Movement Disorders

All movement disorders are progressive.  Dyskinesia is a common symptom of many movement disorders, and is described as anything from a slight tremor to uncontrolled movements.  There are different kinds of dyskinesia, and they all have different clinical symptoms and causes, and require different types of rehab treatment.  Abnormal movement can occur in the head, neck (dystonia, spasmodic torticollis) arms, legs, hands, feet, lips,palate or tongue and is seen in Cerebellar Disorders, Dystonia, Parkinson’s Disease, Progressive Supranuclear Palsy (PSP), Tourette Syndrome, Tremor and more.

Most movement disorders are due to inappropriate signaling within the basal ganglionic loops.  We apply a non-surgical and non-pharmaceutical brain based rehab approach based on current research.  Although some conditions, such as Parkinson’s as of now have no cure, we have assisted many in regaining their life using functional neurology based rehab. Treatment is not a “one size fits all” approach, because everyone’s nervous system and brain are wired differently. Dependent on your exam findings, exercises may include RPSS, frontal lobe training, saccadic eye function, and optokinetics, upper and lower body ergometer, gait retraining, balance training strategies, Interactive metronome, and more.

 


 

Dysautonomia Treatment
Dysautonomia is a broad term that is used to describe a condition associated with the autonomic nervous system. The most common is Postural Orthostatic Hypotension Syndrome known as P.O.T.S. Patients with P.O.T.S. experience an abnormal jump in their heart rate when elevating from a supine (lying) position in order to get blood to their brain. If this reflex doesn’t respond correctly you could experience dizziness or fainting because of decreased blood flow to the brain.

New research suggests that this inappropriate response is due to aberrant firing of or denervation at the Nucleus Tractus Solitarius (NTS), located in the brainstem. Symptoms of orthostatic hypotension include exercise intolerance, excessive fatigue, thirst, lightheadedness, dizziness, anxiety, internal tremulous (also known as orthostatic tremor), sweating, nausea, irritable bowel, brain fog, tinnitus, headaches and more. Unfortunately because these symptoms occur most commonly in women they’re often dismissed as Chronic Fatigue Syndrome or an anxiety based panic disorder.

Changes in blood pressure and heart rate can be due to many things. The lack of activation or stimulation which causes changes in a cell is what leads to decreased metabolic activity in the cell. Tilt table testing signals the baroreceptor which fires into the NTS letting it know of the changes so that it can respond by firing into the sympathetic system to steadily increase heart rate and blood pressure accordingly. When a cell is sitting too close to threshold a slight stimulus comes in and the cell responds inappropriately resulting in an inappropriate response.

We preform tilt table testing and rehab for those individuals with complications of the autonomic nervous system.


RESEARCH

Links KA, Merims D, Binns MA, Freedman M, Chow TW. Prevalence of primitive reflexes and Parkinsonian signs in dementia. Can J Neurol Sci. 2010 Sep;37(5):601-7. .

Chester A. Ray. Interaction of the vestibular system and baroreflexes on sympathetic nerve activity in humans. Am J Physiol Heart Circ Physiol 279: H2399–H2404, 2000.

Chester A. Ray et al. Effect of baroreflex loading on the responsiveness of the vestibulosympathetic reflex in humans. J Appl Physiol 103: 1001–1006, 2007.

David S. Goldstei. Cardiac denervation in patients with Parkinson disease. Cleveland Clinic Journal of Medicine Volume 74, pg 894:Feb 1 2007.

Phillipse A.M.et al. Brain Stem Stroke Causing Baroreflex Failure and Paroxysmal Hypertension. Stroke 2000, 31:1997-2001

William H. Cooke, Jason R. Carter and Tom A. Kuusela. Human cerebrovascular and autonomic rhythms during vestibular activation. Am J Physiol Regul Integr Comp Physiol 286:R838-R843, 2004.

Rong Zhang et al. Arterial-cardiac baroreflex function: insights from repeated squat-stand maneuvers. Am J Physiol Regul Integr Comp Physiol 297: R116–R123, 2009.

Neggers SFeta l.  A functional and structural investigation of the human fronto-basal volitional saccade network. PLoS One. 2012;7(1):e29517.

Basso MA, Wurtz RH.  Neuronal activity in substantia nigra pars reticulata during target selection. J Neurosci. 2002 Mar 1;22(5):1883-94.

Pinkhardt EH et al. Eye movement impairments in Parkinson’s disease: possible role of extradopaminergic mechanisms. BMC Neurol. 2012 Feb 29;12:5.

Hikosaka, O., Takikawa, Y. and R. Kawagoe.  Role of the Basal Ganglia in the Control of Purposive Saccadic Eye Movements. Vol. 80, No. 3, July 2000.

Fukushima K, Fukushima J, Warabi T.  Vestibular-related frontal cortical areas and their roles in smooth-pursuit eye movements: representation of neck velocity, neck-vestibular interactions, and memory-based smooth-pursuit.  Front Neurol. 2011;2:78.