Loss of coordination of movement when walking. Violation of coordination of movements. Various pathologies of the brain and spinal cord

This phenomenon is a neuromuscular disorder, which is characterized by a violation of the coordination of movements of the upper and lower extremities as well as gait.

Ataxia is a symptom of other diseases, which are sometimes caused by a genetic predisposition.

Symptoms of impaired coordination - what may indicate that the coordination of movements is impaired?

The pathology under consideration is characterized by the following manifestations:

1. Inability to maintain balance while standing. A person can stagger in different directions, falls are also possible. If the ailment in question makes itself felt exclusively in a standing position, they talk about static ataxia.
2. Error in balance (unsteadiness, falling on the side or back), which occur during any movements. If violations are manifested only at the time of the commission of motor acts, the doctor diagnoses dynamic ataxia.
3. Tremor of the limbs, which is barely noticeable when staying in calm state. A similar phenomenon becomes pronounced when a person is nervous or stressed.
4. Speech disorders. The patient speaks slowly or too quickly, sometimes confuses the order of words in a sentence, emphasizes each syllable in a word. Uncontrollable movements sometimes join this symptom. eyeballs, handwriting change. In some cases, hearing deteriorates.
5. Breathing errors (not always).

In some cases, the overall picture is supplemented by nausea, vomiting, migraines, dizziness.

Ataxia as a symptom - under what pathologies can coordination be impaired in an adult or a child?

The pathological condition under consideration refers to a secondary ailment. It does not occur by itself, but is a manifestation of a certain disease:

1. Violations in the functioning of the brain:

• Multiple sclerosis.
• characterized by an excess of cerebral fluid in the ventricular sector of the brain.
• Defects in development cranium and brain: Arnold-Chiari disease.
• Disseminated encephalomyelitis, as well as other pathologies resulting from the breakdown of myelin.
• Serious errors associated with the blood supply to the brain.
• Severe trauma to the skull, which led to malfunctions in the functioning of the brain.
• Pathological neoplasms in the cerebellum or brain.
• Stroke.

2. Intoxication of the body

This refers to intoxication that has developed against the background of poisoning with heavy metals, synthetic glue, sleeping pills

Ataxia in these cases is often episodic, and resolves itself after contact with these stimuli is stopped.

3. Metabolic disorders

4. Incorrect work of the vestibular apparatus

• Peripheral vestibulopathy - inflammatory processes in retrolabyrinthine structures, which are accompanied by hearing loss, spontaneous regular movement of the eyeballs.
• Labyrinthitis. In addition to ataxia, the patient complains of nausea, headache, increased body temperature. Similar phenomena are a consequence of inflammatory reactions in the inner ear.
• Tumor processes in the sheaths of the vestibular nerve.

5. Deficiency of vitamin B1, B12, E in the blood

This phenomenon is the result malnutrition or a consequence of alcoholism.

6. Hereditary diseases:

• Louis Bar syndrome. The first signs of the disease can be observed already in the first months after the birth of a child. Disturbances in the work of the vestibular apparatus worsen every year, and often by the age of 10 years the child loses the ability to walk. Big Picture complemented mental retardation, weak defensive reactions organism (at little patient often diagnosed with inflammation of the lungs, bronchi, sinusitis). In addition, these patients are prone to cancer.
• Friedreich's ataxia. It has an autosomal dominant inheritance pattern, and families where there are more consanguineous marriages high probability the birth of a child with similar abnormalities. Pathology manifests itself in initial stage gait disturbances. Further, in the course of progression, a tremor of the limbs, malfunctions of the heart, hearing loss, pathological changes skeleton (habitual dislocations of the joints, kyphoscoliosis, etc.).
• Ataxia Pierre-Marie. Has a chronic progressive nature. The disease often makes itself felt after crossing the 35-year milestone. The symptoms of static and dynamic ataxia are accompanied by facial expression disorders, mental state, as well as ptosis, visual impairment. This pathology has an autosomal dominant inheritance.

Classification of ataxia

Depending on which section of the brain or vestibular apparatus is damaged, there are several types of ataxia:

sensitive

Due to the fact that defects are localized in posterior fibers spinal cord, this type of ataxia is also called posterior columnar. hallmark the indicated deviation is an increase in symptoms in the absence of visual control.

Outwardly, the disease manifests itself as follows:

• Strong bending of the legs at the joints when walking, and lowering them to the floor with the whole sole. The patient has the impression that he is walking on a soft surface, therefore, when moving, he constantly looks at his lower limbs.
• Loss of sensation in the legs.
• Inability to feel the direction of motor acts.
• Obsessive motor operations with fingers.

vestibular (labyrinthine)

Occurs against the background of defects in the structure of one of the components, which forms vestibular apparatus. Main symptoms:

• Severe dizziness, which can be observed even at rest.
• Nausea.
• Vomit.
• Involuntary movement of the eyeballs.
• Hearing impairment. It often occurs with the development of vestibular ataxia against the background of ear diseases.

All these manifestations become more pronounced with a change in body position, or with sharp turn head.

Cortical (frontal)

The cause of the pathological condition under consideration is disturbances in the area of ​​the frontal lobe of the cerebral cortex. provoke this species ataxia can cause cancer, poor blood supply brain, abscesses.

Characteristic signs of the disease:

• Leaning, leaning over, or falling when turning.
• Shaky when moving. With extensive degenerative changes the patient cannot walk or even stand.
• Mental disorders in the form of hallucinations, loss of smell.

Cerebellar

It is a neuromuscular disorder that arose against the background of defects in the structure of the cerebellum, in which statistical and dynamic motor skills suffer.

Symptoms may vary, depending on the location and parameters of the affected area of ​​the cerebellum:

• Unsteadiness when moving, falling forward or backward. Errors associated with the coordination of movements increase with a sharp change in the position of the body, as well as with a change in the trajectory.
• Unusually wide stride.
• Speech is fast and slurred or slow. When speaking, the patient emphasizes each syllable.
• Handwriting changes due to . This symptom observed with damage to the cerebellar hemispheres.
• Uncontrolled eye movements.

In some medical sources, a separate place in the classification is given psychogenic ataxia. This pathology characterized by a bizarre gait on the part of the patient. It seems from the outside that he is skating or walking on stilts.

The condition under consideration often appears when hysterical fit- or as a result of a strong stressful situation.

Symptoms of impaired coordination, which serve as the basis for immediate medical attention

AT ambulance should call urgently in the event that violations of motor skills and dynamics of movements are accompanied by:

• An increase in body temperature.
• Vomiting and nausea.
• Strong dizziness.
• disorientation in space.
• hallucinations.
• A sharp increase in blood pressure and heart rate.

One or more of these symptoms may be signs of a stroke, traumatic brain injury, poisoning of the body, other pathological conditions that require urgent hospitalization.

Diagnosis and treatment of impaired coordination of movements in an adult or child

To identify the considered neuromuscular disorder, the following set of diagnostic measures can be used:

1. Conversation with the doctor, during which the following points are clarified:

• Time of appearance of complaints of problems with walking.
• The presence of similar complaints among the next of kin of the patient.
• Taking powerful drugs.

2. Examination by a neurologist and ENT doctor

3. General analysis of blood, urine,

Here they pay attention to the erythrocyte sedimentation rate, the number of leukocytes, the level of amino acids in the urine.

4. DNA test for suspected hereditary ataxia

5. The concentration of vitamins of group B, E in the blood

6. Electroencephalography

It makes it possible to identify the diffuse activity of different sections of the brain, which can vary in the presence of certain pathologies.

7. Magnetic resonance angiography

By means of this technique, blood vessels that supply the brain.

8. CT and MRI of the head, spinal cord

It helps to study in detail the structure of the brain, to examine the material for the presence of tumor formations, abscesses, hemorrhages.

Ataxia(from the Greek ataxia - disorder) - a disorder of coordination of movements; a very common dysmotility. Strength in the limbs is slightly reduced or completely preserved. Movements become inaccurate, awkward, their continuity and sequence are upset, balance is disturbed in a standing position and when walking. Static ataxia - imbalance in a standing position, dynamic ataxia- lack of coordination during movement. Diagnosis of ataxia includes neurological examination, EEG, EMG, MRI of the brain, if the hereditary nature of the disease is suspected - DNA analysis. Therapy and prognosis for the development of ataxia depend on the cause of its occurrence.

Development cortical ataxia(frontal) is caused by damage to the frontal lobe of the brain caused by dysfunction of the fronto-pontocerebellar system. With frontal ataxia, the leg contralateral to the affected cerebellar hemisphere suffers to the maximum extent. When walking, instability is observed (to a greater extent on turns), tilt or collapse to the side ipsilateral to the affected hemisphere. In severe lesions of the frontal lobe, patients cannot walk or stand at all. Visual control does not affect the severity of violations when walking. Cortical ataxia other symptoms characteristic of damage to the frontal lobe are also characteristic - a grasping reflex, changes in the psyche, a violation of smell. The symptom complex of frontal ataxia is very similar to cerebellar ataxia. The main difference of the cerebellar lesion is demonstrative hypotension in the atactic limb. The causes of frontal ataxia are abscesses, tumors, cerebrovascular accidents.

hereditary cerebellar Pierre-Marie ataxia- a hereditary disease of a chronic progressive nature. It is transmitted in an autosomal dominant manner. Its main manifestation is cerebellar ataxia. The pathogen has a high penetrance, skipping generations is very rare. A characteristic pathoanatomical sign of Pierre-Marie's ataxia is cerebellar hypoplasia, less often - atrophy of the inferior olives, the pons of the brain (pons varoli). Often these signs are combined with combined degeneration. spinal systems (clinical picture reminiscent of Friedreich's spinocerebellar ataxia).

The median age of onset is 35 years, when gait disturbance appears. Subsequently, it is joined by a violation of facial expressions, speech and ataxia in the hands. There is static ataxia, adiadochokinesis, dysmetria. Tendon reflexes are increased (to pathological reflexes). Involuntary muscle tremors are possible. The strength in the muscles of the limbs is reduced. Progressive oculomotor disorders are observed - paresis of the abducens nerve, ptosis, insufficiency of convergence, less often - Argyle Robertson's symptom, atrophy of the optic nerves, decreased visual acuity, narrowing of the visual fields. Mental disorders manifested in the form of depression, decreased intelligence.

Familial Friedreich ataxia- a hereditary disease of a chronic progressive nature. It is transmitted in an autosomal dominant manner. Its main manifestation is mixed sensory-cerebellar ataxia resulting from a combined lesion of the spinal systems. Blood marriages are very common among the parents of patients. A characteristic pathoanatomical sign of Friedreich's ataxia is the progressive degeneration of the lateral and posterior columns of the spinal cord (up to medulla oblongata). Goll's bundles are more affected. In addition, the cells of Clark's pillars are affected, and with them the posterior spinocerebellar pathway.

The main symptom of Friedreich's ataxia is ataxia, which is expressed in an uncertain, awkward gait. The patient walks with a flourish, deviating from the center to the sides and placing his feet wide. Charcot designated such a gait as tabetic-cerebellar. With the development of the disease, discoordination extends to the hands, muscles chest and face. Facial expressions change, speech becomes slow, jerky. Tendon and periosteal reflexes are significantly reduced or absent (primarily on the legs, later on upper limbs). In most cases, hearing is reduced.

With the development of Friedreich's ataxia, extraneural disorders appear - heart damage and skeletal changes. On the ECG - deformation of the atrial wave, rhythm disturbance. There is paroxysmal pain in the heart, tachycardia, shortness of breath (as a result physical tension). Changes in the skeleton are expressed in a characteristic change in the shape of the foot - a tendency to frequent dislocations of the joints, an increase in the arch and extension of the fingers, as well as kyphoscoliosis. Among the endocrine disorders that accompany Friedreich's ataxia, diabetes, hypogonadism, and infantilism are noted.

Ataxia-telangiectasia(Louis-Bar syndrome) is a hereditary disease (a group of phakomatoses) transmitted in an autosomal recessive manner. Very often accompanied by dysgammaglobulinemia and hypoplasia thymus. The development of the disease begins at an early age. childhood when the first ataxic disorders appear. In the future, ataxia progresses and by the age of 10 walking is almost impossible. Often, Louis-Bar syndrome is accompanied by extrapyramidal symptoms (hyperkinesis of the myoclonic and athetoid type, hypokinesia), mental retardation, damage cranial nerves. A tendency to repeated infections (rhinitis, sinusitis, bronchitis, pneumonia) is characteristic, which is primarily due to the lack of immunological reactions of the body. Due to the deficiency of T-dependent lymphocytes and class A immunoglobulins, the risk of malignant neoplasms is high.

Complications of ataxia

• A tendency to recurrence reveals an axonal-demyelinating lesion of the sensory fibers of the peripheral nerves.

  When differentiating ataxia, it is necessary to take into account the variability of the clinical picture of ataxia. AT clinical practice there are rudimentary varieties of ataxia and its transitional forms, when the clinical manifestations are similar to those of familial paraplegia (spastic), neural amyotrophy and multiple sclerosis.

  Diagnosis of hereditary ataxia requires direct or indirect DNA diagnostics. With the help of molecular genetic methods, ataxia is diagnosed in a patient, after which indirect DNA diagnostics are performed. With its help, the possibility of inheritance of the pathogen of ataxia by other children in the family is established. It is possible to conduct a comprehensive DNA diagnosis, it will require the biomaterial of all family members (the biological parents of the child and all other children of this parental couple). AT rare cases prenatal DNA diagnostics is indicated.

  Treatment and prognosis of ataxia

  Ataxia is treated by a neurologist. It is predominantly symptomatic and should include: general strengthening therapy (vitamins of group B, ATP, anticholinesterase agents); special complex gymnastic exercises Exercise therapy aimed at strengthening muscles and reducing discoordination. In Friedreich's ataxia, taking into account the pathogenesis of the disease, drugs that support mitochondrial function can play an important role in the treatment ( succinic acid, riboflavin, coenzyme Q10, vitamin E).

  For the treatment of ataxia-telangiectasia, in addition to the above algorithms, correction of immunodeficiency is necessary. For this, a course of treatment with immunoglobulin is prescribed. Radiation therapy in such cases is contraindicated, in addition, excessive x-ray radiation and prolonged exposure to the sun.

  Prediction of genomic hereditary diseases unfavorable. There is a slow progression of neuropsychiatric disorders. The ability to work in most cases is reduced. However, thanks to symptomatic treatment and prevention of recurrence infectious diseases, injuries and intoxications, patients have the opportunity to live to an advanced age. FROM preventive purpose the birth of children in families where there are patients with hereditary ataxia should be avoided. In addition, it is recommended to exclude the possibility of any kindred marriages.

Dizziness are common cause visits to a doctor. They can range from mild and short-term to long-term, accompanied by severe imbalances that seriously disrupt the usual way of life.

Dizziness may be accompanied by the following sensations:

Weakness, "faintness", a state close to fainting, loss of consciousness.

Imbalance - a feeling of unsteadiness, in which there is a possibility of falling due to the inability to stand on one's feet.

Vertigo - dizziness, in which there is a sensation of rotation of the body or surrounding objects.

When talking with your doctor, try to describe your feelings in as much detail as possible. This will greatly facilitate the task of the specialist in identifying possible cause given state and choice of treatment.

The causes of dizziness are varied.: from the most basic, such as motion sickness, to diseases inner ear. Sometimes dizziness is a symptom of a life-threatening condition such as a stroke, as well as a sign of heart and blood vessel disease.

The most common causes of vertigo are diseases of the inner ear: benign paroxysmal positional vertigo (BPPV), infections of the inner and middle ear (otitis media), Meniere's disease, " seasickness"- motion sickness.

Benign paroxysmal positional vertigo (BPPV) is accompanied by a sensation of rotation of objects around the patient or a sensation of rotation of the patient himself ("everything is spinning in the head"). It is characterized by short-term attacks of one or another sensation, which can be provoked by certain positions of the head (tilting the head up or down), or occur only in lying position or when turning in bed, trying to sit up. Usually this type of vertigo is not threatening (unless it leads to falls) and responds well to adequately prescribed medication.

Special diagnosis of BPPV includes:

a neurological examination, during which the doctor will pay attention to what movements of the eyes or head can cause dizziness. If necessary, the doctor will conduct additional "vestibular tests" aimed at identifying "nystagmus" - involuntary movements of the eyeballs;

videonystagmography is a research method that also allows you to fix nystagmus with video camera sensors and analyze it in slow motion. The study is carried out in different positions of the head and body and allows us to find out if the disease of the inner ear is the cause of dizziness;

magnetic resonance imaging of the brain (MRI), which allows you to exclude the pathology of brain structures that can cause dizziness, for example, such benign neoplasm like a neuroma auditory nerve and etc.

Another common cause of dizziness is cerebral circulation, which lead to a decrease in the level of blood flow and insufficient supply of oxygen to the brain due to diseases and conditions such as:

Atherosclerosis of cerebral vessels (extracranial and intracranial).

Dehydration (dehydration).

Arrhythmias of cardiac activity.

orthostatic hypotension.

Acute cerebrovascular accident.

Transient ischemic attack(TIA).

Dizziness can also develop as a result of taking a certain group medicines, especially when their dosages are exceeded. Such a property may have:

Antidepressants.

Anticonvulsants.

Antihypertensive drugs (lowering arterial pressure).

Sedative drugs.

Tranquilizers.

Other common causes of dizziness include anemia, concussions, panic attacks, migraine, generalized anxiety disorder, hypoglycemia (low blood glucose levels).

If you experience dizziness, you should:

move more slowly (especially when moving from one position to another);

Drink plenty of fluids (being hydrated will make you feel better for many types of dizziness)

avoid excessive consumption of caffeine and nicotine (they can provoke a decrease in the level of cerebral circulation).

You should make an appointment to see a doctor if:

dizziness arose for the first time, or habitual dizziness has changed its characteristics (frequency of occurrence, duration of attacks);

difficulty walking up to total loss balance and fall;

hearing decreased.

Seek immediate medical attention if dizziness is caused by a head injury or is accompanied by at least one of the following symptoms:

chest pain;

palpitations, "flutter";

dyspnea;

visual or speech disturbances;

weakness in one or more limbs;

loss of consciousness lasting more than 2 minutes;

convulsions.

Violation of coordination of movement (ataxia) is a symptom of a certain pathological process that provoked a malfunction of the central nervous system, in particular the brain, less often than other body systems. Removal of the symptom requires complex diagnostics and elimination of the root cause. Self-medication is unacceptable, as it can lead to the development serious complications, not an exception to disability and death.

Etiology

Impaired coordination of movements in children or adults may be due to the following etiological factors:

• trauma to the brain or spinal cord;
• autoimmune diseases;
• physical exhaustion of the body;
• excessive consumption of alcoholic beverages;
• impact narcotic substances;
• muscular dystrophy;
• catalepsy - pathological process, which is characterized by weakening of the muscles as a result of a strong emotional shock, stress, a fit of anger;
• sclerotic changes;
• age-related changes in older people.

In addition, impaired coordination of movements can be observed in diseases of the musculoskeletal system.

Symptoms

To common features should include the following:

• unsteadiness of gait and standing;
• loss of clarity and coordination of movements;
• trembling of the limbs and head is noted;
• movements become unsteady;
• feeling and.

Depending on the main factor of movement disorders, clinical manifestations may be supplemented specific features that are characteristic of a particular disease.

In pathologies that affect the brain and central nervous system, such additional features:

• , for no apparent reason;
• dizziness;
• feeling of weakness in the legs;
• , possibly with seizures ;
• unstable blood pressure;
• change in the rhythm of breathing;
• psychoneurological disorders - visual or auditory hallucinations, delirium, impaired clarity of consciousness.

Due to the above violations, a person may fall. Depending on the degree of injury, the patient's consciousness may also be disturbed.

With physical exhaustion of the body, the following clinical picture can be observed:

• , even with a slight physical activity;
• nausea and vomiting;
• change in stool frequency and consistency;
• symptoms of muscle atrophy.

In diseases of the musculoskeletal system, the overall clinical picture can be supplemented pain syndrome in affected joints, impaired motor function, limited movement.

Regardless of what symptoms are present, if you have this symptom, you should immediately consult a doctor.

Diagnostics

First of all, the doctor clarifies the complaints, the anamnesis of the disease, the patient's life, after which he conducts a thorough objective examination of the patient. To determine the underlying factor, the following laboratory and instrumental diagnostic methods are carried out:

• general analysis of blood and urine;
• deployed biochemical analysis blood;
• ultrasound procedure internal organs.

Depending on the current clinical manifestations, the diagnostic program can be adjusted. The doctor describes the tactics of treatment only after setting accurate diagnosis, which is established on the basis of the results of the survey.

Treatment

The elimination of this disorder is carried out in a complex manner. Basic therapy will depend on the underlying factor. Medical treatment may include taking the following medications:

• neuroprotectors;
• nootropics;
• activators of cellular metabolism.

Except drug treatment, the program must be signed exercise. Gymnastics in violation of balance and coordination allows you to speed up the process of recovery and rehabilitation.

As for prevention, in this case there are no specific recommendations, since this is not individual disease, a nonspecific symptom. At the first symptoms, you should consult a doctor, and not self-medicate.

Motor coordination is the ability to make precise, purposeful movements.

Violation of coordination of movements means that there have been some violations of communications in the central nervous system. An extensive system of nerves is located in the space of the brain and spinal cord. The signal that you send to your muscles must pass through it in order to perform the movement of the arm, leg or other parts of the body. In violation of the central nervous system distortion or incorrect signal transmission occurs.

Muscle control disorders can depend on many factors. This is a strong degree of exhaustion, alcohol and drug abuse, head injuries, multiple sclerosis, muscular dystrophies, Parkinson's disease, stroke and catalepsy ( rare form muscle weakness, which is noted in some individuals under the influence of strong emotions, such as anger or joy).
Impaired coordination of movements is dangerous for the patient, as this can lead to a fall and injury.

Impaired coordination of movements can be observed in elderly patients, as well as in people with neurological diseases such as after a stroke. Often, impaired coordination can be associated with changes in the musculoskeletal system (impaired coordinated muscle work, weakness in the muscles of the thigh and lower leg, etc.). Watching such people, one can notice that he has disorders of standing and walking, all movements become uncoordinated, loose, sweeping. A person cannot draw a circle in the air with his hand (it turns out a broken, zigzag line). Can not index finger right on the tip of the nose. The lack of stability during movement affects the handwriting of a person: the lines become crooked and run into each other, the letters become uneven, large.

Examples of impaired coordination of movements can be:

Shaking of the limbs or head (tremor)

Tremor can be quite significant or almost imperceptible. Sometimes it manifests itself during movement, in other cases - on the contrary, at the time of rest. The tremor may be exacerbated by anxiety and stress. Not enough strong muscles the torsos do not provide a solid, stable base for the movement of the arms and legs. As a result, when walking, the legs step unevenly, the steps become uneven, and unsteadiness occurs.

Ataxia

Loss of coordination of movements in case of injury frontal lobes brain, cerebellum, deep sensory pathways in the spinal cord and brain. It is manifested by a violation of balance when standing (static ataxia) or a disorder of coordination of movements (dynamic ataxia).

What diseases cause impaired coordination

Which doctors to contact if there is a violation of coordination