Incoordination (Ataxia)

What is incoordination or ataxia?

Incoordination is irregularity in movements resulting from inharmonious action of the muscles due to loss of voluntary control over them. Ataxia is incoordination of movements. The cerebellum is located behind the brain stem and controls functions of movement, mobility, balance and posture. When you are experiencing ataxia, it is often due to problems with your cerebellar function.

There are different forms of ataxia, but these all refer to problems with coordination. Some examples include:

• Cerebellar ataxia - Referring to problems with moving the limbs (arms and legs), eyes, or trunk. This is due to problems with your cerebellum, a part of your brain that controls motor skills (movement).
• Gait ataxia - Is incoordination of walking. This can be mild (shuffling gait) to severe (the person cannot walk at all).
• Postural ataxia - Refers to problems with coordinating movements in certain positions. For example, you may have trouble sitting or standing, due to your incoordination.

Ataxia may be a result of many diseases or conditions. Most commonly, it is due to medications. Some medications that may cause ataxia include:

• Chemotherapy drugs: High dose cytosine arabinoside (Ara-C), high bolus doses of fluorouracil (5-FU) or chlorambucil
• Antibiotics - such as aminoglycosides (gentamycin, tobramycin).
• Heart medications, such as betablockers, amiodarone

Other causes:

• Alcohol intoxication
• Problems with the anatomical structures of your body
• Endocrine diseases may cause ataxia
• Inflammation of your inner ear, caused by infection will lead to poor mobility, dizziness, ataxia, and imbalance.

What are some symptoms to look for?

• Changes in the way you walk, loss imbalance.
• The need to hold on to something to stay steady.
• Increasingly slow, irregular, or clumsy movements.
• Falling.
• Generalized weakness or tiredness, not being able to perform usual activities.
• Dizziness
• Double vision.
• Vertigo (feeling like the room is spinning around you).
• Hearing loss. Weakness in hearing. Muffled hearing.
• Blurred vision.
• Ringing in the ears.
• Changes in speech (i.e. slurred speech)
• Nausea and vomiting
• Difficulty with tasks such as writing your name, changing position from sitting to standing.
• Fever and/or chills (if infection or flu-like syndrome causing dizziness or imbalance)

Dizziness and problems with mobility and imbalance may be a symptom or sign of a serious problem. Notify your doctor if you experience any of the symptoms mentioned here.

Things you can do:

Notify your health care professional if noticing any of the symptoms described above so evaluation can occur.

Safety:

• With moderate imbalance, walk slowly and often. Walk with assistance if you are having severe dizzy episodes, weakness, or imbalance.
• If you are at risk for falling down due to weakness or ataxia:
• Remove throw rugs from your usual walking path in your home if you are at risk for falling down. Avoid clutter, if possible.
• Place track lighting, or keep the areas that you spend the most time in, well lit. this will prevent your chance of falling, if you are able to see more clearly.
• If you are at risk for falling down due to weakness or unsteady movements, and you live or spend most of the day alone, try to carry a cordless phone, or another device to notify someone if you fall down.
• Wear well-fitting shoes. Make sure the shoelaces or Velcro straps are tied tightly.
• Do not operate any heavy machinery. It is also important to be careful when taking new medications.
• Use any braces, canes, walker or other supportive devices prescribed by your health care professional.

Other therapies:

• Physical therapy (PT): May be recommended or requested to evaluate for safety concerns, optimize mobility and for assistance with other interventions as appropriate such as exercise for muscle strengthening or assistive devices.
• Occupational therapy (OT): If you are experiencing imbalance or problems with mobility, in general, you may be taught in OT how to do many tasks that you normally do, in a more effective manner.

To help prevent problems related to imbalance and poor mobility:

• Keep your bowels moving. People with poor mobility may become constipated (see managing side effects - constipation for additional information).
• Take deep breaths. It is necessary to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. This is especially important if you are unable to move around very often. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• If you smoke, you should quit. If you do not smoke, avoid smoke-filled rooms. Smoking can affect the way your medications work. Discuss with your healthcare provider techniques that can help you quit.
• Change position often (every 2 hours) to relieve pressure points.
• Move legs and arms for mobility. Use "pressing down the gas petal" motion, or make circling motions with your ankles to help prevent blood clots.

Other:

• Depending on the cause of imbalance and poor mobility problems, your symptoms may last a few days to a few months. It is important to follow all the instructions your healthcare provides.
• Exercise, under the supervision of your healthcare provider such as walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood (oxygenation).
• Make sure to get enough sleep at night. This may help to lessen trouble in the daytime with incoordination, fatigue and weakness. If you have trouble sleeping:
• Do not eat or exercise within 2 hours of bedtime
• Make the room dark
• If you have an electronic clock, or one with an illuminated face, turn the face away from you.
• Use the bed only for sleeping
• Keep a consistent schedule. Make sure you go to bed each night and wake up each morning, at the same time.
• Minimize daytime naps. If you must take a nap, do not sleep for more than an hour at a time. Longer naps will make you feel more tired, increase weakness and interrupt nighttime sleep.
• If these techniques do not work, consult your healthcare provider.
• If you experience weakness symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.