What is impaired coordination of movements? Treatment of vestibular disorders

Ataxia(from the Greek ataxia - disorder) - disorder of coordination of movements; a very common motor disorder. Strength in the limbs is slightly reduced or completely preserved. Movements become inaccurate, awkward, their continuity and consistency are disrupted, balance in a standing position and when walking is disturbed. Static ataxia is a violation of balance in a standing position, dynamic ataxia is a violation of coordination when moving. 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-pontine-cerebellar system. In frontal ataxia, the leg contralateral to the affected cerebellar hemisphere is most affected. When walking, there is instability (more so when turning), tilting or leaning to the side ipsilateral to the affected hemisphere. With severe lesions of the frontal lobe, patients cannot walk or stand at all. Vision control has no effect on the severity of walking disorders. Cortical ataxia is also characterized by other symptoms characteristic of damage to the frontal lobe - the grasping reflex, mental changes, and impaired sense of smell. The symptom complex of frontal ataxia is very similar to cerebellar ataxia. The main difference between cerebellar lesions is evidence of hypotonia in the ataxic limb. The causes of frontal ataxia are abscesses, tumors, and 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 high penetrance, skipping generations is very rare. A characteristic pathological sign of Pierre-Marie ataxia is cerebellar hypoplasia, less often - atrophy of the inferior olives, the pons (pons). Often these signs are combined with combined degeneration spinal systems(the clinical picture resembles Friedreich's spinocerebellar ataxia).

The average age of onset is 35 years when gait disturbance appears. Subsequently, it is accompanied by disturbances in facial expressions, speech and ataxia in the hands. Static ataxia, adiadochokinesis, and dysmetria are observed. Tendon reflexes are increased (to pathological reflexes). Involuntary muscle twitches are possible. Strength in the muscles of the limbs is reduced. Progressive oculomotor disorders are observed - paresis of the abducens nerve, ptosis, convergence insufficiency, less often - Argyll Robertson's symptom, optic nerve atrophy, decreased visual acuity, narrowing of visual fields. Mental disorders manifest themselves in the form of depression, decreased intelligence.

Familial Friedreich's 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 combined lesion spinal systems. Among the parents of patients, consanguineous marriages are very common. A characteristic pathological sign of Friedreich's ataxia is increasing degeneration of the lateral and posterior columns of the spinal cord (up to medulla oblongata). Gaulle's bundles are most affected. In addition, the cells of Clark's columns are affected, and along with them the posterior spinocerebellar tract.

The main symptom of Friedreich's ataxia is ataxia, expressed in an uncertain, clumsy gait. The patient walks in a sweeping manner, deviating from the center to the sides and placing his feet wide. Charcot designated this gait as a tabetic-cerebellar gait. As the disease progresses, incoordination spreads to the arms and muscles. chest and face. Facial expressions change, speech becomes slow and jerky. Tendon and periosteal reflexes are significantly reduced or absent (primarily on the legs, then on upper limbs). In most cases, hearing is reduced.

With the development of Friedreich's ataxia, extraneural disorders appear - cardiac lesions and skeletal changes. The ECG shows deformation of the atrial wave, rhythm disturbance. Observed paroxysmal pain in the heart, tachycardia, shortness of breath (as a result physical stress). Skeletal changes are expressed in characteristic change foot shape - a tendency to frequent dislocations of the joints, increased arches and extension of the toes, as well as kyphoscoliosis. Among the endocrine disorders accompanying Friedreich's ataxia are diabetes, hypogonadism, and infantilism.

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

Complications of ataxia

• A tendency to recurrence is revealed by axonal demyelinating damage to the sensory fibers of peripheral nerves.

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

  To diagnose hereditary ataxias, it is necessary to conduct direct or indirect DNA diagnostics. Using molecular genetic methods, ataxia is diagnosed in a patient, after which indirect DNA diagnostics are performed. With its help, the possibility of inheriting the ataxia pathogen by other children in the family is established. It is possible to carry out complex DNA diagnostics; it will require biomaterial from all family members (the child’s biological parents and all other children of this parental couple). IN in 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 (B vitamins, ATP, anticholinesterase drugs); special complex gymnastic exercises aimed at strengthening muscles and reducing incoordination. With Friedreich's ataxia, taking into account the pathogenesis of the disease, drugs that support mitochondrial functions can play a major role in treatment ( succinic acid, riboflavin, coenzyme Q10, vitamin E).

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

  The prognosis of genomic hereditary diseases is unfavorable. There is a slow progression neuropsychiatric disorders. Working capacity in most cases is reduced. However, thanks symptomatic treatment and preventing recurrences infectious diseases, injuries and intoxications, patients have the opportunity to live to old age. For preventive purposes, the birth of children in families where there are patients should be avoided. hereditary ataxia. In addition, it is recommended to exclude the possibility of any related marriages.

Dizziness is common cause visiting a doctor. They can range from mild and short-lived to long-term, accompanied by severe imbalances that seriously impair familiar image life.

Dizziness may be accompanied by the following sensations:

Weakness, “lightheadedness”, a state close to fainting, loss of consciousness.

Impaired balance is a feeling of instability in which the likelihood of falling is felt due to the inability to stand on one’s feet.

Vertigo is dizziness that causes 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 a specialist in identifying possible reason of this state and selection 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 disease and blood vessels.

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

Benign paroxysmal positional vertigo (BPPV) is accompanied by a sensation of objects rotating around the patient or a sensation of rotation of the patient himself (“everything is spinning in the head”). Characterized by short-term attacks one or another sensation that can be provoked by certain positions of the head (throwing the head up or down), or occur only in a lying position or when turning in bed, trying to sit up. Typically, this type of dizziness is not dangerous (unless it leads to falls) and responds well to adequately prescribed drug therapy.

Special diagnostics for BPPV include:

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

Videonystagmography is a research method that also allows you to record “nystagmus” with video camera sensors and analyze it in slow motion. The test is carried out in different positions of the head and body and allows us to find out whether a disease of the inner ear is the cause of vertigo;

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

Another common cause of dizziness is disorders cerebral circulation, which lead to decreased blood flow and insufficient oxygen supply 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 may also develop as a result of taking a certain group of medicines, especially when their dosages are exceeded. The following may have a similar property:

Antidepressants.

Anticonvulsants.

Antihypertensive drugs (lowering arterial pressure).

Sedatives.

Tranquilizers.

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

If dizziness occurs, you should:

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

drink more fluids (sufficient hydration will improve well-being 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 with your doctor if:

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

having difficulty walking, to the point of completely losing balance and falling;

hearing has decreased.

You should consult a doctor immediately if dizziness occurs as a result of a head injury or is accompanied by at least one of the following symptoms:

chest pain;

rapid heartbeat, “fluttering”;

dyspnea;

visual or speech disturbances;

weakness in one or more limbs;

loss of consciousness lasting more than 2 minutes;

convulsions.

Neurologist highest category, specialist in the field of extrapyramidal pathologies, doctor of the highest category

Impairments in coordination and gait, stability and balance are not diseases in themselves. These disorders are symptoms that occur in a wide variety of diseases.

Balance is regulated automatically by the vestibular and muscular apparatus, so people don’t really think about how to maintain vertical position while walking, when we stand or sit. While muscular and vestibular apparatus work smoothly and reliably, a person simply does not need to think about it. However, like all systems of the body, the vestibular apparatus can work with disturbances. It is in such cases that a person experiences coordination disorders and movement disorders. Coordination of movements allows a person to perform precise movements and consciously control them. When vestibular disorders occur, a person experiences unsteadiness when walking and instability of the torso.

If the patient has impaired coordination of movements, this indicates some changes in the functioning of the central nervous system. The human central nervous system is a complex formation of nerve cells, which are located in the head and spinal cord. At moments when a person wants to make a particular movement, a signal is sent from the brain, in response to which the person’s limbs, torso or other parts of the body begin to move. In cases where the central nervous system works with disturbances, the signal from the brain is transmitted in a distorted form or does not reach its goal at all.

There are quite a few factors that influence poor coordination of movements:

• various brain injuries;
• strokes;
• physical exhaustion of the body;
• sclerotic changes;
• muscle dystrophy;
• exposure to alcohol, narcotic and other toxic substances;

Enough a rare occurrence is catalepsy. This is a disorder in which the muscles weaken due to strong positive or negative emotions experienced by humans.

Loss of motor coordination is considered dangerous deviation, because in a state where a person cannot adequately control his movements, it is quite easy to get injured.

Various movement disorders are often observed in old age. In addition, such deviations may be a consequence of previous neurological diseases or diseases of the musculoskeletal system.

There are several main manifestations of motor coordination disorders:

• Tremor, manifested in rhythmic trembling hands or head. This disorder can be almost unnoticeable at rest, and increase with anxiety.
• Uneven, shaky movements.
• Ataxia. This disorder is caused by damage to the frontal regions of the brain, nerve fibers or cerebellum. At static ataxia It is difficult for a person to maintain balance in a standing position, while in a dynamic position it is difficult for him to move in a balanced manner.

If you experience any of the symptoms described above, you should contact a neurologist, cardiologist or toxicologist.

A person needs coordination of movements in order to maintain balance and accurately perform various actions, control your body. This skill is achieved through the work of muscles; balance control is located in the cerebellum.

Abrupt violation coordination of movements occurs for several reasons and requires contacting a doctor. Usually this condition is accompanied severe dizziness and can take you by surprise public place, transport, on the street.

Physiologically, the condition can occur with a sharp rise from horizontal position into a vertical position (for example, from a bed), while starting. This may cause orthostatic collapse.

In general, the causes of deviations are neurological, that is, related to the activity of the brain. The question arises as to why some conditions begin abruptly while others worsen over time. The causes of deviations in movement are numerous: it could be Parkinson's disease or polyneuritis, that is, multiple inflammation of the nerves.

The cause of the pathology depends on those additional symptoms that are of concern:

1. If the pain intensifies when turning the head and sudden movements, then the reasons should be sought by a neurologist. This is most likely osteochondrosis of the cervical spine, which is caused by the accumulation of salts. This condition begins gradually, intensifying over time.
2. If a headache suddenly appears, when the head begins to feel dizzy and coordination of movements is impaired, the problem may be the occurrence of an acute cerebrovascular accident.
3. IN at a young age a cerebral circulatory disorder called syndrome may occur vertebral artery.
4. Since the cerebellum is responsible for balance, its disturbance may be a sign of a brain tumor localized in the cerebellum.
5. The reasons may lie in neurotic deviations. These could be panic attacks; psychosomatic symptoms prevail here.

The pathology occurs gradually, causing pain in the neck when turning the head, as well as some disturbance in neck movement. Patients used to be elderly, but now the disorder affects people under 40 years of age.

The reason for this violation is passive image life, sedentary work, absence physical activity in the form of exercises, exercise equipment, etc.

Delayed diagnosis of impaired motor coordination leads to more serious abnormalities - for example, vertebral artery syndrome. In addition, people with and begin to feel dizzy.

Among the studies that make it possible to diagnose osteochondrosis, the most famous is the Romberg pose, in which there is no instability of gait or body position.

When SPA begins, appears headache. The condition intensifies when raising the head, turning the torso or neck. The disease is typical for middle-aged people, since in the presence of atherosclerosis in adulthood, a stroke is more likely to occur.

Reasons why it occurs similar condition, are different: this is increased blood pressure, scoliosis, osteochondrosis of the cervical spine.

With osteochondrosis, compression of the artery occurs, which provides the main blood flow to the brain. That’s why your head starts to feel dizzy and hurt, and you feel like the ground is falling away from under your feet.

Help for this condition is to eliminate dizziness and restore blood circulation. For this purpose massage is used, vasodilators. If blood pressure rises, then antihypertensive drugs are used.

If your head hurts and feels dizzy, and also appears unsteady gait, speech impairment, then we can talk about a stroke. This acute disorder cerebral circulation, which appears with frequent increases in pressure against the background of vascular atherosclerosis.

If you often have a headache, this may be a sign of increased blood pressure. Frequent vascular spasms can lead to cerebral infarction, which is called

This is why symptoms appear: blood clots, which are areas of atherosclerotic tissue covering blood vessels, circulate in the circulatory system. They can clog any small or narrowed vessel by changes. If a blockage occurs in the brain, then a circulatory disturbance occurs in a certain area.

The principles of treatment of the disease are as follows:

1. Elimination of the cause, that is, a blood clot, is possible if the patient is admitted to medical institution no later than 6 hours after the onset of manifestations.
2. Eliminate dizziness by prescribing vasodilators.
3. Reception antihypertensive drugs They will help you if you have a headache.

The causes of an attack are different: these include sound and auditory stimuli, smell, and alcohol intake.

This is a condition that manifests itself various signs at different people. During an attack, an unreasonable feeling of animal fear occurs, a headache appears, squeezing like a hoop, blurred vision, double vision, and breathing problems may appear.

Fight with panic attacks is to accept sedatives, eliminating headaches.

The human body is the most complex system imaginable. We don't think about how to take a step or clench our hand into a fist. But to ensure even the simplest movement, a whole cascade of reactions and interactions is needed, starting from awareness of the need to perform a particular action and to transmitting an impulse to the muscle. And all this is coordinated and controlled by the human nervous system. If at least one of the links fails, a violation of coordination of movements occurs when a person loses the ability to perform precise processes, instability appears when walking; in severe cases, the patient is unable to even get out of bed and needs constant assistance.

Coordination problems are more common among older people. age groups. As the body ages, the activity of the nervous system slows down somewhat. In addition, with age, a certain “baggage” of diseases accumulates, which can cause impaired coordination of movements (discoordination). The most susceptible to pathology are people who have worked with small parts for many years, as well as people suffering from vascular pathology, with a history of injuries to the nervous system or musculoskeletal system, and abusing alcohol and drugs.

Causes of coordination problems in children

1. Early organic lesion central nervous system, which can be caused by insufficient oxygen supply to the child’s brain during pregnancy, childbirth and after it.

2. Cerebral palsy.

3. Injuries to the nervous system and limbs (during childbirth, household injuries, car accidents).

4. Hereditary diseases(Friedreich's disease, Glippel-Lindau syndrome, Pelizaeus-Merzbacher demyelinating encephalopathy and others).

5. Infectious diseases And inflammatory processes brain and its membranes:

• meningitis;
• encephalitis.

6. Intoxication:

• medicinal, as a result of use high doses medicines;
• poisoning carbon monoxide, heavy metals, chemical compounds;
• endogenous (hepatitis, severe viral or bacterial infection, kidney pathology).

In children early age It is impossible to detect the presence of coordination disorders. Pathology can be noticed only after the child learns to perform voluntary actions (pick up a toy, bring a spoon to his mouth).

Causes of coordination problems in adults

For adults, all of the above reasons are valid. But while in children most changes are congenital, in adults acquired diseases come to the fore:

1. Vascular pathology of the brain:

• stroke;
• atherosclerosis of cerebral vessels;
• encephalopathy.

2. Parkinson's disease.

3. Tumors.

4. Intoxication of the body:

• alcoholic;
• narcotic;
• hepatic as a result of cirrhosis;
• renal for acute or chronic renal failure.

5. Diseases and injuries of the musculoskeletal system.

Loss of coordination with dizziness

Often coordination disorders are accompanied by dizziness. This is a sign that in pathological process The brain is involved, namely its vestibular center, which is responsible for the balance of the body in space. In addition to dizziness and incoordination, additional concerns may include:

• nausea, sometimes vomiting, sharply increasing when turning the head or any movements;
• pain and discomfort in cervical spine spine;
• headaches, noise in the head;
• increased blood pressure.

Causes of poor coordination with dizziness:

1. Stroke in the veno-basilar basin and other vascular pathology.
2. Cervical osteochondrosis, in which there is a decrease in blood flow to the brain, ischemia of its centers develops.
3. Meniere's disease- disease of the inner ear.
4. Hypertonic disease. As pressure increases, the lumen of blood vessels decreases, which leads to disruption of the nutrition of the vestibular centers.
5. Tumors, brain cysts.

Treatment for impaired coordination of movements

The key to success in the treatment of coordination disorders is finding out their cause. If it can be eliminated, coordination defects may completely disappear. But most processes are often irreversible; the development of some of them can be slowed down or suspended. In any case, when incoordination occurs, the nervous system is involved to one degree or another, so drugs to nourish neurons must be prescribed:

• nootropics (piracetam, emoxypine);
• neuroprotectors (cerebrolysin, cortexin, gliatilin);
• activators of cellular metabolism (Actovegin, Ceraxon).

For acute vascular pathology required immediate treatment in order to stop the process of neuron death and minimize the consequences of the disaster. In other situations, therapy is carried out in courses 2-3 times a year and during exacerbations. In addition, in each specific case it is necessary to prescribe drugs aimed at the cause (antiparkinsonian, antihypertensive).

Congenital pathology and hereditary diseases They are practically not amenable to drug correction, so symptomatic treatment is carried out. Of great importance in restoring coordination disorders is physiotherapy, which must be constant. Physiotherapy methods, acupuncture, and massage are used.