What Is A Movement Disorder?

Jul 28

Movement disorders can be some of the most frustrating and debilitating problems anyone can confront. People living with movement disorders can lose control of their bodies, lose the ability to generate proper motor responses, and lose the ability to interact with the world.

In the broadest sense, movement disorders are either hyperkinetic, i.e. people move too much, or hypokinetic, i.e. they move too little. Unwanted and intrusive movements are considered to be hyperkinetic disorders. Slowing of movement and inability to properly initiate movement are hallmarks of hypokinetic disorders. In some conditions such as Parkinson’s disease, both hyperkinetic tremors and hypokinetic slowing of movement can be part of the same clinical presentation.

Movement disorders are like struggles for control of the body. People describe themselves as feeling like marionettes, with sensations that their bodies are being played by remote puppeteers. They attempt to activate a muscle or motor program and nothing happens, or a different muscle or program activates instead.

Movement disorders may include muscle spasms or contractures lead to involuntary posturing, or changes in gait and balance. They can be uncomfortable, or even severely painful. Tremors make handwriting illegible, and can even make it difficult to hold utensils to feed oneself. Falls are very common consequences of these conditions.

What are Some Different Types of Movement Disorders?

Tremors are very common forms of movement disorders. The most common of these is called an Essential Tremor. This is a condition where people experience unwanted rhythmic shaking of their hands, or sometimes feet. In many cases, the tremor involves unwanted movement of the head as well. Usually the tremor stops when the body part is at rest, and starts up again during movement.

Dystonia is a condition that involves an involuntary twisting sensation of muscles, which will often force the head or body part to be restricted in a specific posture. There are static forms of dystonia, where the body part is stuck in a particular posture, or kinetic variants that involve movement. Some people experience both variants at the same time. Beyond the unwanted movement, Dystonia can be extremely uncomfortable due to the ongoing muscle contracture.

Myoclonus is a movement disorder that involves sudden, spontaneous jerking of body parts, as if from an electrical shock. This is not far from the truth, as sudden, spontaneous electrical activity in parts of the motor system drives the jerking movement seen in myoclonus.

Neurodegenerative conditions can create movement disorders. Parkinson’s disease is the most common neurodegenerative condition that creates inappropriate movement, involving tremors, slowness of movement, balance difficulty, and frequent falls. Progressive Supranuclear Palsy and Multiple System Atrophy are additional neurodegenerative conditions that lead to movement disorders.

In many cases, more than one type of movement disorder may be present at the same time. Movement disorders may be sporadic and random, or constant. In all cases, they are incredibly frustrating to deal with.

How Common are Movement Disorders?

The most common adult movement disorder is essential tremor. Approximately 1% of the entire population has an essential tremor, however the prevalence increases markedly with age, and especially with advanced age. 4.6% of people age 65 and older have essential tremors, increasing to almost 22% of people 95 and older (1).

Primary dystonia is rare, with between 2-50 cases per million for early-onset, and between 30-7320 cases per million for late-onset dystonia (2).

Myoclonus is more common, with 8.6 cases per 100,000 people (3). Parkinson’s disease is far more common, with nearly one million people in the US living with PD (4).

What Causes Movement Disorders?

Most movement disorders involve several parts of the brain, including the basal ganglia, the cerebellum, the frontal motor cortex, and the parietal sensory cortex in various combinations. Movement disorders usually arise from dysfunction in the basal ganglia, the cerebellum, or both (5).

There is usually some form of genetic lesion that predisposes people towards unwanted patterns of movement, often coupled with some form of trauma or neurodegeneration that leads to expression of the disorder (29).

What Goes Wrong in the Brain with Movement Disorders?

The basal ganglia contain two major pathways, known as the direct and indirect pathways. All motor activity involves activation of both of these systems. The direct pathway initiates movement, and acts as the gas pedal for the motor system. The indirect pathway inhibits movement, and acts as the brake pedal. Normal motor function depends on an appropriate balance between motor initiation and motor inhibition. We need to be able to step on the gas properly to engage a motor program, then take our foot off the gas and hit the brake pedal when it is time to stop the activity.

Most movement disorders involve the basal ganglia, which for various reasons lose the necessary balance between motor initiation and inhibition. Hypokinetic movement disorders like early stage Parkinson’s disease involve some failure in the direct pathway, and the brain is unable to properly take its foot off the brakes and step on the accelerator. The opposite is true with hyperkinetic disorders like dystonia, in which the gas pedal is being floored, and the inability to hit the brakes becomes impaired (6).

One essential component of these conditions is a failure of integration between sensory maps. The brain creates unconscious visual, vestibular (inner ear), and proprioceptive (muscle and joint) maps that help localize the body and its various parts in the visual and gravitational environment.

The parietal lobe has a map in the sensory cortex, which is where you feel most of the physical sensations from your body parts. In many movement disorders, problems with the basal ganglia result in smearing of this sensory map, such that the brain’s definition between body parts breaks down. It loses the ability to coordinate individual muscles as a result (7).

In other conditions, the brain perceives a mismatch between eyes and inner ear pathways, creating an inappropriate perception of where the body is in space and in relation to gravity. The posturing and muscle contractions that develop are reflexes that the brain creates to resist a perceived fall that is not actually taking place (8).

In still other cases, systems that oscillate in the brainstem to create timing signals for motor coordination break down, or systems in the cerebellum that process sensory feedback from muscles and joints degenerate. The brain needs to essentially turn up the volume on the feedback to know where the body is in space, resulting in patterns of debilitating tremor (9).

How are Movement Disorders Usually Treated?

Traditional treatment options are generally very limited, ranging from pharmaceutical dopamine replacement to facilitate basal ganglia function, to Botox injections to shut off dystonic muscles (28).

These approaches only manage symptoms and do not halt the progression of the disorder. More invasive therapies such as deep brain stimulus show promise, however, these involve all the risks associated with brain surgery.

How is the NeuroRescue Program Different?

We employ a wide variety of therapies and modalities in the treatment of movement disorders. All of our interventions are backed by current neuroscience research.

The therapies we include in your NeuroRescue Program will be determined based on your unique history, presentation, and diagnostic testing data. All of our therapy protocols are tailored to the unique needs of the individual.

Much of what happens in movement disorders is related to the inability to properly localize yourself in the environment. Your brain makes sense of where you are in the world through inputs from your muscles and joints, inputs from your inner ear, and inputs from your eyes. The eyes are constantly scanning the world to provide the brain with a visual map of the surrounding space. It does this with saccades, which are fast eye movements from target to target.

In order for you to move through and interact with the world, you first need to know where the world is. This requires that saccades are fast, accurate, stable, and have very quick reaction times. As we have seen, the basal ganglia are critically involved in movement disorders. The basal ganglia are also involved in generation of saccades, which frequently become dysfunctional in movement disorders. Saccades can become slow to initiate, lose accuracy, and are easy to fatigue.

Research shows that the breakdown in saccades seen with Parkinson’s disease leads to postural instability (10), impairs the ability to turn (11), and leads to freezing of gait (12). Saccades have been shown to be impaired in cervical dystonia (13), essential tremor (14), ataxias (15), and myoclonus (16). We find that by rehabilitating saccades in a very precise manner, we can often improve balance, gait, and postural stability, as well as reduce unwanted spontaneous movements.

Another more complicated eye movement is called an anti-saccade, where a target is presented, and a person needs to inhibit the reflex to look at the target and instead consciously choose to look in the other direction. Anti-saccades are involved in a number of executive functions, and these give rise to foundational cognitive processes.

Research shows that anti-saccades break down in PD, leading to problems with planning, reasoning, and emotional regulation (17). We find that by rehabilitating these eye movements we can often restore some of the cognitive flexibility and emotional regulation lost to this disease.

Your program may include specific eye exercises to stimulate involved regions of the brain and cerebellum (18), or complex motor tasks to promote cerebellar and frontal lobe integration (19). It may include vestibular rehabilitation to improve balance, gait, and cognition (20), to visual optokinetic stimulation to improve motor control and postural stability (21, 22). It may include a number of different types of electrical stimulation to improve eye movements, balance, gait, tremor, cognition, blood pressure regulation, and even swallowing (23-25). It may even include therapies such as transcranial magnetic stimulation to improve motor function, emotional regulation and balance (26), and virtual reality exercises to improve the ability to function in the world and decrease fall risk (27).

No two movement disorder presentations are alike, and the same holds true for the NeuroRescue program. A cookie-cutter approach will be doomed to fail in a condition as complicated as a movement disorder.

It is one thing to know what to do, and another thing entirely to know when to stop. Even the ideal neurological therapy can become ineffective and even problematic when fragile brain systems are pushed beyond their limits.

By paying critical attention to your fatigability, we can ensure that all of your steps are moving forward, and none of them are steps backward. This enables us to get our best results in the shortest possible time. More importantly, it allows you to move beyond your condition and begin to engage in the world normally again.

The changes we see in a short period of time are often dramatic. At the end of our treatment, most people usually need to spend a few minutes per day performing some of their exercises to maintain their gains.

While our therapies do not cure the underlying condition, people can often regain control of their bodies and can return to full engagement in their lives.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that have been impacted by your movement disorder. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to help you live a healthy, vibrant, and fulfilling life.

Your Next Best Step:

Living with a movement disorder is challenging, but many of the symptoms can be manageable, function can be enhanced, and quality can often be significantly improved.

To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.

And remember, it’s never too late to start getting better.