Motor Disorders

Introduction

• Motor disorders are defined in the  (DSM-5 as a new sub-category of 

neurodevelopmental disorders. Motor disorders are disorders of the 
nervous system that cause abnormal and involuntary movements.
They can result from damage to the motor system. Motor disorders
include 
developmental coordination disorder
 stereotypic movement disorder
 tic disorders including Tourette syndrome
1: developmental coordination disorder

• Movement difficulties can occur for many reasons and may take place
at a number of different stages as a child takes in information and uses
it to perform a motor task. Children are constantly receiving and using
information from the environment. A child may have difficulty making
sense of information received through their senses, using this
information to choose a plan of action, organizing the specific motor
movements of the task, sending the right message to produce a
coordinated action, or combining all of these things in order to control
the movement while it is happening. The result of any of these
problems is the same: the child will appear clumsy and awkward and
will have difficulty learning and performing new motor tasks.
• Children with DCD have been shown to have difficulties controlling
their posture and with their awareness of objects or their body in
space. They appear to have difficulties planning movements (e.g
sitting down on a chair or figuring out how to jump), with the timing
and amount of force needed during movement (e.g., using too much
or too little force to pick things up, being late reaching to catch a ball),
and when combining information from their sensory and motor
systems (e.g., needing to use a lot of visual information when
climbing stairs or fastening buttons).
Motor milestones or motor skills: What is the difference?

• While some children with DCD are mildly delayed in the normal
development of motor milestones (rolling over, sitting unsupported,
walking), most are not. Children with DCD first show significant motor
delay when they are required to learn movements that involve
coordination or skill. These activities vary from one culture to the next
but all are skills that are learned from caregivers or other children.
• Early indicators of difficulty can be seen as the child tries to manage a
spoon, manipulate a toy, pedal a tricycle or scribble with a crayon.
Self-care skills are always delayed. 
Children will have difficulty with simple tasks, such as:

Fine Motor Skills Gross Motor Skills

•Poor timing & Poor balance. Tripping over one's

own feet is also common. Problem in chewing food Learning basic movement patterns.
•Difficulty combining movements into a controlled Developing a desired writing speed.
sequence. Establishing the correct pencil grip
•Difficulty remembering the next movement in a The acquisition of graphemes – e.g. the letters of
sequence. the Latin alphabet, as well as numbers
•Problems with spatial awareness
•Trouble picking up and holding onto simple objects
such as pencils, owing to poor muscle tone
•Clumsiness to the point of knocking things over
and bumping into people accidentally.
•Difficulty in determining left from right.
Are children with DCD all the same?

• Children with DCD make up what is called a 'heterogeneous' group,

which means that they are not all alike. Children might differ in the
degree of their difficulties (mild or severe), and in how much the
disorder affects daily tasks (affecting nearly every activity to affecting
only specific activities). They may have challenges in gross motor and
postural functions or only in fine motor skills requiring eye-hand
coordination. The degree of difficulty may also appear to vary
depending on the environmental and task demands placed on the
child in the early years. Finally, children with DCD also differ in the
degree to which they display co-occurring conditions, including non-
verbal learning disabilities, speech/articulation difficulties, and
attention deficit disorder.
 Causes
• Although there are many theories, it is not yet possible to offer a clear
answer about what causes DCD. As children with DCD can have 
associated difficulties in addition to their motor difficulties, it seems
unlikely that a single factor will explain the coordination problems
observed in this group of children.
• Most recently, researchers have suggested a possible link between
the cerebellum as the cerebellum is critical for developing automatic
movement control and the ongoing monitoring of movements, both
of which are affected in DCD.
 Stereotypic movement
• Stereotypic movement disorder is classified in the fifth revision of
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as
a motor disorder, in the category of neurodevelopmental disorders.
• a motor disorder with onset in childhood involving repetitive,
nonfunctional motor behavior (e.g., hand waving or head banging),
that markedly interferes with normal activities or results in bodily
injury. The behavior must not be due to the direct effects of a
substance or another medical condition. The cause of this disorder is
not known
 Signs & Symptoms
Common repetitive movements of SMD include
• head banging
• arm waving
• hand shaking
• rocking and rhythmic movements
• self-biting, self-hitting, skin-picking
•  other stereotypies are thumb-sucking, nail biting, trichotillomania, 
bruxism and abnormal running or skipping
 Diagnosis
• Stereotyped movements are common in infants and young children; if
the child is not distressed by movements and daily activities are not
impaired, diagnosis is not warranted. When stereotyped behaviors
cause significant impairment in functioning, an evaluation for
stereotypic movement disorder is warranted. There are no specific
tests for diagnosing this disorder, although some tests may be
ordered to rule out other conditions. SMD may occur with 
Lesch-Nyhan syndrome, intellectual disability, and fetal alcohol
exposure or as a result of amphetamine intoxication
 Con….
When diagnosing stereotypic movement disorder, DSM-5 calls for
specification of
• with or without self-injurious behavior
• association with another known medical condition or environmental
factor
• Level of sevarity
 Differential diagnosis

• Other conditions which feature repetitive behaviors in the differential

diagnosis include autism spectrum disorders, 
obsessive–compulsive disorder, tic disorders(e.g., Tourette syndrome
), and other conditions including dyskinesias.  Unlike the tics tend to
appear around age six or seven, repetitive movements typically start
before age three, are more bilateral than tics, and consist of intense
patterns of movement for longer runs than tics. Tics are less likely to
be stimulated by excitement. Children with stereotypic movement
disorder do not always report being bothered by the movements as a
child with tics might.
 Prognosis
• Prognosis depends on the severity of the disorder. Recognizing
symptoms early can help reduce the risk of self-injury, which can be
lessened with medications. Stereotypic movement disorder due to
head trauma may be permanent
 Epidemiology

• Although not necessary for the diagnosis, individuals with intellectual

disability are at higher risk for SMD. It is more common in boys, and
can occur at any age
 Tic Disorder
• A tic is an abrupt, uncontrollable movement or sound that deviates from a
person’s normal gestures. For example, a person with tics may blink rapidly and
repeatedly, even if nothing is irritating their eyes.
• The most notable tic disorder is Tourette’s syndrome, in which both physical and
verbal tics occur in the same individual, often at the same time. Transient tic
disorder also involves both types of tics, but they often occur individually. In
2013, the Diagnostic and Statistical Manual, 5th Edition (DSM-5) renamed this
disorder as provisional tic disorder.
• Many people at some point experience spasm-like movements of particular
muscles. These movements, known as tics and twitches, often affect the eyelids
or face. They can, though, occur anywhere in the body.In most instances, tics and
twitches are harmless and temporary.
 Tics
• While many people use the terms tic and twitch interchangeably,
there are differences between these two forms of movements.There
are two types of tics
motor tics
vocal tics
These short-lasting sudden movements (motor tics) or uttered sounds
(vocal tics) occur suddenly during what is otherwise normal behavior.
Tics are often repetitive, with numerous successive occurrences of the
same action. For instance, someone with a tic might blink his eyes
 multiple times or twitch her nose repeatedly.
Vocal tics: a tic can cause you to repeatedly clear your throat, click
your tongue, or make a certain noise, such as a grunt or a moan
Motor tics: Motor tics can be classified as either simple or complex.
Simple motor tics may include movements such as eye blinking, nose-
twitching, head-jerking, or shoulder shrugging. Complex motor tics
consist of a series of movements performed in the same order. For
instance a person might reach out and touch something repeatedly or
kick out with one leg and then the other.
• Tics are often classified not as involuntary movements but
as unvoluntary movements. This means that people are able to
suppress the actions for a time. The suppression, though, results in
discomfort that grows until it is relieved by performing the tic.
• While people of all ages can experience tics, they are most prevalent
in children. Experts say that around 25% of children experience tics.
And tics are far more likely to affect boys than girls
 Twitches
•  Unlike tics, the majority of muscle twitches are isolated occurrences,
not repeated actions. Muscle twitches are also known as myoclonic
jerks. They are entirely involuntary and cannot be controlled or
suppressed.
• One type of muscle twitch is benign essential blepharospasm.
Blepharospasm refers to the muscles of one or both eyelids twitching
uncontrollably. This often occurs repeatedly over a sustained period of
time. In extreme cases, which are rare, benign essential blepharospasm
may also involve the eyebrows, mouth and neck. While an eyelid
twitch may mimic an eye-blinking tic, it is different because it cannot be
controlled. It also occurs most often in adults
• Experts believe that the eyelid twitching of blepharospasm is caused
by the misfiring of certain cells in one area of the brain. Eyelid
twitches may be aggravated by having dry eyes. They may also be
worsened by stress, lack of sleep, caffeine, and harsh light conditions
 Types of Tics
The majority of tics are not severe. So they have very little effect on a
person's quality of life. In some instances, though, tics may occur often
enough to be disruptive and troubling. When they do, they can affect
many areas of a person's life, including school, work, and social life.
• Transient tic disorder: This disorder most commonly appears in youth.
It affects between 5% and 25% of school-age children. Transient tic
disorder is characterized by the presence of one or more tics for at least
one month but less than one year. The majority of tics seen in this
disorder are motor tics, though vocal tics may also be present. Many
children with the disorder experience multiple episodes of the transient
tics.
• Chronic motor or vocal tic disorder: While transient tics disappear
within a year, chronic tics can last for a year or more. Chronic tic
disorder is characterized by the presence of one or more long-lasting
tics. They may be either motor or vocal, but not both. For a diagnosis of
chronic tic disorder, symptoms must begin before age 18. Chronic tics
occur in less than one in 100 children.
• Tourette's syndrome: In some instances, what appears to be a chronic
tic may be a sign of Tourette's syndrome. This syndrome is the most
severe tic disorder. It is characterized by the presence of both motor
tics and vocal tics. Symptoms typically begin when children are
between ages 5 and 18 years.
• The severity of Tourette's syndrome often changes over time. There
may be periods of reduced tic frequency followed by heightened tic
activity. Fortunately, many people with Tourette's syndrome find that
their condition improves as they get older.
 Causes
• No one knows exactly what causes tics to occur. Stress and sleep
deprivation seem to play a role in both the occurrence and severity of
motor tics.
• Some research indicates that tic disorders may be inherited. A genetic
mutation can cause Tourette’s syndrome in rare cases.
• Abnormalities in the brain may also be responsible for tic disorders.
Such abnormalities are the cause of other mental conditions, such as
depression and attention deficit hyperactivity disorder (ADHD).
 Diagnosis
Someone must meet all the following conditions to receive a transient tic disorder
diagnosis:
• Individual must have one or more motor tics (such as blinking or shrugging the
shoulders) or vocal tics (such as humming, clearing the throat, or yelling a word
or phrase).
• Tics must occur for less than 12 months in a row.
• Tics must start before 18 years of age.
• Symptoms must not be a result of medication or drugs, or of another medical
condition such as Huntington disease or post-viral encephalitis.
• Individual must not have Tourette’s syndrome or any other chronic motor or
vocal tic disorder diagnosis.
 Treatment
• Transient tic disorder in children often goes away without treatment.
It’s important that family members and teachers don’t call attention
to the tics. This can make the child more self-conscious and aggravate
their symptoms.
• Medication can’t completely cure tic disorders, but it can reduce
symptoms for some people. Doctors often prescribe a drug that
reduces the dopamine in the brain. Dopamine is a neurotransmitter
that may influence tics.