Motor Disorders

Motor disorders are involuntary or uncontrollable movements of the body is caused by malfunctions of the nervous system. They can result in involuntary movement or lack of intended movement. Motor disorders include tremors, jerks, twitches, contractions, spasms and jerking movements.

There are several motor disorders included in the DSM-5. These include developmental coordination disorder, stereotypical movement disorder, and tic disorders such as Tourette’s Disorder, persistent (chronic) motor or vocal tic disorder and provisional tic disorder.

Causes of motor disorders

The most common cause of most motor disorders is pathological changes in certain brain areas. Mutations in the cerebellum are usually the cause of most motor disorders. Moving involves many aspects of the brain working together to accomplish the task. Brain signals are necessary to instruct muscles to perform a particular action. Involuntary movements or involuntary actions occur when certain parts of the brain malfunction, which causes incorrect or uncontrollable signals sent to the brain and muscles.

Read: Body-Focused Repetitive Behavior

Developmental coordination disorder

A chronic neurological disorder characterized by developmental coordination disorder (DCD), developmental dyspraxia, or simply dyspraxia, beginning in childhood. This condition can also affect an individual’s ability to plan their movements and coordinate their actions because the brain messages are not correctly transmitted to their bodies. Skills of motor movement are impaired in children as they age according to their chronological age. When other neurological impairments such as cerebral palsy, multiple sclerosis, or Parkinson’s disease are absent from the patient’s history, only developmental coordination disorder (DCD) can be diagnosed.

Criteria include the following:

  • Although the child is intelligent for his or her age, there will be a significant reduction in motor coordination
  • It can be difficult for a child to manage motor coordination and planning in everyday life
  • There is no other medical condition responsible for difficulties with coordination
  • The motor coordination of a child that also experiences intellectual disability or other developmental disabilities is still disproportionately affected

Management

This is not a curable condition. It is instead treated with therapy. People suffering from this condition can benefit from physical therapy and occupational therapy.

It is helpful for people with this condition to find alternate methods of conducting activities or keeping organized, such as typing on a laptop instead of writing with a pen or keeping diaries and calendars. The Cochrane review of tasks-oriented interventions for developmental coordination disorder (DCD) concluded there was inconsistency and called for more research and controlled trials.

Read: Nail Picking Disorder

Statistics

It is more commonly associated with males than females, with an approximately four-to-one ratio of males to females. The exact number of people who have this disorder is unknown because there are no specific laboratory tests to detect it, making diagnosis one of eliminating all other possibilities. It affects approximately five to six percent of children.

Stereotypic movement disorder

A child’s daily activities should not be impaired if the child’s stereotyped movements are not distressing and the child is not distressed by them. A diagnosis of stereotypic movement disorder is needed when stereotyped behaviors significantly impair functioning. The only way to diagnose this disorder is to rule out other conditions with some tests, though no specific test is available. It has been reported that stereotypical movement disorder (SMD) occurs in association with Lesch-Nyhan syndrome, intellectual disability, and fetal alcohol exposure, or as a consequence of amphetamine use.

The DSM-5 calls for the following criteria to be used in diagnosing stereotypic movement disorder:

  • Self-injury or not
  • Other known illnesses or environmental factors
  • Level of severity

Stereotypic movement disorders (SMD) involve the repetition of repetitive movements such as head banging, arm-waving, hand-shaking, rocking, hitting, and skin-picking. Other repetitive movements include thumb-sucking, nail biting, trichotillomania, bruxism, and abnormal running or skipping.

Read: Tongue Biting Disorder

Statistics

The number of children with stereotypical movement disorders (SMD) is about 3% to 4%. The presence of stereotypies is an often physiological and transient phenomenon, with up to 60% of children with neurologically normal development showing some stereotypic behaviors or movements between two and five years old.

So, SMD is classified into two groups: primary and secondary, depending on whether another neuropsychiatric disorder is present as well. Individuals with intellectual disabilities are more at risk of SMD, however, they are not necessary for diagnosis. SMD occurs more frequently in boys and regardless of their age.

Treatment

Although no cure has been found for these disorders, some studies have analyzed the effectiveness of medication treatment, but parents have not reported that medication therapy was effective in treating symptoms. The benefits of behavioral therapy appear to outweigh the disadvantages of medication therapy.

Therapy aimed at reducing unwanted movement was found to provide a combination of awareness and reinforcement of other behaviors. Another study examined the effectiveness of parent-administered, home-based behavioral therapy, and this assessment indicated a significant improvement over baseline results.

Read: Cheek Biting Disorder

Tic disorders

Tourette syndrome (TS or Tourette’s)

Tourette syndrome (TS or Tourette’s) is diagnosed when a person displays the following signs and symptoms

  • A person with tics may exhibit at least two motor tics (for instance, blinking or shaking their shoulders) and at least one vocal tic (for example, humming, clearing the throat, or shouting a word or phrase), which may or may not be synchronized
  • Tics have been present for at least a year. Tissures can occur on and off throughout the day (generally in bouts), nearly every day or intermittently
  • Children who exhibit tics before they turn 18 years of age
  • An ailment not caused by taking medicine or other drugs, or caused by another medical problem (for example, seizures, Huntington disease or postviral encephalitis)

This disorder begins during childhood or adolescence and is characterized by tics and other motor movements. An individual with this condition has at least one vocal (phonic) tic and at least one movement (motor) tic. There are several common tics, including blinking, coughing, clear throats and wiggling the face.

In many cases, they are preceded by a muscular jerk or pain, can be temporarily suppressed, and generally manifest in the form of changes in location, intensity, and frequency. Tic disorders range from milder to more severe tic disorders like Tourette’s. Casual observers may not notice the tics.

Tourette’s syndrome has historically been viewed as a rare and bizarre disorder associated with coprolalia (the use of offensive or derogatory words and gestures). There are no longer considered to be many instances of Tourette’s in children in school-age; about 1% do have it, and coprolalia affects a minority of children.

Currently, there is no test specifically designed to diagnose Tourette’s; those who have it are not always correctly diagnosed since most cases are very mild, and tics for most children are reduced by the time they reach adolescence. The results are that many patients are not diagnosed or never seek medical care.

Although extreme Tourette’s symptoms occur rarely in adulthood, they are often sensationalized in the media, and only a small minority of people suffer from these debilitating symptoms. People with Tourette’s are not intellectually impaired, and they live normal lives.

Read: Dystonia Disorder

Persistent (chronic) motor or vocal tic disorder

Patients with persistent tic disorders must meet the following criteria:

  • If you blink or shrug your shoulders, you have motor tics (for example, humming), but not vocal tics (for example, yelling out a sentence)
  • Ticks occur frequently, almost daily, or on and off continuously for more than a year
  • Ticks appear before the age of 18
  • It is important to note that the onset of tics is not caused by taking medications or other products or by being ill (for example, seizure, Huntington’s disease or postviral encephalitis)
  • Do not have Tourette’s syndrome

Provisional tic disorder

Persons with provisional tic disorders must meet the following criteria:

  • If you blink or shrug your shoulders, or hum, clear your throat, or yell out words or phrases, you may have motor or vocal tics
  • These tics last no more than 12 months at a time
  • Begin before the age of 18
  • Tics that are not caused by medical conditions (such as Huntington disease or postviral encephalitis) or by taking medicine or other drugs
  • No Tourette’s or persistent vocal or motor tics

Read: Generalized Dystonia

Statistics

There are more male tic disorders than female tic disorders. Children between the ages of seven and twelve are most likely to experience tic disorders. Tic disorders affect up to one person out of 100, usually before puberty.

Treatment of tic disorders

It is impossible to cure Tourette’s or find a single treatment that works for this condition. Behavioral therapies are the most effective way of treating tics in the majority of cases, rather than medication. Any treatment plan must include education, and explanation alone can often provide enough assurance that no additional treatment is required.

There is a higher incidence of ADHD and OCD in those with Tourette’s who are referred to a specialty clinic than in the broader community of people with the disorder. When co-occurring diagnoses are correctly distinguished and treated, the individual often suffers more impairment than with tics alone.

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2 thoughts on “Motor Disorders – A Brief Overview

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