Definition

Uncoordinated movement is due to a muscle control problem that causes an inability to coordinate movements. It leads to a jerky, unsteady, to-and-fro motion of the middle of the body (trunk) and an unsteady gait (walking style). It can also affect the limbs.

The medical name of this condition is ataxia.

Alternative Names

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

Considerations

Smooth graceful movement requires a balance between different muscle groups. A part of the brain called the cerebellum manages this balance. If this does not happen properly, ataxia often results.

Ataxia can severely affect daily living activities.

Causes

Diseases that damage the cerebellum, spinal cord, or peripheral nerves can interfere with normal muscle movement. The result is large, jerky, uncoordinated movements.

Brain injuries or diseases that can cause uncoordinated movements include:

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

Poisoning or toxic effects caused by:

• Alcohol
• Certain medicines
• Heavy metals such as mercury, thallium, and lead
• Solvents such as toluene or carbon tetrachloride
• Illicit drugs

Other causes include:

• Certain cancers, in which uncoordinated movement 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 disease causing damage to the spinal cord (such as compression fractures of the spine)

Home Care

Physical therapy that includes swimming, stretching, walking, and balancing exercises can help with coordination and slow the damage. A home safety evaluation by a physical therapist may be helpful.

Take measures to make it easier and safer to move around at home. For example, get rid of clutter, leave wide walkways, and remove throw rugs or other objects that might cause slipping or falling. Make sure there is adequate lighting at night.

People with this condition should be encouraged to take part in normal activities. Family members need to be 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 their weaknesses.

Ask the health care provider whether walking aids, such as a cane or walker, would be helpful.

People with ataxia are prone to falls. Talk with the provider about measures to prevent falls.

Family support is important. It helps to openly discuss your feelings. Self-help groups are available in many communities. 

When to Contact a Medical Professional

Contact your 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 an emergency, you will first be stabilized so that symptoms do not get worse.

The provider will perform a physical exam, which may include:

• A detailed examination of the nervous system and muscles, paying careful attention to walking, balance, and coordination of pointing with fingers and toes.
• Asking you to stand up with your feet together and the eyes closed. This is called the Romberg test. If you lose your balance, this is a sign that your sense of position is reduced. In this case, 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 medicines 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 ordered include:

• Antibody testing to check for 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. If a specific problem is causing the ataxia, the problem will be treated. For example, if a medicine is causing coordination problems, the medicine may be changed or stopped. Other causes may not be treatable. The provider can tell you more.

References

Jankovic J, Lang AE. Diagnosis and assessment of Parkinson disease and other movement disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 24.

Okun MS, Lang AE. Other movement disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 382.