy syndromes, in addition to absence seizures and tonic-clonic seizures.
    They may be caused by genetic disorders, metabolic disorders, electrolyte imbalances (calcium, magnesium, potassium, sodium, chloride, and phosphate levels), for example kidney disease, or brain disorders (encephalopathy). They may also be caused by poorly functioning kidneys, liver, or thyroid, neurodegenerative disorders, juvenile myoclonus epilepsy, cerebral oxygen deficiency, or COVID-19.

     

    Causes of brain injury include traumatic brain injury, encephalitis, autoimmune inflammation of the brain, cerebral infarction/ischemic stroke, and hypoxic-ischemic encephalopathy (HIE).

    In adults, this may also be due to a lack of oxygen before and around birth (asphyxia), and due to oxygen deficiency after surviving cardiac arrest and successful resuscitation, as seen in Lance Adams syndrome (LAS) and myoclonic status epilepticus (MSE).

     

    Finally, myoclonus may be caused by medications. Myoclonus may also occur alongside other movement disorders, such as ataxia, dystonia, or chorea.

     

    P

     

    • Parkinsonism: for detailed information, see our special page on
      parkinsonism and atypical parkinsonism. A few symptoms in brief:
      • Trembling or shaking (tremor) of the arms and legs (usually at rest)
      • Lack of movement, lack of spontaneous movements, slowed movements, and reduced arm movement when walking
      • Postural abnormalities and loss of postural reflexes
      • Difficulty with fine motor skills, small hand movements (often also smaller handwriting)
      • Difficulty starting, such as getting out of bed or a chair
      • Stiffness
      • Reduced facial expression: a 'masked face'
      • Softer speech, monotone voice

     

    • PIVC / Parieto-Insular Vestibular Cortex
      Injuries to the PIVC may cause symptoms such as impaired gait/abnormal gait. The brain areas (parietal lobe, Reil's island/insula, and the vestibular organ) regulate balance in the human vestibular system. Information from balance and the senses is processed in the cerebral cortex when the position of the head and body changes. Specifically, the PIVC is involved in processing visual perception, self-motion perception, estimating what is above and below, and whether body movement is in balance with gravity.
      Brain areas that assist with spatial orientation, enable movement, and help maintain balance on a page to come.

     

    • PLMD Periodic Limb Movement Disorder is not really a movement disorder. It is a sleep disorder. While the person is asleep, her or his legs suddenly make violent, jerking movements. This happens several times a night. Some people also experience sudden bending and stretching movements in their arms during sleep.

     

    • Postviral ataxia (paraviral ataxia) is a movement disorder characterized by jerky, uncoordinated movements resulting from a previous viral infection (chickenpox, Ebstein-Barr virus / mononucleosis, mycoplasma virus, and others). A postviral ataxia may also develop after vaccination. Symptoms may include uncoordinated movements, slurred speech, double vision or jerky eye movements, and trembling arms, legs, or head.

     

    R

    • Rigidity hypokinesia is stiffness (rigidity) with reduced movement (hypokinesia). For more detailed information, see our special page on parkinsonism.

     

    S

    • SCA-1 / ADCA SCA-1 stands for Spinocerebellar ataxia type 1. Spino refers to the spinal cord and Cerebellar to the cerebellum. Ataxia refers to the uncoordinated gait. SCA-1 is a hereditary disease: a child of a parent with the condition has a 50% chance of developing the disease.

     

     

    • Stiff-person syndrome (SPS), a rare neurological and chronic disease that, due to a disruption in the spinal cord and brain, causes alternating muscle stiffness and painful muscle spasms throughout the body. It primarily affects the trunk muscles. The progressive course can lead to postural deformities. This occurs, for example, in the lower back and hips. Some patients have antibodies that damage the spinal cord and the cerebellum. Another part has antibodies that are related to proteins that control the brakes in the body. Read more here.

     

    • Spasms are not officially considered movement disorders. See information on the page.

     

    • Spasticity is not officially considered movement disorders. See information on the page. Some neurologists do classify spasticity as a neurological movement disorder.

     

     

    T

     

    • Thalamic Injuries The thalamus is a relay center that serves both sensory (feeling) and motor (movement) functions.
      Damage to the thalamus may lead to movement disorders, such as akinesia without loss of strength and hemiparesis. Uncoordinated, involuntary movements (ataxic choreoathetosis) also occur in cases of, for example, a cerebral infarction in the thalamus. Injuries to the right thalamus can cause hemiparesis.
      Everything depends on the location of the thalamus that is damaged. There are six major nuclei.
      Incorrect regulation of the basal ganglia-thalamocortical circuits (connections between the basal ganglia, the thalamus, and the cerebral cortex) can also occur. The thalamus receives nerve pathways from the cerebellum, the globus pallidus internus, and the substantia nigra and projects to the motor cortex, premotor cortex, and supplementary motor area.

     

    • Tics are sudden, brief, rapid, and recurrent, non-rhythmic, and stereotyped semi-voluntary motor movements that can last seconds. There is an urge to move. Tics repeatedly occur during the same movement. Multiple tics may occur. The tics can be suppressed for a short time and are therefore called semi-voluntary movements. Tics are likely caused by disrupted coordination between the basal ganglia. The striatum, a part of the basal ganglia, plays a particular role.
      In PANDAS, children develop tics after experiencing a streptococcal infection (for example, after a sore throat or a wound). The tics are then accompanied by behavioral disturbances. Tics
      can also be caused by medications. On this website of PUBMED you will find extensive information.

     

    • Tremors are characterized by abnormal, involuntary, rhythmic movements of the hand, head, or limbs. Some types of tremor can be caused by metabolic problems, medication, or structural brain problems.

     

    V

     

    • Vascular parkinsonism is a condition characterized by parkinsonian symptoms caused by chronic disturbances of cerebral blood flow. For example, this may be due to multiple lacunar infarcts in the midbrain or a larger infarction in the basal ganglia. In approximately a quarter of people with this condition, the symptoms develop acutely. In others, they develop gradually.

     

    Y

    Young-onset parkinsonism (YOPD) means that parkinsonism symptoms develop between the ages of 21 and 45. See also information on juvenile parkinsonism (JPD) and early-onset parkinsonism (EOPD).

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