Chapter 20: Intervention for Involuntary Contractions and Movement

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Utilize evidence-based tools for adequate examination, evaluation, and treatment of patients with dyskinesia.

2. Describe the role of the basal ganglia and its connection with other neural substrates related to typical movement and dyskinesia.

3. Identify the unique impairments at all levels of the International Classification of Functioning, Disability, and Health affecting individuals with dyskinesia throughout the lifespan.

Introduction

The purpose of this chapter is to provide information on evidence-based interventions for individuals with a variety of involuntary movement disorders. Involuntary movement disorders affect an individual’s ability to control and modify movement. The movement disorders discussed in this chapter will be limited to those causing dyskinesia or abnormal involuntary movements arising most often from pathology within the basal ganglia, a group of subcortical motor-modulation nuclei. Pathological changes within the basal ganglia can also cause bradykinesia (slowness of movement) and rigidity (joint stiffness) as seen in patients with Parkinson disease. However the focus of this chapter is dyskinesia or involuntary movement. Due to the unique impairments seen in patients with dyskinesia, therapeutic interventions differ from those used with patients who have other movement-related impairments such as spasticity or rigidity (described in Chapter 19), or ataxia (irregular inaccurate movement) (described in Chapter 21). These unique characteristics, as well as their roles in clinical decision-making, will be considered in this chapter. As you read this chapter, refer to Table 20-1 for a brief description of each dyskinesia to be addressed. Refer also to Table 20-6 for a summary of current evidence to support interventions for patients with dyskinesias with a more comprehensive table available online.

A variety of dyskinesias will be discussed, including common problems at all levels of the International Classification of Functioning, Disability, and Health (ICF) model (Steiner, 2002). Definitions for athetosis, ballismus, chorea, choreoathetosis, dystonia, myoclonus, tics, and tremor are provided in Table 20-1. Common diseases causing dyskinesias will also be discussed to include etiology, pathophysiology, and known demographic information as well as the progressive or nonprogressive nature of the disease. Evidence-based tests and measures and intervention techniques will be presented. Cases of a patient with Huntington disease and a patient with dystonia will also be presented.