What is Dysdiadochokinesia?
Dysdiadochokinesia is a medical condition where the patient has difficulty in performing quick and alternating movements.1 Dysdiadochokinesia commonly is abbreviated as DDK. In this condition the patient’s ability to perform rapid and alternating movements gets impaired. The cause of Dysdiadochokinesia is usually lesions on the posterior lobe of the cerebellum, which makes it difficult to turn the antagonizing groups of muscles on and off.2 The diagnosis of this condition is made after the patient is told to perform a sequence of simple movements, such as screwing on a light bulb, turning a door knob, or rubbing the shin using the opposite heel. Patients suffering from dysdiadochokinesia won’t be able to do them quickly or steadily.
Dysdiadochokinesia is also known as dysdiadochokinesia, dysdiadochokinesia, dysdiadochokinesia and is derived from the Greek word, “diadochos” which means “succeeding,” and “kinesis” which means “movement.”
Adiadochokinesia is a medical condition where the patient is completely unable to perform rapid and alternating movements.
Causes of Dysdiadochokinesia
Dysdiadochokinesia is one of the characteristics of cerebellar ataxia and ataxic dysarthria. The cause is often lesions to either the frontal lobe or the cerebellar hemispheres or can be a combination of both. Dysdiadochokinesia occurs due to inability to switch on and switch off the antagonizing muscle groups in a coordinated manner. Dysdiadochokinesia also occurs with multiple sclerosis3 and Friedreich’s ataxia and motor speech disorders (dysarthria).
Signs & Symptoms for Dysdiadochokinesia
- Patent with Dysdiadochokinesia experiences change in his/her equilibrium and walking. The changes include slowness, awkwardness and rigidity in movements.
- Patient has poor coordination of the arms, hands and/or legs.
- Dysarthria is present which dull or incomprehensible speech is.
- Dysdiadochokinesia patient finds it difficult to stop one movement and start another movement immediately in the opposite direction.
- As this condition of Dysdiadochokinesia progresses, there are additional symptoms experienced by the patient which are associated with other parts of the brain or the nervous system, such as tremor, weakness, spasticity, inability to move eyes, insanity and loss of sensitivity in the hands and/or feet.
Diagnosis of Dysdiadochokinesia
Before commencing the treatment, the diagnosis is made by performing series of tests on the patient to assess the extent of this disease.
MRI Scan: This imaging test is done to detect the lesion present in cerebellum.
Point-to-Point Movement Evaluation: Patient is told to move their forefinger and touch their nose with it and then touch the outstretched finger of the analyst with the same finger. The patient is told to do these movements rapidly.
Rapidly Alternating Movement Evaluation: The patient is told to place the dorsum of one hand against another hand or thigh. Then patient is told to move his hand back again to palm side up; and then to continuously do the hand flipping as fast as possible.
Romberg Test: The patient’s balance is checked by telling them to stand still and keeping their heels together.
Gait Test: The patient is told to walk normally and then walk heel to toe. The doctor checks the patient’s foot to see if its function is normal or not.
Plantar Reflex Test or Babinski Test: This test is a very important test where the patient is pricked using a pointed pin and the patient’s involuntary action is checked.
Clonus Test: Patient is given upwards and downwards movement of the leg or a knee-jerk to assess the reflex action.
Heel Shin Test: The patient is told to place one leg over the second leg to assess the patient’s brain coordination system.
Achilles Reflex Test: In this test, the patient’s foot is touched with a cold object to check the reflex.
Treatment for Dysdiadochokinesia
- Treatment of Dysdiadochokinesia Caused by Cerebellum Lesions: The cause of Dysdiadochokinesia is often lesions in the cerebellum and treatment of the lesion can be difficult, as there are various causes for it. A lesion which is not causing any symptoms or not growing is usually monitored without any medical intervention. Whereas, depending on the cause, treatment for other lesions consists of antibiotics, surgery or chemotherapy. If the cause is damage of brain tissue due to patient’s immune system, then medications which change this response are prescribed.
- Treatment of Dysdiadochokinesia Caused by other Conditions: If the cause of dysdiadochokinesia is some other condition, then treatment is done for that underlying condition first which will improve dysdiadochokinesia. If a metabolic disorder is causing the dysdiadochokinesia, then patient is treated with appropriate medications and diet. Dysdiadochokinesia due to vitamin deficiency is treated with vitamin therapy.
- Exercises to Treat Dysdiadochokinesia: Physical therapy helps in resolving many swallowing and gait disorders. Exercises are explained to the patient and should be done under the guidance of a physical therapist. Exercises will strengthen the muscles.
- Treatment of Dysdiadochokinesia Using Special Equipment: Special equipment can be used to assist with walking and performing other activities.
Exercises for Dysdiadochokinesia
Warm up Exercises: This should be done with at least 5 minutes of continuous activity, such as running, jogging, arm bike, riding, treadmill etc. Doing warm up before actual exercising helps in increasing the temperature of the muscle and body, increasing the range of motion, decreasing stiffness, dilating the blood vessels and helping with mental co-ordination.
Balance Training: This exercise can be done for 20 minutes. Modified Lee Silverman LVST program was developed for patients suffering from Parkinson’s disease and this exercise can also help patients with Dysdiadochokinesia, as it involves moving the patient’s arms and legs in a coordinated manner. These movements can be done while standing and sitting, and they help in challenging the patient’s balance in a safe manner.
Romberg Exercise: The Dysdiadochokinesia patient is told to stand with feet together, tandem and semi-tandem, with the eyes kept open for 10 seconds, and then the patient is told to close eyes for 10 seconds in each position.
Unilateral Stance: For adults, the standard method is to stand on one leg for about 30 seconds. This can be repeated over and over again for improvement. There are different methods through which the patient can work on and challenge his/her balance by engaging visual, somato-sensory cognitive and vestibular systems. Surface and stimuli can be changed to provoke postural reactions and balance strategies, by standing with feet together, then standing with the feet apart and standing on one leg etc.
Strengthening Exercises: These exercises for Dysdiadochokinesia can be done for about 25 minutes. Our muscle strength decreases with age and doing strength training programs helps in increasing the lower extremity strength and functional balance ability. All the exercises should be done at a slow pace and with complete range of motion. According to studies, maintaining a muscle contraction while performing through complete range of motion helps in releasing dystrophin, which helps in building the strength of the muscles.
- Strengthening Exercises for Dysdiadochokinesia Consists of: Targeting pelvic muscles, straight leg raise, hip abduction, hip adduction, knee to chest, bridging, hamstrings curls, long arc quad and squats.
- Exercises which can be done with the use of strength building machines include leg press, calf press, hip abduction/adduction, plank and seated row.
- Core exercises are also important to strengthen your muscles, especially the upper extremity muscles.
There can be proximal weakness in the upper extremities, especially in the shoulders, which are a bit weaker than the elbows or hands in patients with ataxia. So, Dysdiadochokinesia patient should concentrate on working these muscles first. The position should also be changed when exercising. For example, when doing leg exercises, don’t just do them while lying down on the mat, but also do them while sitting and standing. If the patient is not able to stand independently, then standing with support and performing these exercises with arms also helps in activating different groups of muscles. If the patient is wheelchair bound, then even just changing the surface by sitting in a different chair also helps in activating different muscles while exercising the upper extremities.