Coordination Problems (Ataxia and Clumsiness)

What coordination problems look like

Coordination depends on three systems working together: the cerebellum, which times and grades movements; sensory nerves and the spinal cord, which tell the brain where your limbs are (proprioception); and the inner ear and eyes, which handle balance. Muscle strength must also be normal.

When coordination fails, you may notice:

• unsteady, wide-based walking, like being drunk, and frequent falls
• missing targets when reaching, knocking things over
• trouble with fine tasks such as buttoning, writing or typing
• a tremor that worsens as the hand approaches a target (intention tremor)
• slurred, slow or "scanning" speech
• jerky eye movements (nystagmus) or blurred vision with head movement
• difficulty swallowing

Types of ataxia

Causes of coordination problems

Sudden onset (minutes to hours)

• Stroke or bleeding in the cerebellum or brainstem. Severe dizziness, vomiting, headache, double vision and inability to walk.
• Alcohol and drug intoxication: alcohol, benzodiazepines, cannabis, and toxic levels of anti-seizure medicines (phenytoin, carbamazepine) or lithium.
• Head injury and concussion.
• Wernicke encephalopathy: thiamine (vitamin B1) deficiency in heavy drinkers, after bariatric surgery or with severe vomiting. Unsteadiness, confusion and eye movement problems. Treated urgently with IV thiamine.
• Low blood sugar.

Over days to weeks

• Multiple sclerosis: episodes of unsteadiness, numbness, vision loss or double vision in young adults.
• Infection or post-infectious inflammation: acute cerebellar ataxia in children after chickenpox or other viral infections, which usually resolves within weeks. Encephalitis in adults.
• Guillain-Barré syndrome: rapidly rising weakness and unsteadiness after an infection.
• Brain tumors or abscesses in the back of the brain, often with morning headaches and vomiting.

Over months to years

• Long-term alcohol use: degeneration of the cerebellum causes a broad-based, unsteady gait. See alcohol use disorder.
• Vitamin B12 deficiency: damages the spinal cord and nerves, causing sensory ataxia, numbness and memory problems. Common with pernicious anemia, metformin, acid-reducing medicines and vegan diets without supplements.
• Peripheral neuropathy: from diabetes, chemotherapy or other causes.
• Underactive thyroid, celiac disease (gluten ataxia) and vitamin E deficiency.
• Inherited ataxias: Friedreich ataxia (starts in childhood or teens), spinocerebellar ataxias (adult onset, often with a family history).
• Neurodegenerative diseases: multiple system atrophy, Parkinson's disease, progressive supranuclear palsy.
• Normal pressure hydrocephalus: a shuffling, "magnetic" gait, urinary incontinence and memory problems in older adults.
• Paraneoplastic syndromes: a rare immune reaction to a hidden cancer causing rapidly progressive ataxia.

In children

• Developmental coordination disorder (dyspraxia): lifelong clumsiness, difficulty with handwriting, dressing, ball skills and sport, without another neurological disease. It affects about 5% of school-age children.
• Acute cerebellar ataxia after a viral illness.
• Accidental ingestion of medicines or alcohol.
• Inner ear infections and migraine-related vertigo.
• Rare genetic conditions and tumors.

How doctors diagnose coordination problems

The doctor will ask how fast the problem developed, whether it affects one or both sides, and about alcohol, medicines, diet, weight loss surgery, family history and other symptoms such as numbness, vision changes or headaches.

The neurological exam includes:

• finger-to-nose and heel-to-shin tests to look for overshooting and tremor
• rapid alternating hand movements
• walking heel-to-toe in a straight line
• Romberg test: standing with feet together, eyes closed. Swaying or falling with eyes closed points to sensory ataxia
• eye movement, speech, strength, reflexes and sensation

Tests may include:

• MRI of the brain, urgently if stroke, bleeding or a tumor is suspected
• Blood tests: B12, folate, vitamin E, thyroid function, glucose, celiac antibodies, medicine levels, liver function
• Nerve conduction studies for neuropathy
• Lumbar puncture for suspected infection or MS
• Genetic testing for inherited ataxias

Treatment

Treatment depends on the cause:

• Stroke: emergency clot-busting treatment or clot removal, if given in time.
• Medicine or alcohol toxicity: stopping or adjusting the drug, and thiamine for at-risk drinkers.
• Vitamin deficiencies: B12 injections or tablets, thiamine, vitamin E. Early treatment can reverse symptoms, but long-standing damage may be permanent.
• MS: steroids for relapses and disease-modifying therapy.
• Celiac disease: a strict gluten-free diet.
• Inherited and degenerative ataxias: no cure for most, but omaveloxolone is approved for Friedreich ataxia in people 16 and older.

Rehabilitation and daily life

• Physical therapy: balance and gait training reduces falls and improves function.
• Occupational therapy: adapted utensils, writing aids and home modifications such as grab rails.
• Speech therapy: for slurred speech and swallowing problems.
• Walking aids such as a cane or walker when needed.
• Avoid alcohol, which worsens all forms of ataxia.

Frequently asked questions

What causes sudden loss of coordination?

Sudden loss of coordination is most often caused by stroke, alcohol or drug intoxication, head injury or very low blood sugar. A sudden onset with face droop, slurred speech, double vision or severe dizziness is a stroke warning sign. Call 911 immediately.

What is the medical term for coordination problems?

The medical term is ataxia. It describes a lack of muscle control or coordination of voluntary movements, such as walking, picking up objects or speaking. Ataxia is a symptom with many causes, but it can also be the name of specific inherited conditions such as Friedreich ataxia.

Can vitamin deficiency cause poor coordination?

Yes. Vitamin B12 deficiency damages nerves and the spinal cord and causes unsteady walking, especially in the dark. Thiamine (B1) deficiency can cause sudden unsteadiness with confusion. Vitamin E deficiency causes a slower ataxia. Early treatment often improves symptoms.

Why am I suddenly so clumsy?

Short-term clumsiness is often from tiredness, stress, alcohol, or sedating medicines. New clumsiness that persists, worsens, or comes with numbness, weakness, slurred speech or vision changes should be checked by a doctor, and sudden clumsiness on one side needs emergency care.

Is poor coordination in children a sign of a disorder?

Some children are simply later to master skills. A child who is much clumsier than peers, struggles with handwriting, dressing and sports, and does not catch up may have developmental coordination disorder. Clumsiness that is new or worsening needs prompt medical assessment.