What Is It, Causes, Diagnosis, Treatment, and More

Author: Georgina Tiarks

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Jillian Dunbar

What is dysdiadochokinesia?

Dysdiadochokinesia (DDK) refers to the inability to perform rapid, alternating movements, often due to an underlying cause. Ordinarily, individuals can rapidly switch between opposing movements in a coordinated fashion, like when unscrewing a light bulb. However, someone with DDK will find that their muscle response is slow or awkward, especially in the upper and lower limbs. This can include poor coordination while rapidly tapping one’s finger or foot, opening and closing one’s fist, and switching muscular positions from flexion (i.e., bent) to extension (i.e., straight). 

What causes dysdiadochokinesia?

DDK often results from cerebellar dysfunction. The cerebellum is the part of the brain responsible for coordinated muscle movement, balance, gait (i.e., walking), and complex tasks. When an underlying problem affects the cerebellum, a person may have difficulty with speech, stability, and limb control. 

DDK is a feature of cerebellar ataxia, or impaired coordination, and can be the result of a variety of conditions affecting the cerebellum. Cerebellar dysfunction can either be acquired or genetic. Some acquired conditions that impact the cerebellum include metabolic dysfunction conditions (e.g., Hashimoto disease or celiac disease), vascular problems (e.g., intracranial hemorrhage or stroke), brain cancer, infections (e.g., Lyme disease), inflammatory diseases (e.g., multiple sclerosis), or psychiatric problems (e.g., schizophrenia). In addition, genetic brain conditions, such as Parkinson disease and Huntington disease, can also impact the cerebellum. 

Certain medications such as barbiturates and sedatives, as well as toxins from recreational drugs, alcohol, and botulinum can also lead to DDK. Finally, deficiencies in vitamins B, E, and thiamine can also increase the risk of developing cerebellar dysfunction.

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Can stroke cause dysdiadochokinesia?

Strokes impacting the cerebellum can cause DDK. This usually occurs as a result of a blocked blood vessel preventing oxygen flow to the cerebellum. The resulting low oxygen levels can cause significant damage to the cerebellum and potentially lead to DDK.

How is dysdiadochokinesia diagnosed?

Diagnosis of DDK typically requires a physical examination to assess motor control and cerebellar function. Various tests that may be performed include rapid movement testing, the Romberg test, and the Stewart Holmes rebound test. Rapid movement tests can be performed in a variety of ways but most commonly, the individual will be asked to start with the palm of one hand on a flat surface. They will then be asked to flip their hand repeatedly, so the palm side of their hand moves from a downward-facing to an upward-facing position. Separately, the Romberg test requires the individual to stand with their heels together and eyes closed. If the individual has trouble balancing, it may indicate cerebellar dysfunction. Finally, the Stewart Holmes rebound test requires the individual to push against resistance, which is then suddenly removed. The examiner will assess how well the individual can control their movement after the resistance is taken away. 

Additionally, further differential diagnosis is usually required to determine the underlying cause of the DDK. After completing a thorough physical examination and medical history review, blood tests may be performed to detect potential vitamin deficiencies, toxins, autoimmune antibodies, lipids, or changes in hormone levels. A full blood cell count may also be performed to help assess possible underlying conditions. Imaging techniques, such as computerized tomography (CT) scans, may also be required to determine the source of cerebellar dysfunction. Finally, if genetic disorders are suspected, providers may recommend genetic testing.

How is dysdiadochokinesia treated?

Treatment for DDK largely focuses on treating the underlying cause. Once the underlying condition is managed, providers may work on resolving the associated symptoms that one may experience with DDK. Oftentimes providers will encourage physical therapy, such as balance exercises, strength training, and other exercises to improve motor function. In some cases, speech and occupational therapy may also be beneficial. 

What are the most important facts to know about dysdiadochokinesia?

Dysdiadochokinesia (DDK) refers to the inability to perform coordinated, rapid muscle movements. DDK is often a symptom related to an underlying problem impacting the cerebellum. The cerebellum is the portion of the brain that controls balance, coordination, and complex tasks. When this area of the brain is damaged, the individual may have difficulty with fast, alternating motions. Clinicians can diagnose DDK using a variety of tests to assess motor function. They may also need to perform additional imaging and blood work to understand the underlying cause. Treatment will largely depend on resolving the underlying cause but may also include the management of symptoms through physical, occupational, or speech therapy.

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Related links

Spinocerebellar ataxia (NORD)

Resources for research and reference

Barrett KE, Barman SM, Brooks HL, Yuan JJ. Ganong's Review of Medical Physiology. 26th ed. New York: McGraw-Hill; 2019.

Lalwani AK. Current Diagnosis & Treatment Otolaryngology—Head and Neck Surgery. 4th ed. New York: McGraw-Hill; 2020.

Suneja M, Szot JF, LeBlond RF, Brown DD. DeGowin’s Diagnostic Examination. 11th ed. New York: McGraw-Hill; 2020.