How Neurological Conditions Affect Body Movements

While basic movements may appear simple, any movement is the result of a complex process involving communication between nerves, muscles, and several parts of the brain.  Nerves of the spinal cord modulate the constant flow of information between brain and muscles, regulating all the elements associated with smooth action.  Movement disorders result from changes to specific regions of the brain or nervous system.  An assortment of neurological conditions affects body movements, and many of them worsen over time.

If troubling symptoms are present, it’s important to see a doctor as soon as possible.  Early treatment can slow disease progression.  Specialists help patients to manage pain and symptoms in order to improve their quality of life.  To help you determine if you or a loved one might need to visit a specialist, we’ll take a look at the characteristics of some of the most common movement disorders.

Parkinson’s Disease 

Parkinson’s Disease is a progressive disorder caused by a combination of genetic and environmental factors.  Degeneration of nerve cells in the substantia nigra, a part of the brain controlling movement, causes cells to die or become damaged, losing their ability to produce dopamine.  The symptoms of Parkinson’s include rigidity, bradykinesia, akinesia, tremors, and postural instability.  Rigidity and the ensuing jerky movements occur when muscles are resistant to movement.

One of the classic symptoms of Parkinson’s is bradykinesia or slow movement.  Bradykinesia is characterized by a slow, shuffling walk.  Eventually it leads to akinesia, the loss of movement.  Tremors are frequently rhythmic and can briefly disappear during movement.  Postural instability manifests in stooped posture and sometimes a forward or backward lean, which can potentially lead to falls.

Huntington’s Disease 

Huntington’s Disease is a progressive, degenerative, and fatal condition caused by deterioration of nerve cells in the brain.  It causes uncontrollable jerking movements in the arms, legs, torso, and face.  Other difficulties include rigidity, abnormal eye movements, impaired speech, and trouble speaking and swallowing.  Huntington’s is an inherited disease.

Lou Gehrig’s Disease / ALS (Amyotrophic Lateral Sclerosis)

Lou Gehrig’s Disease is a rapidly progressing disease that attacks nerve cells controlling voluntary movement in the arms, legs, and face.  It leads to difficulty with walking and posture, tripping, weakness, slurred speech, and muscle cramps.  Eventually, the patient loses strength and the ability to move arms, legs, and body.

Tourette Syndrome 

Tourette Syndrome is a hereditary neurological disorder characterized by tics, which are repetitive, involuntary movements and vocalizations.  Examples of motor tics include blinking, grimacing, and shoulder shrugging.  Common vocal tics are throat clearing, grunting, coughing, and sniffing.

Tardive Dyskinesia 

Tardive Dyskinesia results from prolonged use of medications prescribed for the treatment of psychiatric conditions, including some types of antipsychotics and neuroleptics.  It’s characterized by involuntary movements such as grimacing, lip smacking, eye blinking, and rapid limb movements.  In some cases, tardive dyskinesia can be reversed after usage of the drug is terminated.

Ataxia 

Ataxia is a degenerative disorder caused by damage to the cerebellum, a part of the brain that controls voluntary movement.  It results in loss or decrease of control over fine motor skills.  Patients frequently display an unsteady gait, clumsiness, poor coordination, and eye twitching.  Walking, writing, and eating with utensils may become challenging.

Spasticity 

Spasticity occurs when injuries or a neurological disorder damage the pathways controlling voluntary movement.  Frequent culprits include multiple sclerosis, cerebral palsy, spinal cord injuries, strokes, and traumatic brain injuries.  Spasticity manifests in increased muscle contractions that cause stiffness, which then interferes with movement, speech, and walking.  Symptoms may not always be present; they can be brought on by rapid movement or sensory stimulation.

Essential Tremor 

Essential Tremor is an uncontrollable shaking or trembling, typically in one or both hands or arms.  It worsens with movement and can be absent at rest.  While Essential Tremor isn’t life-threatening, it progresses over time.  If symptoms become severe, they can interfere with holding things, eating, putting on makeup, shaving, writing, and even talking.

Dystonia 

Dystonia is caused by abnormal functioning of the basal ganglia, a deep part of the brain that helps control the coordination of movement.  Prolonged bursts of electrical activity create sustained, directional movement, which differs from the rhythmic back and forth nature of tremors.  Symptoms include uncontrollable twisting, repetitive movements, and abnormal posture.  Dystonia can affect the arms, legs, torso, eyelids, and vocal cords.  Its intensity increases during periods of stress and fatigue.

Restless Legs Syndrome 

Restless Legs Syndrome is a disorder of the nervous system that causes abnormal, uncomfortable sensations in the legs while lying down or relaxing.  Only movement relieves the itchy, pins and needles feeling.  While symptoms can come and go, they’re generally worst at night, leading to sleep issues.

Multiple System Atrophy (MSA) 

Multiple System Atrophy is a rare disease, a progressive and degenerative disorder that affects movement and involuntary bodily functions such as blood pressure.  MSA shares many characteristics of Parkinson’s, such as slow movements, rigid muscles, and poor balance.  Other symptoms include loss of coordination and difficulties with speech and swallowing.  MSA is eventually fatal.

Myoclonus 

Myoclonus, a muscle twitch, is a symptom rather than a disease itself.  It occurs when a muscle or group of muscles suddenly begins to twitch or jerk.  While hiccups are a completely normal, healthy form of myoclonus, episodes can be much more serious when caused by an underlying condition such as epilepsy or nervous system disorders.

If you suspect a movement disorder, a diagnosis can be made through magnetic resonance imaging (MRI), positon emission topography (PET), electromyography (EMG), and movement neurophysiology.  While there may be no cure, specialists can minimize symptoms and relieve pain.  Treatment options include medication, physical or occupational therapy, Botox injections, and a surgical procedure called deep brain stimulation.

Physical therapists assist patients by working with them on fall prevention, mobility, balance, walking, transfers, and posture re-education.  Occupational therapists help with daily activities such as dressing, feeding, grooming, bathing, and using the toilet.  An occupational therapist might work with a patient on skills including handwriting, computing, housework, and phone usage.  The goal of both physical and occupational therapy is maximum independence and quality of life.

This post was written by GSC Therapy and highlights many of the most common neurological conditions that may affect body movements.  Physical and/or occupational therapy can be a critical component in assuring that you maintain a maximal level of function and independence in order to age well even if you’re experiencing complex neurological conditions.

For more information on how to age well and how to self-treat and self-manage many of the most common musculoskeletal, neurological, and mobility related conditions, be sure to subscribe to my e-mail list and follow me on Facebook by liking The Physical Therapy Advisor!

About GSC Therapy

GS Consulting Group, LLC, was founded in 1997 by Gilbert Smith to provide vocational rehabilitation, job development and placement services and to consult with industry on services including job analysis and pre-employment testing.  In 2000, Kris Smith joined Gilbert and GSC Therapy Services was added to provide outpatient orthopedic therapy and industrial rehabilitation services.  GSC Therapy’s goal is to provide all of our patients with a positive therapy experience.  Feel Better.  Be Healthy.  Live Life.  www.gsctherapy.com

Q & A: A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis)

Q.  I have been diagnosed with Myasthenia Gravis.  It’s affecting my speech, swallowing, and general head, neck, and arm strength.  Are there certain activities that I should modify or avoid?  Which type of exercise can I perform in order to improve my function?  Owen

A.  Thanks for your question, Owen, as it presents an opportunity to discuss a very devastating autoimmune disease, Myasthenia Gravis (MG).  Your willingness and desire to maintain your strength and physical function despite the disease is an encouragement to others who may be suffering as well.

Approximately 50 million Americans (20 percent of the population or one in five people) suffer from autoimmune diseases.  Women are more likely than men to be affected.  Some estimates state that 75 percent of those affected are women.

Myasthenia Gravis (MG) is one of many different types of autoimmune diseases such as Rheumatoid Arthritis (RA), Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS, which is also known as Lou Gehrig’s Disease).

An autoimmune disorder occurs when the body’s immune system attacks and destroys different parts of the body because it has confused itself with a foreign body or invader.  The body’s own immunogenic response against itself is a challenging and difficult problem to fix.  Although there are many different and evolving treatment methods, most (if not, all) autoimmune disorders are not curable.

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In the case of MG, it’s considered a neurologic autoimmune disease because the immune system attacks the nerves that control certain muscles of the body.  Symptoms of MG vary wildly and sometimes can be quite severe.  Symptoms may include:

  • Muscle weakness
  • Drooping of one or both eyelids
  • Double vision
  • Altered speech
  • Difficulty swallowing
  • Problems chewing
  • Limited facial expressions
  • Weakness in your neck, arms, and legs.  (If the neck is weak, it may be hard to hold up your head.)

Proper medical management is critical in all cases of autoimmune diseases.  Those diagnosed with MG (or any other autoimmune disease) should always be medically managed by a specialist in the disease.  In most cases, management of MG will be overseen by a neurologist (preferably, with experience in treating MG and other neurologic autoimmune diseases).  

In order to best address any autoimmune disorder, a multifactorial approach to managing the disease should be implemented.  Although the condition may affect one specific aspect of your body, a healthy and balanced body will always function better and be more resilient to fight and thrive in spite of the condition.  In addition, it’s important that you and your loved ones learn as much about the disease as possible.

A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis):

  • Medical/Physician Management.  Depending on the condition and triggering events, this may include pharmacological management or surgical intervention.  In the case of MG, the trigger may be a tumor in the thymus gland.  Your physician may order a CT Scan of your chest to screen for a tumor.
  • Speech TherapyOften with MG or other autoimmune disorders, you may develop difficulties with swallowing.  I highly recommend that you work with a Speech Therapist (ST).  Speech therapists are highly trained medical professionals that specialize in treating disorders that affect swallowing, speech, and cognition.  They can use very specific treatment modalities from exercise to diet modification.  Neuromuscular electrical stimulation (NMES) can be utilized to help the muscles responsible for swallowing improve in strength and coordination.
  • Nutritional Management.  Consume foods that promote a low inflammatory diet, including a diet high in Omega-3 fatty acids and other natural herbs (like garlic and turmeric) which can naturally lower inflammation.  Consuming food that helps to support the immune system is important because the nervous system is affected by MG and other autoimmune diseases.  This includes a diet high in Omega-3 fatty acids and having adequate Vitamin D3 levels.  Include foods that support the nerves and are typically high in good fats such as avocados, coconut oil, and healthier fish (such as sardines and wild caught salmon).  If you’re experiencing difficulty with swallowing, be sure that your food is prepared in such a way that you can safely eat and that it’s in accordance to advice from your speech therapist.
  • Weight Management.  It’s important to manage your weight effectively.  Excessive body weight can cause additional stress on the body.  Whenever possible, work toward optimizing your health.  This includes maintaining a healthy body weight.  Depending on the autoimmune disease and your body in particular, this may also mean maintaining enough body weight.
  • Activity Modification.  As the disease progresses, it’s important to understand how your body is functioning, and then learn how to adapt to manage the disease.  Unfortunately, certain activities and how you perform them will need to be modified or avoided.  Learn to pace yourself and take more frequent rest breaks.  Adequate night time sleep is also critical.  If any of your joints are affected, learning to limit the use and strain on them will be important.  Utilize adaptive devices (such as a cane) in order to limit the strain placed on your body during activities.  An assistive device will allow you to be mobile and will reduce your risk of falling.
  • ModalitiesThis is a broad category, but there are many ancillary treatments that can be utilized to help you feel more comfortable.  The good news is that they rarely have associated side effects.  In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness.  Gentle massage and TENS (Transcutaneous Electrical Nerve Stimulation, a form of electrical stimulation performed by a physical therapist) may also be beneficial for pain relief.  TENS is different than the neuromuscular electrical stimulation (NMES) used by speech therapy.  TENS is used for pain control only.
  • Limit StressOften in cases of autoimmune disorders and in particular, MG, poor stress management will lead to worsening symptoms.  The ability to effectively manage stress will be critical in managing your symptoms.  There are many different methods to help you manage stress more effectively.  Common methods include:  meditation; journaling; deep breathing; Tai Chi; and yoga.  You may also need to reconsider certain friendships and relationships in your life.  The key to effectively managing stress is to find an enjoyable activity, and then stick with it.  This is a process–a journey (not a destination).
  • Exercise.  Implementing exercise in order to promote general health will not only help you to feel better, but it will optimize your well-being during this very difficult time.
    • Strength TrainingStrength training is encouraged, and the exercise program should be established by a professional who is familiar with managing MG.  All exercises should be performed in a slow and controlled environment within the available range of motion (ROM).  Maintaining muscle mass through strength training is critical and should be performed only one to two times per week to minimize any risk of over fatigue.
    • Endurance Training.  Endurance training is critical for general health and should be included as part of a comprehensive exercise program for individuals with MG.  Focus on less impact activities such as bicycling, rowing, and water aerobics.  Avoid excessive fatigue.
    • Flexibility TrainingFlexibility training is important for everyone as part of a healthy lifestyle.  Take every joint through a full ROM at least once a day.  I highly encourage a regular two to three times a week flexibility program in addition to a daily ROM program.  Tai Chi and yoga both also address aspects of strength and balance and are wonderful for managing stress.  Other options include:  Pilates; water aerobics; and a stretching routine.
    • Aquatic Therapy.  Water can also be very useful in pain control and help with relaxation.  Many find that performing a regular exercise program in an aquatic environment can satisfy most exercise needs, including flexibility and strength.

Managing an autoimmune disorder, such as MG, is difficult and everyone’s journey will be different.  Your specific treatment protocol should be individualized based on your specific condition, how the symptoms are affecting you (which will vary over time), and your current health status.

Thanks, Owen, for the question.  I hope you find this information to be helpful as you manage your condition.

What has your experience with managing autoimmune disorders been like?  Are there any treatments that have or have not worked well for you?  Additional discussion can help others to manage these difficult diseases as well.  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.