Coordination Difficulties (Loss of Coordination)

What coordination difficulties look like

Coordination problems show up in different ways, depending on which part of the movement system is affected:

• Walking: a broad-based, staggering, "drunk-looking" walk, trouble with turns or walking heel to toe
• Hands and arms: overshooting or undershooting when reaching, a tremor that worsens as the hand nears a target (intention tremor), messy handwriting, difficulty with buttons
• Rapid alternating movements: clumsy patting or flipping the hand back and forth
• Speech: slurred, slow, or with irregular rhythm (scanning speech)
• Eyes: jerky eye movements (nystagmus), double vision
• Swallowing difficulties in advanced cases

Coordination is different from strength. People with ataxia often have normal muscle power but cannot control it smoothly. It overlaps with balance problems, which focus on staying upright.

Types of ataxia

Causes of sudden loss of coordination

• Alcohol and drugs: alcohol intoxication is the most common cause of temporary ataxia. Sedatives, some anti-seizure medicines (such as phenytoin and carbamazepine at high levels), lithium and cannabis can also cause it.
• Stroke: a stroke in the cerebellum or brainstem can cause sudden clumsiness, vertigo, vomiting and inability to walk, sometimes without one-sided weakness.
• Head injury and concussion.
• Infections: encephalitis, brain abscess, and post-infectious cerebellitis in children after chickenpox or other viruses. Post-infectious ataxia in children usually resolves within weeks.
• Wernicke encephalopathy: thiamine (vitamin B1) deficiency, most often from heavy drinking or severe vomiting, causing confusion, ataxia and eye movement problems. It needs urgent thiamine treatment.
• Low blood sugar.

Causes of gradual coordination difficulties

• Multiple sclerosis: inflammation in the cerebellum or its connections causes clumsiness, tremor and unsteadiness, often with other neurological symptoms.
• Long-term alcohol use: alcohol-related cerebellar degeneration causes a permanently unsteady gait.
• Vitamin B12 deficiency: damages the spinal cord and nerves, causing sensory ataxia, numbness and tingling. Vitamin E deficiency is a rarer cause.
• Hypothyroidism and celiac disease (gluten ataxia).
• Brain tumors, especially in the back of the brain.
• Inherited ataxias: Friedreich's ataxia usually starts in childhood or adolescence. Spinocerebellar ataxias usually start in adulthood and run in families.
• Peripheral neuropathy from diabetes or chemotherapy.
• Paraneoplastic syndromes: rarely, the immune response to a hidden cancer damages the cerebellum.
• Neurodegenerative diseases such as multiple system atrophy.

Coordination problems in children

Children develop coordination at different rates, but some have persistent difficulties:

• Developmental coordination disorder (dyspraxia): affects around 5 percent of school-age children. They are clumsy, slow to learn skills such as riding a bike, tying laces and handwriting, but have no neurological disease. Occupational therapy helps.
• Cerebral palsy affects movement and coordination from early life.
• Acute ataxia after a viral infection is the most common cause of sudden unsteadiness in young children.
• Accidental ingestion of alcohol or medicines.
• Brain tumors in children often occur in the cerebellum and cause clumsiness, morning headaches and vomiting.

How doctors find the cause

A clinician will ask how quickly the problem started, about alcohol, medicines, diet, other symptoms and family history. The neurological examination includes:

• Finger-to-nose and heel-to-shin tests
• Rapid alternating movements
• Walking normally and heel to toe
• Romberg test: standing with feet together and eyes closed
• Eye movements and speech
• Sensation, reflexes and strength

Tests may include blood tests (vitamin B12, vitamin E, thyroid, glucose, liver function, medication levels, celiac antibodies), urgent CT or MRI of the brain, nerve conduction studies, a lumbar puncture, and genetic testing for inherited ataxias.

Treatment and living with coordination difficulties

Treatment targets the cause: stopping alcohol or the responsible medicine, thiamine or B12 replacement, stroke treatment, MS therapies, gluten-free diet for gluten ataxia, or tumor surgery. For many inherited ataxias there is no cure yet, though omaveloxolone has been approved in the US for Friedreich's ataxia.

Rehabilitation helps in almost every case:

• Physical therapy: balance and gait training, core strengthening, and coordination exercises
• Occupational therapy: adapted cutlery, writing aids, button hooks, and home modifications
• Speech therapy: for slurred speech and swallowing
• Walking aids: a cane, walker or weighted aids
• Fall prevention: remove trip hazards, add grab bars and handrails, and use good lighting

Frequently asked questions

What causes sudden loss of coordination?

The most common cause is alcohol or medicine intoxication. Serious causes include stroke, head injury, brain infection, very low blood sugar and Wernicke encephalopathy. Sudden clumsiness with slurred speech, double vision, facial droop or a severe headache needs emergency care.

Is clumsiness a sign of something serious?

Usually not. Tiredness, distraction, alcohol and some medicines often cause clumsiness. It becomes concerning when it is new and getting worse, affects one side, or comes with slurred speech, numbness, weakness, double vision or headaches. Persistent or worsening clumsiness should be assessed by a doctor.

What is the difference between ataxia and poor balance?

Ataxia is a lack of coordination of movement, affecting walking, hand movements, speech and eye movements. Poor balance is difficulty staying upright, which can come from ataxia but also from inner ear problems, low blood pressure, weak muscles or numb feet. A neurological exam helps tell them apart.

Can vitamin deficiency cause coordination problems?

Yes. Vitamin B12 deficiency damages the spinal cord and nerves, causing unsteadiness and numbness. Thiamine (B1) deficiency causes Wernicke encephalopathy. Vitamin E deficiency is a rarer cause. These are found with blood tests and are treatable, especially when caught early.