Dysdiadochokinesia in MS: Symptoms, Tests, Exercises, and More

Dysdiadochokinesia (DDK) refers to the inability to perform rapid, alternating muscle movements, such as flipping one's hand from back to front on a flat surface, or screwing in a light bulb. DDK can cause problems with upper and lower limbs as well as with speech. This problem is often seen in people with multiple sclerosis (MS) or other conditions that impair coordination.

To diagnose dysdiadochokinesia, a neurologist will perform a series of tests to examine speech and rapid, alternating movements. DDK can be difficult to treat, but a combination of occupational and physical therapy may help manage symptoms, preserve independence, and prevent falls.

This article explains the symptoms and causes of dysdiadochokinesia, along with how it is diagnosed and treated.

Symptoms of Dysdiadochokinesia

Dysdiadochokinesia refers to the inability to perform rapid movements that involve a rapid change in motion. This might include:

• Rhythmic finger tapping
• Rapid foot tapping
• Opening and closing of the fists
• Screwing in a lightbulb
• Repeating varied syllables

DDK typically affects the muscles in the arms, hands, legs, and feet, as well as the muscles in the larynx (voice box) that control speech.

Dysdiadochokinesia is considered a symptom of a group of neurological problems known as ataxia. People with ataxia can present with the following symptoms:

• Problems with balance and walking, including slowness, or awkward movements
• Poor coordination of the arms, hands, or legs
• Slurring or incomprehensible speech
• Difficulties with swallowing
• Difficulty stopping one movement and starting another in the opposite direction
• Tremors and weakness
• Slow eye movements
• Loss of sensitivity in the hands and feet

Dysdiadochokinesia Causes

It's believed that dysdiadochokinesia is often caused by lesions in the cerebellum, a part of the brain that controls voluntary muscle movements, posture, and balance. Damage to the cerebellum can also result in hypotonia, or decrease in muscle tone, which can contribute to the problem.

In addition, dysdiadochokinesia can also be associated with a gene mutation that affects neurotransmitters—the chemicals that communicate information throughout our brain and body.

Diagnosing Dysdiadochokinesia

Typically, a neurologist will perform tests that lead to a diagnosis of dysdiadochokinesia. These tests include:

• Having the patient alternately flip each hand from palm side up to palm side down as quickly as possible on a stable surface like a table
• Asking the patient to demonstrate the movement of turning a doorknob or screwing in a lightbulb
• Having the patient tap their foot quickly on the floor or examiner’s hand
• Asking the patient to repeat syllables such as “papa,” “kaka,” “lala”

A person with dysdiadochokinesia will be unable to perform the above tests in a correct and coordinated fashion. Their movements may be slowed, unusual, or clumsy.

Treatment

Treating dysdiadochokinesia and cerebellar ataxia, in general, is challenging, and there are no specific strategies that are scientifically supported at this time.

A 2014 study in the Journal of Neurology found that physical therapy and occupational therapy may provide some benefit. Strength training, balance exercises, treadmill walking and exercises to improve core strength may all be helpful; speech therapy may also be necessary.

Learning strategies for how to prevent falls and modifying the home (for example, installing grab rails, removing loose carpets, and placing nonskid mats) can help keep someone with DDK safe.

Summary

Dysdiadochokinesia (DDK) is a symptom of ataxia often seen in people with multiple sclerosis. DDK most often affects the muscles in the arms, legs, and larynx. As a result, people with DDK have difficulty performing rapid, alternating movements, which can lead to issues with coordination and speech.

Neurologists diagnose DDK by asking their patients to perform a series of tasks, such as rapidly flipping their hands over or tapping their feet. While there is no known “cure” for DDT, seeking out medical advice and working with physical and occupational therapists can help you keep symptoms down to a manageable level.