REHABILITATION OF MODERATE TO SEVERE TBI: MOVEMENT DISORDERS: AKATHISIA, ATAXIA, ATHETOSIS, BALLISM, CHOREA  

Akathisia

  • Motor restlessness, such as pacing, fidgeting, and toe tapping, or a sense of inner restlessness, such as an uneasy feeling
  • Probably due to dopamine blockade in the prefrontal area (Silvers and Yablon, 1996); may also be caused by gabapentin, an anticonvulsant which has been prescribed for pain in TBI patients (Childers and Holland, 1997)
  • May be associated with dysphoria or a sensation of pain or burning
  • Possible treatment includes movement, amantadine, beta-adrenergic blockers, or benzodiazepines

Ataxia

  • Irregular, discoordinated movements, probably due to axonal injury, that can appear within minutes of the injury
  • Treatment includes weighting utensils, coordination activities, and beta-adrenergic blockers, acetazolamide, phthalazinol, thyrotropin-releasing hormone, choline, or lecithin

Athetosis

  • Slow, continuous, writhing movements of the limbs or axial musculature
  • Treatment includes venterolateral thalamotomy, stereotactic lesioning of the dentate nucleus, and electrical stimulation of the anterior cerebellum

Ballism

  • Large-amplitude flinging or flailing movement due to lesions in the basal ganglia
  • Usually unilateral and called hemiballism
  • Treatment includes anticonvulsant therapy, such as valproic acid, and stereotactic thalamotomy

Chorea

  • Rapid, involuntary, irregular, and purposeless movement that flows from one part of the body to another, due to lesions in the basal ganglia
  • Onset is immediate or weeks, months, or years postinjury
  • Treatment includes anticonvulsant therapy, such as valproic acid and phenobarbital, and stereotactic deconstruction of part of the cerebellum dentate nucleus.

Based on information in Medical Rehabilitation of Traumatic Brain Injury, L.J. Horn and N.D. Zasler, eds. St. Louis, MO, Mosby, 1996, except for information where other papers are cited.