Considerations

Smooth graceful movement requires a fine balance between different muscle groups. A part of the brain called the cerebellum manages this balance.

Causes

Diseases that damage the cerebellum, spinal cord, or peripheral nerves can interfere with normal muscle movement and result in coarse, jerky, uncoordinated movements.

Brain injuries or diseases that can cause uncoordinated movements include:

• Brain injury or head trauma
• Chickenpox or certain other brain infections
• Conditions that are passed through families (such as congenital cerebellar ataxia, Friedreich's ataxia, ataxia - telangiectasia, or Wilson's disease
• Multiple sclerosis
• Stroke ortransient ischemic attack (TIA)

Poisoning or toxic effects caused by:

• Alcohol
• Drugs including aminoglutethimide, anticholinergics, phenytoin, carbamazepine, phenobarbital, tricyclic antidepressants, and any sedative
• Heavy metals such as mercury, thallium, and lead
• Solvents such as toluene or carbon tetrachloride

Other causes include:

• Certain cancers, in which symptoms may appear months or years before the cancer is diagnosed (called paraneoplastic syndrome)
• Problems with the nerves in the legs (neuropathy)
• Spine injury or damage (such as compression fractures of the spine)

Home Care

Use safety measures around the home to make it easier to get around. For example, avoid clutter, leave wide walkways, and avoid throw rugs or other objects that might cause slipping or falling.

People with this condition should be encouraged to take part in normal activities. Family members need to be very patient with a person who has poor coordination. Take time to show the person ways to do tasks more easily. Take advantage of the person's strengths while avoiding his or her weaknesses.

Walking aids, such as a cane or walker, may be helpful.

When to Contact a Medical Professional

Call your health care provider if:

• A person has unexplained problems with coordination
• Lack of coordination lasts longer than a few minutes

What to Expect at Your Office Visit

In emergency situations, the patient will first be stabilized.

The health care provider will perform a physical exam and ask questions about the person's symptoms and medical history.

The physical exam will also include a detailed examination of the nervous system and muscles, paying careful attention to walking, balance, and coordination of pointing with fingers and toes. 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 that the sense of position has been lost and the test is considered positive.

Medical history questions may include:

• When did the symptoms begin?
• Does the uncoordinated movement happen all the time or does it come and go?
• Is it getting worse?
• What medications do you take?
• Do you drink alcohol?
• Do you use recreational drugs?
• Have 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

Tests that may be performed include:

• Antibody testing to rule out paraneoplastic syndromes
• Blood tests (such as a CBC or blood differential)
• CT scan of the head
• Genetic testing
• MRI of the head

You may need to be referred to a specialist for diagnosis and treatment. A home safety evaluation by a physical therapist may be helpful.

Alternative Names

Lack of coordination; Loss of coordination; Coordination impairment; Ataxia; Clumsiness; Uncoordinated movement

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.

Subramony SH. Ataxic disorders. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 22.

Update Date: 2/5/2012

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.