The ability to move antagonistic muscles in rapid succession is called diadochkinesis. Disorders of this type of movement are grouped under the term dysdiadochkinesis and are usually the result of a cerebellar lesion. Treatment of dysdiadochkinesis is limited to physiotherapeutic training.
What is dysdiadochokinesis?
Humans have the ability to perform repetitive movements in rapid succession, such as those required to rotate the forearm in and out in terms of pronation and supination and necessary for processes such as changing light bulbs. This ability is called diadochkinesis. When this ability is impaired, the medical profession refers to it as dysdiadochkinesis. When there is only a slowing of movements, it is called bradydiadochokinesis. Dysdiadochkinesia differs from this in that there are limitations that go beyond speed. Adiadochokinesia, which makes the coordination of the described movements completely impossible for the affected person, is to be distinguished from this. Dysdiadochkinesis is an ataxia and at the same time the symptom of a brain lesion in the regions of fine motor control. Dysdiadochkinesis need not be apparent at first glance, but is a serious symptom that sometimes severely affects affected individuals in their daily lives.
Causes
The ability to make rapid successive movements in the sense of diadochkinesis depends on a person’s fine motor skills. The control of fine motor skills occurs primarily in the brain regions of the cerebellum. Movement programs are designed in the cerebellum. It is also possible for the person to control the processes during the execution of the movement, since various feedbacks are carried out by the kinesthetic analyzer. Subcortical and supraspinal control centers are involved in this control at an unconscious level. Fine coordination is implemented by spinal centers and supraspinal regions of the brainstem. Together with the motor cortex, these centers enable safe movement execution despite any confounding variables. When a fine motor brain region suffers lesions or spinal lesions impair fine motor coordination, dysdiadochkinesis may occur. Most commonly, the phenomenon is due to primary causes such as strokes, Parkinson’s disease, and cerebellar disorders such as lesions in multiple sclerosis. Patients with dysdiadochkinesia can no longer perform rapid successions of antagonistic movements such as pro- and supination in a coordinated and orderly fashion. The symptom can manifest in both upper and lower limbs. Manifestation in the lower limbs results in impairments in walking. Antagonistic movement sequences are all movements that have as their basis the activation of a particular muscle and the immediately subsequent activation of its antagonist. The antagonist of a muscle is its direct opponent. For example, the antagonists of the flexor muscles are the extensors. In most cases, the muscle strength of patients of dysdiadochkinesis is intact. Thus, they are not affected by paresis but by ataxia. If gait ataxia is present in addition to dysdiadochkinesia, this symptom manifests as a wide-legged, unsteady gait pattern. Furthermore, ataxic damage to the brain sometimes leads to movements of the wrong magnitude such as overshooting-extending types of movement. Unfluent, wobbly movements can also be associated with dysdiadochokinesia. The individual associated symptoms depend on the primary cause of dysdiadochokinesia.
Diseases with this symptom
- Ataxia
- Parkinson’s disease
- Multiple sclerosis
- Strained ligaments
- Limp
- Muscle strain
Diagnosis and course of the disease
To diagnose dysdiadochokinesia, the neurological examination serves. For example, as part of this examination, patients are routinely asked to perform with their hands the movements required to screw in a light bulb. If the sequence of movements appears uncoordinated, dysdiadochokinesia is present. In addition, because dysdiadochokinesia is merely a symptom of a central nervous lesion, the primary cause of the ataxic disorder must be determined as part of the diagnosis.For this purpose, the physician usually uses imaging techniques such as MRI, which can image the brain as well as the spine and its tissues. In many cases, the diagnosis of a central nervous lesion precedes the diagnosis of dysdiadochokinesia. The prognosis for patients with dysdiadochokinesis depends on the primary cause for the disorder.
Complications
Dysdiadochokinesia can result in impaired coordination, limited mobility, and other complications. Muscle strains in the wrist are common, and depending on the severity of the disorder, serious ligament strains or even fractures may occur. The complications are triggered by the rapid turning of the hand, which can also lead to pain and circulatory problems in the affected limb. In the cerebellum, where the disease originates, further damage to the nerve cells can occur in the course of the disease, accompanied by multifaceted complaints of the central nervous system. Those affected, mostly stroke patients, sometimes also suffer from severely restricted mobility, which can lead to further disorders of the musculoskeletal system and possibly also of the nervous system. During the treatment itself, complications are unlikely: dysdiadochokinesia is mainly treated by physiotherapy, which can only trigger further complaints in case of severe damage to the nerves. Pain is often the biggest problem for affected individuals, as it occurs abruptly in severe episodes and reduces quality of life. Due to the sensitive nature of the symptoms, painkillers should be chosen carefully and taken under the supervision of a physician, as the already damaged nervous system reacts sensitively to various preparations. Incorrect treatment as a result of an incorrect diagnosis can also lead to complications, since as a result only the symptoms are treated, but not the causes of the disease.
When should you go to the doctor?
Dysdiadochokinesia is a movement coordination disorder. It is the opposite of diadochokinesis, in which there is no problem performing opposite movements in quick succession. However, if dysdiadochokinesia is present, this is only possible irregularly or not at all. Dysdiadochokinesia is almost always based on damage to the cerebellum. Sometimes it can also be based on a functional impairment of the spinal cord or peripheral nerves. These impairments in turn are often caused by a disease: in addition to direct diseases of the cerebellum, strokes, Parkinson’s syndrome and multiple sclerosis are the most common causes. After a preliminary discussion with the general practitioner, the latter will probably refer his patient to a neurologist for further specialist treatment. Regression of dysdiadochokinesia is not expected. Patients benefit here primarily from physiotherapy in order to regain at least part of their quality of life. It is also important to avoid secondary damage. The lack of mobility triggered by dysdiadochokinesia repeatedly leads to muscle tension of the wrist or even to ligament strains and fractures as well as severe pain. In this case, pain therapy with medication is once again a special challenge, because the already impaired nervous system reacts extremely sensitively to pain medication. In the case of dysdiadochokinesia, usually only symptom relief is still possible, but not a cause cure.
Treatment and therapy
In most cases, dysdiadochokinesia cannot be treated causally, but only symptomatically. Lesions in the brain and spinal nerve tissue do not heal in the true sense. The nervous tissue in the central nervous system is capable of regeneration only to an extremely limited extent. Apart from that, even healed lesions in the tissue always leave scars. The nerve cells at the site of the scar are useless and no longer have any function. Therefore, injuries to the central nervous system are often associated with irreversible damage and loss of function. However, studies of stroke patients have shown that adjacent neurons are capable of taking over functions of the damaged neurons. The central nervous system always feels motivated to take over functions when the lost functions seem to be frequently needed.For example, a patient of dysdiadochokinesia can specifically train the sequence of antagonistic muscle movements under physiotherapeutic care. In addition, the central nervous system should thus be induced to shift functions out of the damaged areas and pass them on to intact nerve cells. In this way, dysdiadochokinesia may be curable even if its underlying cause cannot be fully eliminated.
Outlook and prognosis
In general, dysdiadochokinesia results in severe limitation of mobility and coordination. The affected person is often unable to move or find his or her way around on his or her own and is dependent on help from others. If mobility is very limited, walking aids are necessary. To outsiders, the rapid movements or twisting of the hands may appear bizarre. This leads to bullying or teasing, especially in children, and can cause severe mental illness. In many cases, patients also suffer from severe pain that reduces quality of life. Treatment for dysdiadochokinesia often involves pain management and physical therapy. Whether these therapies are successful depends largely on the cause of the dysdiadochokinesia. In patients who have suffered a stroke, complete recovery is not possible in every case. However, the muscles can be trained and thus relearn their usual movement. To prevent dysdiadochokinesia, stroke in particular should be prevented. A healthy lifestyle with plenty of exercise and a healthy diet is suitable for this purpose.
Prevention
Dysdiadochokinesia can be prevented only to the extent that lesions of nervous tissue in the cerebellum can be prevented. For example, because such a lesion can occur as a result of stroke, preventive measures for stroke can also be broadly understood as preventive steps with respect to dysdiadochokinesis.
Here’s what you can do yourself
Self-help methods are very limited for dysdiadochokinesia. In general, a healthy lifestyle has a very positive effect on the symptom. This includes not only a healthy diet, but also regular exercise. This lifestyle can also prevent dysdiadochokinesia, as the risk of stroke is greatly reduced in the process. However, it is not possible to completely eliminate the symptoms of dysdiadochokinesia. In many cases, physiotherapy is necessary. However, the associated exercises can be performed at home. In some cases, this requires the help of friends, relatives or one’s partner. The more the patient exercises, the greater the chances that intact nerve cells will be relocated and that normal movement patterns will once again be possible. Above all, specific movements of the muscles should be trained. This may seem relatively difficult for the patient at first, but can quickly lead to success. However, the patient should also have a strong will. After all, mental support during training is not to be sneezed at. If the movements hurt, painkillers or cooling ointments can be used. However, painkillers should not be used in the long term.
