Dysdiadochokinesia, which is a symptom of multiple sclerosis, can be overwhelming for those who suffer from it. Patients and their families often struggle to understand the causes and treatment of this medical condition.
A true dysdiadochokinesia definition is the inability to respond to quick movements. Here’s a good example: A healthy person who touches a hot stove would quickly pull their hand away from the stove, but someone with dysdiadochokinesia would fail to respond to this sensation and the hand would remain on the hot stove. People who suffer from dysdiadochokinesia (DDK) generally have a hard time performing quick and alternating movements.
The word dysdiadochokinesia is a combination of the Greek diachochos, meaning “succeeding,” and kinesis, which means “movement.” It is believed that a blockage in the posterior lobe that is directed towards the brain leads to DDK.
What causes dysdiadochokinesia?
The theory is that dysdiadochokinesia causes could be the result of lesions in the cerebellar hemisphere or the frontal lobe. It could also be a combination of both. What scientists know is that some people with multiple sclerosis and dysdiadochokinesia have an inability to switch certain muscle groups on and off in a coordinated way due to hypotonia, which means decreased muscle tone. It is interesting to note that dysdiadochokinesia is also a feature of motor speech disorders, also referred to as dysarthria. Medical research suggests that dysdiadochokinesia is associated with a gene mutation that impacts a membrane protein, which transports neurotransmitters. Neurotransmitters are the chemicals that communicate information throughout our brain and body.
Dysdiadochokinesia seems to happen because of an inability to switch antagonizing muscle groups on and off in a coordinated fashion.
Underlying conditions that occur with dysdiadochokinesia
There are conditions that can occur along with dysdiadochokinesia, including ataxia and dysmetria. Ataxia is a lack of muscle control or coordination in terms of voluntary movement. Examples include walking or picking up objects. Ataxia can impact speech, eye movement, and swallowing. While people with multiple sclerosis are known to get ataxia, it is a condition that has also been linked to alcohol abuse, stroke, tumors, brain degeneration, cerebral palsy, and certain medications. Dysmetria is when the cerebellum, which is the part of the brain that allows us to make coordinated movements and process thoughts, isn’t functioning properly. Unfortunately, there is no cure for dysmetria or ataxia. Doctors focus on treating the main medical problem in an effort to bring these conditions under control.
Symptoms of dysdiadochokinesia
While each individual’s experience can be slightly different, here are some of the common dysdiadochokinesia symptoms:
- Changes in equilibrium and walking, such as slowness, awkwardness, or rigidity
- Poor coordination of the arms, hands, and legs
- Dull or hard to comprehend speech
- Difficulty stopping one movement and starting another movement in the opposite direction
- Tremors, weakness, spasticity, inability to move eyes, and loss of sensitivity in hands and feet when the condition progresses
These symptoms can be very frightening to a patient, so medical and family support is crucial.
Diagnosis of dysdiadochokinesia
A dysdiadochokinesia test can come in different forms. For example, a patient can sit comfortably in front of the doctor with his or her right hand on the knee or the palm of the hand on a table. The patient will be asked to turn that palm up and down rapidly. The other hand will also be tested for movement. Another simple test involves getting the patient to alternately touch fingers two through five with the thumb rapidly. The accuracy of point-to-point contact, as well as speed, rhythm, and smoothness will be assessed. Lower extremity testing is also often used to diagnose dysdiadochokinesia.
For instance, sitting on a chair, the patient is instructed to touch the heel to the knee and then slide the heel up and down the lower leg. Smoothness of motion and accuracy are assessed. Sometimes patients are also asked to draw a figure eight or circle with their big toe, tap their foot on the floor, or do what is commonly referred to as the drunken test, where you try walking in a straight line putting your feet heel-to-toe.
Below, we outline some other potential diagnostic tests:
- MRI scan: This is an imaging test that can be conducted in order to detect a lesion in the cerebellum.
- Point-to-point: Similar to the fingers exercise described above, this movement evaluation involves a patient moving their forefinger to touch their own nose and then outstretching the finger to touch the analyst’s finger. This is done in rapid succession.
- Romberg test: This is a balance test that involves the patient standing still and keeping their heels together.
- Gait test: In this test, the patient is instructed to walk normally and then walk heel-to-toe. During the test, foot function is being observed.
- Babinski test: Also referred to as plantar reflex, this test involves the patient being pricked with a pointed pin to measure involuntary action.
- Heel shin test: In this test, the patient places one leg over the other leg so that brain coordination can be assessed.
- Achilles reflex test: The patient’s foot is touched with a cold object to measure reflex.
Treatment for dysdiadochokinesia
As alluded to earlier, treatment depends on the cause, so what will work for one person may not be effective for another. This is why tests/assessments are so important. Here’s a brief look at dysdiadochokinesia treatment based on causes.
Dysdiadochokinesia caused by cerebellum lesions can include antibiotics, surgery, or chemotherapy. If the cause is brain tissue damage to the immune system, specific medications, which can change this response, may be prescribed. There are some cases where the lesions don’t cause any symptoms so there is no treatment, just monitoring.
Dysdiadochokinesia caused by other conditions means treatment is applied to address the underlying condition, which tends to improve the DDK. If a metabolic disorder is a cause, a patient will receive medications and special diet instructions. When the cause is a vitamin deficiency, then vitamin therapy might be the best treatment.
Dysdiadochokinesia that leads to swallowing and gait problems can be treated with exercises. Physical therapy can strengthen weak muscles.
There are situations where dysdiadochokinesia treatment involves using special equipment. For example, devices used to assist with walking or performing different activities.
Exercises for dysdiadochokinesia
Let’s take a look at some dysdiadochokinesia exercises. While the idea of exercising may sound daunting, with the proper guidance, many people who suffer from this condition are able to carry out the following routines.
Warm up: Running, jogging, arm cycling, or using a treadmill are considered warm-up exercises. The warm-up helps increase the temperature of muscles and increases the range of motion. It can also help with mental coordination.
Balance training: This can be done for about 20 minutes and involves moving the legs and arms in a coordinated manner. These are exercises that can be done sitting or standing. They help a person challenge their ability to balance in a safe way.
Romberg exercise: Standing with feet together, tandem and semi-tandem, with the eyes kept open for 10 seconds, the patient then closes eyes for 10 seconds in each position.
Unilateral stance: This involves standing on one leg for 30 seconds – a move that should be repeated over and over again to see improvement. Different strategies are applied to provoke postural reactions and degree of balancing.
Strengthening exercises: Strength training is designed to increase the lower extremity strength and balance ability. Some strengthening exercises release dystrophin, which can help build strength in the muscles. Some strengthening exercises for dysdiadochokinesia include pelvic muscles, leg raises, bridging, hamstring curls, and squats. Some exercises can also be done with machines, such as leg press, calf press, and hip abduction/adduction.
Core exercises are also recommended for some people who suffer from dysdiadochokinesia. These exercises can help improve the strength of the upper extremities.
If you or someone you know has dysdiadochokinesia and has been cleared by a doctor to exercise, they should change up positions. For instance, when doing leg exercises, don’t just do them lying down. Switch things up and do them while sitting and standing too. Those who can’t stand on their own can use a support of some sort and do exercises with their arms to get muscle groups working. People who are confined to a wheelchair can also exercise their muscles just through changing the surface by sitting in a different chair and exercising the upper body.
Living with dysdiadochokinesia is both scary and frustrating. Addressing the underlying cause, whether it is multiple sclerosis or some other condition, as soon as symptoms arise can be important since specific exercises can help. Although there is no quick cure for dysdiadochokinesia, maintaining muscle strength can help make some movement related tasks less challenging.