Lack of coordination; Loss of coordination; Incoordination and irregularity of voluntary movements; Coordination impairment; Ataxia; Clumsiness

Smooth graceful movement results from a fine balance between opposing muscle groups. This balance is coordinated by a portion of the brain called the cerebellum.

Diseases that damage the cerebellum, spinal cord, and peripheral nerves (connecting the cerebellum to the muscle groups) can interfere with the fine tuning of muscular movement and result in coarse, jerky, uncoordinated movement. This condition is called ataxia, and is easily seen in the jerky, to-and-fro motion of the trunk and unsteady gait (walking style).

Ataxia may appear as a congenital defect, or follow a simple viral infection such as chicken pox. It may also appear following encephalitis, head trauma, and diseases affecting the central nervous system or spinal cord. Appearance as a genetic disorder, or as a toxic reaction to drugs, medications, alcohol or environmental toxins is also possible.

• Transient ischemic attack (TIA)
• Stroke
• Multiple sclerosis
• Vertebral abnormalities (such as compression fractures of the back)
• Poisoning by heavy metals such as mercury, thallium, and lead, or solvents such as toluene or carbon tetrachloride
• Alcohol or other drug intoxication
• Drugs such as aminoglutethimide, anticholinergics, phenytoin (in high doses), carbamazepine, phenobarbital and tricyclic antidepressants
• Paraneoplastic syndromes (ataxia may appear months or years before cancer is diagnosed -- an affected person produces antibodies against the neurons in the cerebellum)
• Post-infectious condition (typically following chickenpox)
• Hereditary condition (congenital cerebellar ataxia, Friedreich's ataxia, ataxia telangiectasia, Wilson's disease)

Take safety measures around the home to compensate for difficulties in mobility that are inherent with this problem. For example, avoid clutter, leave wide walkways, and avoid throw rugs or other objects that might cause slipping or falling.

Other family members should encourage the affected person to participate in normal activities. Family members need to have extreme patience with people who suffer from poor coordination. Take time to demonstrate ways of performing tasks more simply, and taking advantage of the afflicted person's strengths while avoiding weaknesses.

• There is unexplained incoordination.
• Incoordination lasts longer than a few minutes.

The medical history will be obtained, and a physical examination performed. In emergency situations, the patient will be stabilized first.

Medical history questions documenting uncoordinated movement in detail may include:

• When did it begin?
• Is it continuous or do episodes come and go?
• Is it getting worse?
• What medications are being taken?
• Is alcohol used?
• Are illegal/illicit drugs being used?
• Has there been any exposure to something that may have caused poisoning?
• What other symptoms are also present?
  • Weakness or paralysis
  • Numbness, tingling, or loss of sensation
  • Confusion or disorientation
  • Seizures

The physical examination may include detailed neurological and muscular examination.

Diagnostic tests that may be performed include:

• Blood tests (such as a CBC or blood differential).
• CT scan of the head.
• MRI of the head.
• Romberg test: the patient is asked to stand erect with the feet together and the eyes closed. If the patient loses balance, this indicates a loss of the sense of position and the test is considered positive.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 713-736.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:2305-2306.