Movement disorders are a group of diseases and syndromes affecting the
ability to produce and control bodily movements.
It seems simple and effortless, but normal movement requires an
astonishingly complex system of control. Disruption of any portion of this
system can cause a person to produce movements that are too weak, too
forceful, too uncoordinated, or too poorly controlled for the task at
hand. Unwanted movements may occur at rest. Intentional movement may
become impossible. Such conditions are called movement disorders.
Abnormal movements are symptoms of underlying disorders. In some cases,
the abnormal movements are the only symptoms. Childhood disorders or
conditions that may cause abnormal movements include:
The incidence rates and demographics vary for different types of movement
disorders. Restless legs syndrome (RLS) affects approximately 12 million
people in the United States. The disorder can affect males and females and
can begin at any age, although it may become worse as a person gets older.
The most common ataxia is Friedreich's ataxia; in the United
States, it affects one in 50,000 people, both male and female.
Causes and symptoms
Movement is produced and coordinated by several interacting brain centers,
including the motor cortex, the cerebellum, and a group of structures in
the inner portions of the brain called the basal ganglia. Sensory
information provides critical input on the current position and velocity
of body parts, and spinal nerve cells (neurons) help prevent opposing
muscle groups from contracting at the same time.
To understand how movement disorders occur, it is helpful to consider a
normal voluntary movement, such as reaching to touch a nearby object with
the right index finger. To accomplish the desired movement, the arm must
be lifted and extended. The hand must be held out to align with the
forearm, and the forefinger must be extended while the other fingers
THE MOTOR CORTEX
Voluntary motor commands begin in the motor cortex, located on the outer
wrinkled surface of the brain. Movement of the right arm is begun by the
left motor cortex, which generates a large volley of signals to the
involved muscles. These electrical signals pass along upper motor neurons
through the midbrain to the spinal cord. Within the spinal cord, they
connect to lower motor neurons, which convey the signals out of the
spinal cord to the surface of the muscles involved. Electrical stimulation
of the muscles causes contraction, and the force of contraction pulling on
the skeleton causes movement of the arm, hand, and fingers.
Damage to or death of any of the neurons along this path causes weakness
or paralysis of the affected muscles.
ANTAGONISTIC MUSCLE PAIRS
The previous description of movement is too simple, however. One
important refinement to it comes from considering the role of opposing, or
antagonistic, muscle pairs. Contraction of the biceps muscle, located on
the top of the upper arm, pulls on the forearm to flex the elbow and bend
the arm. Contraction of the triceps, located on the opposite side, extends
the elbow and straightens the arm. Within the spine, these muscles are
normally wired so that willed (voluntary) contraction of one is
automatically accompanied by blocking of the other. In other words, the
command to contract the biceps provokes another command within the spine
to prevent contraction of the triceps. In this way, these antagonist
muscles are kept from resisting one another. Spinal cord or brain injury
can damage this control system and cause involuntary simultaneous
contraction and spasticity, an increase in resistance to movement during
Once the movement of the arm is initiated, sensory information is needed
to guide the finger to its precise destination. In addition to sight, the
most important source of information comes from the "position
sense" provided by the many sensory neurons located within the
limbs (proprioception). Proprioception is what allows a person to touch a
finger to his or her nose, even with eyes closed. The balance organs in
the ears provide important information about posture. Both postural and
proprioceptive information are processed by a structure at the rear of the
brain called the cerebellum. The cerebellum sends out electrical signals
to modify movements as they progress, "sculpting" the
barrage of voluntary commands into a tightly controlled, constantly
evolving pattern. Cerebellar disorders cause inability to control the
force, fine positioning, and speed of movements (ataxia). Disorders of the
cerebellum may also impair the ability to judge distance so that a person
under- or over-reaches the target (dysmetria). Tremor during voluntary
movements can also result from cerebellar damage.
THE BASAL GANGLIA
Both the cerebellum and the motor cortex send information to a set of
structures deep within the brain that help control involuntary components
of movement (basal ganglia). The basal ganglia send output messages to the
motor cortex, helping to initiate movements, regulate repetitive or
patterned movements, and control muscle tone.
Circuits within the basal ganglia are complex. Within this structure, some
groups of cells begin the action of other basal ganglia components and
some groups of cells block the action. These complicated feedback circuits
are not entirely understood. Disruptions of these circuits are known to
cause several distinct movement disorders. A portion of the basal ganglia
called the substantia nigra sends electrical signals that block output
from another structure called the subthalamic nucleus. The subthalamic
nucleus sends signals to the globus pallidus, which in turn blocks the
thalamic nuclei. Finally, the thalamic nuclei send signals to the motor
cortex. The substantia nigra, then, begins movement and the globus
pallidus blocks it. This complicated circuit can be disrupted at several
Disruptions in other portions of the basal ganglia are thought to cause
, tremors, dystonia, and a variety of other movement disorders, although
the exact mechanisms are not well understood.
Some movement disorders, including Huntington's disease and
inherited ataxias, are caused by inherited genetic defects. Some diseases
that cause sustained muscle contraction limited to a particular muscle
group (focal dystonia) are inherited, but others are caused by trauma. The
cause of most cases of Parkinson's disease is unknown, although
genes have been found for some familial forms.
Abnormal movements are broadly classified as either hyperkinetic (too much
movement) and hypokinetic (too little movement). Hyperkinetic movements
Hypokinetic movements include:
Diagnosis of movement disorders requires a careful medical history and a
thorough physical and neurological examination.
The medical history helps the physician evaluate the presence of other
conditions or disorders that might contribute to or cause the disorder.
Records of previous diagnoses, surgeries, and treatments are reviewed. The
medical history is evaluated to determine if there is a history of
muscular or neurological disorders. Genetic testing is available for some
forms of movement disorders.
The physical and neurological exams may include an evaluation of the
child's motor reflexes, including muscle tone, mobility, strength,
balance, and endurance; heart and lung function; cranial nerve function;
and an examination of the child's abdomen, spine, throat, and ears.
The child's height, weight, and blood pressure also are checked and
recorded. Routine blood and urine analyses are performed.
Brain imaging studies are usually performed. Imaging techniques include
scan (CT scan), positron emission tomography (PET), or
magnetic resonance imaging
(MRI) scans. A lumbar puncture (spinal tap) may be necessary. Video
recording of the abnormal movement is often used to analyze movement
patterns and track progress of the disorder and its treatment.
Other tests may include
of the spine and hips or diagnostic blocks with local anesthetics to
provide information on the effectiveness of potential treatments.
To aid diagnosis, a multi-disciplinary team may be consulted so the proper
treatment can be planned. Occupational and physical therapy evaluations
may be helpful to determine upper and lower extremity movement patterns
and passive range of motion.
In some cases, nerve conduction studies with electromyography of the
affected muscles may be performed to evaluate the child's muscular
activity and provide a comprehensive
of nerve and muscle function.
In both tests, the examiner uses a computer, monitor, amplifier,
loudspeaker, stimulator, and high-tech filters to see and hear how the
muscles and nerves are responding during the test. In the nerve conduction
study, small electrodes are placed on the skin over the muscles to be
examined. A stimulator delivers a very small electrical current (that does
not cause damage to the body) through the electrodes, causing the nerves
to fire. In the electromyogram, a very thin, sterilized needle is inserted
into various muscles. The needle is attached by wires to a recording
machine. The patient is asked to relax and contract the muscles being
examined. The electrical signals produced by the nerves and muscles during
these tests are measured and recorded by a computer and displayed as
electrical waves on the monitor. The test results are interpreted by a
specially trained physician.
An EEG (
) may be performed to detect seizures, analyze general brain
functioning, and measure brain activity associated with movement or
sensation. This test measures the electrical signals from the brain.
Surface electrodes attached to the scalp measure voltages in the brain.
The electrical activity can be measured while the child is resting or, in
some cases, when the child is moving. An evoked potentials study may be
part of the EEG test. Evoked potentials record the response of the brain
to a sensory, visual, or auditory stimulus.
Treatment of a movement disorder begins with a proper diagnostic
evaluation. Treatment options include physical and occupational therapies,
medications, surgery, or a combination of these treatments.
The goals of treatment are to increase the child's comfort,
, ease mobility, help with activities of daily living such as hygiene,
ease rehabilitation procedures, and prevent or decrease the risk of
developing a joint contracture. The type of treatment recommended will
depend upon the severity of the disorder; the child's overall
health; the potential benefits, limitations, and side effects of the
treatment; and the impact of the treatment on the child's quality
Clinicians should work with the child and parents or caregivers to develop
an individual treatment plan. Specific treatment goals will vary from one
person to the next. Treatment should be provided by a movement disorders
specialist or specially trained pediatric neurologist and a
multi-disciplinary team of specialists that may include a physiatrist,
physical therapist, occupational therapist, gait and movement specialists,
social worker, and surgical specialists as applicable, such as a pediatric
orthopedic surgeon or pediatric neurosurgeon.
In some cases, treatment is not recommended or desired, because it would
actually interfere with the patient's current mobility and it would
not improve function. For example, some people with multiple sclerosis who
experience significant leg weakness find that spasticity makes their legs
more rigid, helping them to stand, transfer to a chair or bed, or walk.
Physical therapy includes stretching exercises, muscle group strengthening
exercises, and range of motion exercises to prevent muscles from
shortening (contracture), preserve flexibility and range of motion, and
reduce the severity of symptoms. Exercises should be practiced daily, as
recommended by the physical therapist. Prolonged stretching can lengthen
muscles, and strengthening exercises can restore the proper strength to
affected muscles. Aquatic therapy also may be recommended, since there is
less stress on the body when in the water.
A physical therapist can instruct the patient on proper posture
guidelines. Proper posture is critical, especially while sitting and
sleeping, to maintain proper alignment of the hips and back. Balancing
is also important.
Occupational therapy may include splints, casts, or braces on the affected
arm or leg to enable proper limb positioning, and maintain flexibility and
range of motion. The therapy may include training for proper limb
positioning while seated in a wheelchair or lying in bed.
Physical and occupational therapists can provide guidelines on how to
adapt the child's environment to ensure
Medications can help compensate for some imbalances of the basal
ganglionic circuit. Drugs to treat movement disorders include oral
medications, injected medications, and continuous delivery medications.
These medications work by preventing nerves from signaling the muscles to
contract, thereby preventing muscle contractions.
If treatment with a single medicine fails to effectively treat the
disorder, a different medicine may be tried or an additional medicine may
be prescribed. The most important medication guidelines are to ensure that
the child takes the medication exactly as prescribed, and to never
discontinue any medication without first talking to the child's
doctor, even if the medication does not seem to be working or is causing
unwanted side effects.
Baclofen (Lioresal) is a muscle relaxant that works on nerves in the
spinal cord to reduce spasticity. The benefits of baclofen include
decreased stretch reflexes, improved passive range of motion, and reduced
muscle spasms, pain, and tightness. Side effects include drowsiness and
sedation, as well as weakness, decreased muscle tone, confusion, fatigue,
. Baclofen should not be taken with central nervous system depressants or
Levodopa (L-dopa) is a medication that is converted to dopamine in the
brain. Dopamine is a chemical that aids in the transmission of nerve
signals. Sinemet is a combination medication containing levodopa and
carbidopa. Carbidopa enables L-dopa to be converted to dopamine after the
L-dopa enters the brain, thereby lowering
the oral dose and decreasing side effects. Side effects include nausea,
, and low blood pressure.
Anticholinergics, including trihexyphenidyl (Artane) and benztropine
(Benztrop MES, Cogentin), block acetylcholine receptors in the brain.
Acetylcholine receptors are integral proteins that respond to the
neurotransmitter acetylcholine by opening a pathway in the membrane for
ion diffusion across the cell membrane. Side effects include dry mouth,
, urinary retention, and rapid heart rate. These side effects are usually
much less frequent in children than adults; therefore, much higher doses
are usually prescribed in children.
Benzodiazepines, such as diazepam (Valium), clonazepam (Klonopin,
Rivotril), and lorazepam (Ativan) act on the central nervous system to
improve passive range of motion, reduce muscle overactivity and painful
spasms, and provide overall relaxation. These medications are often taken
at night because they cause drowsiness, but they also can relieve muscle
spasms that interrupt
. Side effects include unsteadiness, loss of strength, low blood pressure,
gastrointestinal symptoms, memory problems, confusion, and behavioral
Dantrolene sodium (Dantrium) acts on the muscles to directly interfere
with the chemistry of the muscle contraction. It is generally used when
other medications are not effective. Benefits may include improved passive
movement, decreased muscle tone, and reduced muscle spasms, tightness, and
pain. Side effects include generalized weakness—including weakness
of the respiratory muscles—as well as drowsiness, fatigue,
diarrhea, and sensitivity to the sun. Liver problems may occur with this
medication, and frequent lab tests are performed to evaluate liver
Tizanidine (Zanaflex) acts on the central nervous system. It does not
usually cause reduced muscle strength. The most common side effect is
sedation, and other side effects include low blood pressure, dry mouth,
dizziness, and hallucinations. Liver problems may occur with this
medication, and frequent lab tests are performed to evaluate liver
A variety of other medications may be used to treat movement disorders,
including antiepileptic drugs that stimulate GABA receptors in the
brain's basal ganglia; neuroleptics that block dopamine D2-like
receptors; Clonidine (Catapres) and selective serotonin reuptake
inhibitors (SSRIs, such as fluoxetine, commonly known as Prozac) for the
treatment of tics; and channel modulators that affect the behavior of
channels that transport small molecules such as potassium, sodium, or
calcium across cell membranes.
Botulinum-toxin type A (Botox, Dysport) or type B (Myobloc) is injected
locally into the affected muscle group to relax the muscles in dystonia or
spasticity. It works by preventing nerves from sending signals to the
muscles that cause them to contract. Although the treatment takes one to
two weeks to reach its full effectiveness, the beneficial effects last
three to four months. Botulinum-toxin allows more normal limb positioning
and improved mobility. In some patients, the injections also decrease
pain. Injections may be used to make casting easier, ease the adjustment
of a new brace, or delay surgery.
Botulinum-toxin is made by the bacteria that cause
. However, the amount of botulinum-toxin injected to treat spasticity is
such a small amount that it would not cause botulism poisoning. This
treatment is very safe, and the injections can be given in a
doctor's office without the use of sedation or anesthesia.
Injections can be repeated, but should be spaced from three to six months
apart to avoid exceeding the recommended dose. Botulinum-toxin injections
may be used in combination with other treatments.
Botulinum-toxin injections are typically expensive and may not be covered
by insurance. A Reimbursement Hotline established by Allergan, the
manufacturer of Botox, is a resource for reimbursement questions: (800)
530-6680 or online at http://www.botox.com. Elan, the
manufacturer of Myobloc, also has resources available to answer questions
about reimbursement. Interested persons may call (888) 461-2255 or go
online at http://www.elan.com.
Alcohol and phenol are injected in combination, but are less common
treatments. The medications are injected directly onto nerves that supply
spastic muscles to destroy them. The injections cut off the signals to
those muscles, allowing them to relax. This treatment may be used to treat
spasticity in larger muscle groups closer to the trunk, such as the thigh
muscles. Although this treatment is generally less expensive than
botulinum-toxin injections, there are more serious side effects.
Short-term medications such as lidocaine, a local anesthetic, can be used
to assess the potential benefit of botulinum-toxin or alcohol and phenol
CONTINUOUS DELIVERY MEDICATIONS
Baclofen usually is taken as an oral medication but also can be delivered
directly into the spinal fluid when the oral medication does not
effectively control symptoms. An intrathecal baclofen delivery system,
surgically placed by a neurosurgeon, continuously releases prescribed
amounts of baclofen in small doses directly into the spinal fluid via a
small catheter and pump. This type of
delivery system causes fewer and less severe side effects than the oral
Pump refills and medication adjustments are generally made once every two
to three months after the initial dosage is established. The pump system
lasts from three to five years, at which time it needs to be replaced.
Surgery is only recommended when all other treatments have been tried and
have not effectively controlled the child's symptoms.
Selective dorsal rhizotomy surgery, also called selective posterior
rhizotomy, involves a surgical resection of part of the spinal nerve. By
cutting the sensory nerve rootlets that cause the spasticity, muscle
stiffness is decreased while other functions are maintained. Potential
benefits of this surgical procedure include pain relief, reduced
spasticity to improve walking or aid sitting in a wheelchair, increased
ability to bend at the waist, and improved use of the hands. Sometimes
rhizotomy results in improved breathing and better control of the arms,
legs, and head.
Thalamotomy is a surgical procedure used to destroy part of the thalamus,
which is thought to produce abnormal brain activity that causes tremor.
Pallidotomy is a surgical procedure used to destroy part of the globus
pallidus, which is thought to become overactive with certain disorders,
such as Parkinson's disease. Although effective, these surgeries
have significant risks, including paralysis, loss of vision, or loss of
speech if the precise location of the brain is not targeted during
surgery. With the advent of a less invasive approach called deep brain
stimulation, these surgeries have become less common.
Deep brain stimulation (DBS) is a way to inactivate the parts of the brain
thought to cause overactivity or tremor in certain muscles, without
destroying a part of the brain. It is currently a treatment option for
adult patients with Parkinson's disease, but research is underway
to determine if the procedure can benefit children with movement
During the DBS procedure, an electrode placed in a precise area of the
brain delivers small, electrical shocks to interrupt the abnormal brain
activity that leads to symptoms. The electrode has four metal contacts
that can be used in different combinations. A few patients may have
stimulators implanted on both sides of the brain, but this increases the
risk for complications. The electrode is connected by a wire to a
pacemaker-like device implanted under the skin in the chest. This device
generates the electrical shocks. The electrical stimulation can be
adjusted as the patient's condition progresses over time, and the
stimulator can be turned off in the event that other beneficial therapies,
such as brain cell transplantation, are performed.
Orthopedic surgery may be performed to correct a contracture. During
contracture release surgery, the tendon of a contractured muscle is cut,
the joint repositioned to a more normal angle, and a cast is applied.
Regrowth of the tendon to this new length occurs over several weeks
following surgery. After the cast is removed, physical therapy can help
strengthen the muscles and improve range of motion. This procedure is most
commonly performed on the Achilles tendon but may also be performed on the
knees, hips, shoulders, elbows, and wrists. Tendon transfer surgery is
another technique to treat contractures. During this procedure, the tendon
attached to a spastic muscle is cut and transferred to a different site,
preventing the muscle from being pulled into an abnormal position. The
disadvantages of these orthopedic procedures are that they are
irreversible and they may need to be repeated.
Other orthopedic surgeries that may accompany contracture release surgery
include osteotomy, in which a small wedge is removed from a bone to allow
repositioning. A cast is applied while the bone heals in a more natural
position. Osteotomy is more commonly performed on the bones in the hips or
feet. Arthrodesis is a fusing of bones that normally move independently,
to limit the ability of a spastic muscle to pull the joint into an
abnormal position. Arthrodesis is more commonly performed on the bones in
Transplantation of fetal cells into the basal ganglia has produced mixed
results in Parkinson's disease and is being researched for
application in other movement disorders.
Brief application (about 10 minutes) of cold packs to spastic muscles may
help ease pain and improve function for a short period of time.
Electrical stimulation may be used to stimulate a weak muscle to
counteract the action of a stronger, spastic muscle.
Alternative and complementary therapies include approaches that are
considered to be outside the mainstream of traditional health care. Among
the therapies that may be helpful are acupuncture, homeopathy, touch
therapies, postural alignment therapies, and biofeedback.
The progress made will depend on the individual and his or her condition.
Biofeedback training may be used to teach the patient how to consciously
reduce muscle tension. Biofeedback uses an electrical signal that
indicates when a spastic muscle relaxes. The patient may be able to use
biofeedback to learn how to consciously reduce muscle tension and possibly
Coenzyme Q10 supplements may be beneficial, as some people with movement
disorders may have low levels of this substance. Coenzyme Q10 is a natural
substance produced by the body that transports electrons during cellular
respiration, or the process in which cells get their energy from oxygen.
Initial trials of cannabinoids, the active ingredient in marijuana, have
shown promise in the treatment of muscle stiffness and limb straightening
associated with multiple sclerosis. Further research is needed to
determine the beneficial effects of marijuana-derived substances on
neuromuscular symptoms associated with movement disorders. Researchers
caution that smoking marijuana is dangerous, especially since there may be
other harmful substances mixed in with the illegal drug.
Before learning or practicing any particular technique, it is important
for the parent or caregiver and child to learn about the therapy, its
safety and effectiveness, potential side effects, and the expertise and
qualifications of the practitioner. Although some practices are
beneficial, others may be harmful to certain patients. Alternative
therapies should not be used as a substitute for medical therapies
prescribed by a doctor. Parents should discuss these alternative
treatments with the child's doctor to determine the techniques and
remedies that may be beneficial for the child.
Dietary guidelines are individualized, based on the child's age,
diagnosis, overall health, severity of disability, and level of
functioning. Specific nutritional problems, such as swallowing or feeding
difficulties, may be a concern in some patients and should be managed by a
team of specialists, including a speech therapist. Early identification,
treatment, and correction of specific feeding problems will improve the
health and nutritional status of the patient.
A well-balanced and carefully planned diet will help maintain general good
health for people with movement disorders. Specialists recommend that
people with multiple sclerosis and other movement disorders adhere to the
same low-fat, high fiber diet that is recommended for the general
population. A diet rich in fresh fruits and vegetables will ensure
adequate intake of antioxidants, substances that help protect against free
Children with movement disorders may have different energy needs,
depending on their condition. One study indicated that ambulatory and
non-ambulatory adolescents with cerebral palsy had decreased energy needs
compared with a control group of normal adolescents. Therefore, a
child's specific calorie needs should be evaluated by a registered
dietitian who can work with the parents to develop an individualized meal
plan. The child's weight should be obtained once a week or at least
once a month to determine if caloric intake is adequate.
A child's self-feeding skills can impact his or her health outcome.
One study indicated that 90 percent of children with good to fair motor
and feeding skills reached adulthood. In contrast, a lack of self-feeding
skills was associated with a six-fold increase in mortality (rate of
Maintaining a healthy weight is important to prevent the development of
chronic diseases such as diabetes, high blood pressure (
), and heart disease.
Tube feedings may be required in some patients with
failure to thrive
, difficulty swallowing, or an inability to ingest adequate calories
orally to maintain nutritional status or promote growth.
The prognosis for a patient with a movement disorder depends on the
specific disorder. There is no cure for movement disorders. However, they
can be well-managed with the proper combination of physical and
occupational therapies, medication, and surgery. The long-term outlook
depends on the severity of the disorder.
Prevention depends on the specific disorder.
—Spontaneous; produced by active efforts. Active range of motion
exercises are those that are performed by the patient without
Activities of daily living (ADL)
—The activities performed during the course of a normal day, for
example, eating, bathing, dressing, toileting, etc.
—Based on the same traditional Chinese medical foundation as
acupressure, acupuncture uses sterile needles inserted at specific
points to treat certain conditions or relieve pain.
—Lack of oxygen.
—A condition marked by impaired muscular coordination, most
frequently resulting from disorders in the brain or spinal cord.
Autonomic nervous system
—The part of the nervous system that controls so-called
involuntary functions, such as heart rate, salivary gland secretion,
respiratory function, and pupil dilation.
—A training technique that enables an individual to gain some
element of control over involuntary or automatic body functions.
—A potent bacterial toxin or poison made by
; causes paralysis in high doses, but is used medically in small,
localized doses to treat disorders associated with involuntary muscle
contraction and spasms, in addition to strabismus. Commonly known as
—Extremely slow movement.
Central nervous system
—Part of the nervous system consisting of the brain, cranial
nerves, and spinal cord. The brain is the center of higher processes,
such as thought and emotion and is responsible for the coordination and
control of bodily activities and the interpretation of information from
the senses. The cranial nerves and spinal cord link the brain to the
peripheral nervous system, that is the nerves present in the rest of
—A nonprogressive movement disability caused by abnormal
development of or damage to motor control centers of the brain.
—Involuntary movements in which the arms or legs may jerk or
—Involuntary rapid, irregular, jerky movements or slow, writhing
movements that flow into one another.
—Referring to clonus, a series of muscle contractions and partial
relaxations that alternate in some nervous diseases in the form of
Computed tomography (CT)
—An imaging technique in which cross-sectional x rays of the body
are compiled to create a three-dimensional image of the body's
internal structures; also called computed axial tomography.
—A tightening of the uterus during pregnancy. Contractions may or
may not be painful and may or may not indicate labor.
—A tightening or shortening of muscles that prevents normal
movement of the associated limb or other body part.
—Any abnormality in the structure or function of brain tissues.
—An uncontrollable (involuntary) shaking of the hands, head, and
face. Also called familial tremor because it is sometimes inherited, it
can begin in the teens or in middle age. The exact cause is not known.
—Small involuntary muscle contractions visible under the skin.
Fetal tissue transplantation
—A method of treating Parkinson's and other neurological
diseases by grafting brain cells from human fetuses onto the basal
ganglia. Human adults cannot grow new brain cells but developing fetuses
can. Grafting fetal tissue stimulates the growth of new brain cells in
affected adult brains.
—Deep sleep induced by a combination of medicines that allows
surgery to be performed.
—One of a group of hereditary degenerative diseases of the spinal
cord or cerebellum. These diseases cause tremor, spasm, and wasting of
—A holistic system of treatment developed in the eighteenth
century. It is based on the idea that substances that produce symptoms
of sickness in healthy people will have a curative effect when given in
very dilute quantities to sick people who exhibit those same symptoms.
Homeopathic remedies are believed to stimulate the body's own
—A rare hereditary disease that causes progressive chorea (jerky
muscle movements) and mental deterioration that ends in dementia.
Huntington's symptoms usually appear in patients in their 40s.
Also called Huntington's chorea.
—Reflexes that persist too long and may be too strong. For
example, a hyperactive grasp reflex may cause the hand to stay clenched
in a tight fist.
—Unusual flexibility of the joints, allowing them to be bent or
moved beyond their normal range of motion.
—Having excessive muscular tone or strength.
—A substance used in the treatment of Parkinson's disease.
Levodopa can cross the blood-brain barrier that protects the brain. Once
in the brain, it is converted to dopamine and thus can replace the
dopamine lost in Parkinson's disease.
—Pain-relieving medication used to numb an area while the patient
remains awake. Also see general anesthesia.
Magnetic resonance imaging (MRI)
—An imaging technique that uses a large circular magnet and radio
waves to generate signals from atoms in the body. These signals are used
to construct detailed images of internal body structures and organs,
including the brain.
—An expressionless look, caused by reduced movements of the face.
—A nerve cell that specifically controls and stimulates voluntary
—A progressive, autoimmune disease of the central nervous system
characterized by damage to the myelin sheath that covers nerves. The
disease, which causes progressive paralysis, is marked by periods of
exacerbation and remission.
—Localized muscle contraction that occurs when the brain signals
the muscle to contract.
—Involuntary contractions of a muscle or an interrelated group of
muscles. Also known as myoclonic seizures.
—A doctor who specializes in disorders of the nervous system,
including the brain, spinal cord, and nerves.
—Physician who performs surgery on the nervous system.
Nocturnal leg cramps
—Cramps that may be related to exertion and awaken a person
—A healthcare provider who specializes in adapting the physical
environment to meet a patient's needs. An occupational therapist
also assists patients and caregivers with activities of daily living and
provide instructions on wheelchair use or other adaptive equipment.
—A doctor specializing in treatment of the musculoskeletal
—A set of symptoms originally associated with Parkinson disease
that can occur as side effects of neuroleptic medications. The symptoms
include trembling of the fingers or hands, a shuffling gait, and tight
or rigid muscles.
—A slowly progressive disease that destroys nerve cells in the
basal ganglia and thus causes loss of dopamine, a chemical that aids in
transmission of nerve signals (neurotransmitter). Parkinson's is
characterized by shaking in resting muscles, a stooping posture, slurred
speech, muscular stiffness, and weakness.
—Movement that occurs under the power of an outside source such
as a clinician. There is no voluntary muscular contraction by the
individual who is being passively moved.
Periodic limb movement disorder
—A disorder characterized by involuntary flexion of leg muscles,
causing twitching and leg extension or kicking during sleep.
—Nerves outside the brain and spinal cord that provide the link
between the body and the central nervous system.
—A physician who specializes in physical medicine and
—A healthcare provider who teaches patients how to perform
therapeutic exercises to maintain maximum mobility and range of motion.
Positron emission tomography (PET)
—A computerized diagnostic technique that uses radioactive
substances to examine structures of the body. When used to assess the
brain, it produces a three-dimensional image that shows anatomy and
function, including such information as blood flow, oxygen consumption,
glucose metabolism, and concentrations of various molecules in brain
Progressive supranuclear palsy
—A rare disease that gradually destroys nerve cells in the parts
of the brain that control eye movements, breathing, and muscle
coordination. The loss of nerve cells causes palsy, or paralysis, that
slowly gets worse as the disease progresses. The palsy affects ability
to move the eyes, relax the muscles, and control balance. Also called
—A variety of unusual, involuntary movements that occur in
children with psychiatric disorders or in response to anxiety, stress,
depression, anger, or grief. Psychogenic movements are thought to
represent the physical expression of an intolerable mental conflict.
Range of motion (ROM)
—The range of motion of a joint from full extension to full
flexion (bending) measured in degrees like a circle.
Restless legs syndrome (RLS)
—A disorder in which the patient experiences crawling, aching, or
other disagreeable sensations in the calves that can be relieved by
movement. RLS is a frequent cause of difficulty falling asleep at night.
—A constant resistance to passive motion.
—Involuntary crossing of the legs.
Spinal cord injury
—Injury to the spinal cord, via blunt or penetrating trauma.
—Interruption of blood flow to a part of the brain with
consequent brain damage. A stroke may be caused by a blood clot or by
hemorrhage due to a burst blood vessel. Also known as a cerebrovascular
—A neurological disorder characterized by multiple involuntary
movements and uncontrollable vocalizations called tics that come and go
over years, usually beginning in childhood and becoming chronic.
Sometimes the tics include inappropriate or obscene language
—A rare, inherited disorder that causes excess copper to
accumulate in the body. Steadily increasing amounts of copper
circulating in the blood are deposited primarily in the brain, liver,
kidneys, and the cornea of the eyes. It can cause psychiatric symptoms
adaptive equipment that may be helpful. Some of these tips include:
Raising a child with a movement disorder can be challenging. Support
groups are available to provide information and assistance.
Jankovic, Joseph J., and Eduardo Tolosa. "A Guide to Movement
Parkinson's Disease and Movement Disorders.
4th ed. Philadelphia: Lippincott, Williams, and Wilkins, 2002: 704.
Fundamentals of Anatomy and Physiology.
Englewood Cliffs, NJ: Prentice Hall, 1989.
Watts, Ray L., and William C. Koller, eds.
Disorders: Neurologic Principles and Practice.
New York: McGraw-Hill, 1997.
"Position of the American Dietetic Association: Providing Nutrition
Services for Infants, Children and Adults with Developmental Disabilities
and Special Health Care Needs."
Journal of the American Dietetic Association
104, no. 1 (2004): 97–107.
"Task Force on Childhood Motor Disorders Consensus Report of a
Meeting at the National Institutes of Health." (2001): April
Brain Injury Association of America.
8201 Greensboro Dr., Ste. 611, McLean, VA 22102. (800) 444-6443 or (703)
761-0750. Web site: &;lt;http://www.biausa.org>.
Movement Disorders Society.
555 East Wells St., Suite 1100, Milwaukee, WI 53202-3823. (414) 276-2145.
Web site: http://www.movementdisorders.org.
National Center on Birth Defects and Developmental
Centers for Disease Control. 4770 Buford Highway., NE, Ste. F-35,
Atlanta, GA 30341. (770) 488-7080. Web site:
National Institute on Disability and Rehabilitation Research.
Office of Special Education and Rehabilitative Services. U.S. Department
of Education, 400 Maryland Ave., SW,
Washington, DC 20202-7100. (202) 245-7640. Web site:
National Institute of Neurological Disorders and Stroke
National Institutes of Health. P.O. Box 5801, Bethesda, MD 20824. (800)
352-9424 or (301) 496-5751. Web site:
National Rehabilitation Information Center (NARIC).
4200 Forbes Blvd., Ste. 202, Lanham, MD 20700. (800) 346-2742 or (301)
459-5900. Web site: http://www.naric.com.
National Spinal Cord Injury Association.
6701 Democracy Blvd., #300-9, Bethesda, MD 20817. (800) 962-9629 or (301)
214-4006. firstname.lastname@example.org. Web site:
WE MOVE (Worldwide Education and Awareness for
204 W. 84th St. New York, NY 10024. (800) 437-MOVE. Web site:
Spinal Cord Injury Information Network.
Available online at: http://www.spinalcord.uab.edu.