Motor Disorders

A motor disorder is a condition where a person has unusual or involuntary movements. These are usually the result of brain injuries.

Different parts of the brain control different functions pertaining to motor tasks (movement). The type of motor disorder a child has depends upon the area of the brain affected and the extent of the damage.

Some damages are not apparent until the child develops and starts missing milestones. Sometimes, physicians simply diagnose the child with a motor disorder. When the child gets older, a more specific diagnosis is usually made.

People with motor disorders have unusual or involuntary movements, which result from brain damage or abnormalities. The most common motor disorder is cerebral palsy, also known as CP (1).

In most cases, cerebral palsy stems from a birth injury, i.e. a medical complication or error that occurs around the time of birth and causes neonatal brain damage. If medical professionals fail to do all they can to prevent a birth injury, and this causes cerebral palsy or another permanent disability, they have committed an act of medical malpractice.

Motor disorders that stem from birth injuries are preventable. Prenatal care physicians and obstetricians should always be vigilant for potential complications, especially in women with high-risk pregnancies. Medical professionals should use a fetal heart rate monitor to check for signs of fetal distress. These are indications that a baby is being deprived of oxygen and may require immediate attention.

If a baby is exhibiting signs of fetal distress, physicians are required intervene. Some interventions are simple, such as repositioning the mother. However, in certain cases, an emergency C-section may be warranted. In some cases, physicians may attempt interventions such as an assisted delivery (use of forceps or vacuum extractors) or drug-enhanced labor, even when there is reason to believe these actions are dangerous.

Providing insufficient prenatal care, failing to monitor for signs of fetal distress, postponing necessary interventions such as emergency C-sections, and neglecting to provide therapeutic hypothermia are all forms of negligence. If these actions cause harm, it constitutes medical malpractice.

Treatment for motor disorders often involves a combination of therapies, medications, and surgeries. The following are some common examples of treatments for motor disorders.

The main goal of physical therapy, or PT, is to promote motor and developmental skills. Physical therapy for children with cerebral palsy and other motor disorders can improve strength, balance, flexibility, and much more. It can maximize the child’s abilities and minimize negative symptoms such as pain.

Occupational therapy focuses on developing the skills needed for daily living, such as feeding, dressing, toileting, grooming, and transfers. The goal should be for the child to function as independently as possible with or without the use of assistive technology.

Some children with motor disorders have issues with speaking and communication. This may result from dysarthria (difficulty speaking due to muscle weakness) and/or apraxia (difficulty speaking because signals from the brain are not properly transmitted to the necessary muscles) (7).  Speech therapy can be used to help improve not only speaking, but also swallowing and drooling problems. Additionally, some children benefit from augmentative and alternative communication (AAC) devices.

Incorporation of play into a child’s treatment program is important. The child should view physical and occupational therapy as fun, not work. Caregivers should seek fun and creative ways to stimulate children, especially those who have a decreased ability to explore their own environment.

Recreational activities that can benefit children with motor disorders include hippotherapy, sports, cycling, water therapy, and more.

There are many different types of medications that can be used to treat motor disorders. Some of the most common include:

• Anticholinergic medications: These drugs can help to decrease involuntary muscle movements and excessive drooling.
• Anticonvulsant medications: Many people with motor disorders also have seizure disorders. Anticonvulsants can inhibit seizure activity.
• Antidepressants: The physical and/or cognitive limitations imposed on people with motor disorders often lead to feelings of frustration and sometimes more serious mental health concerns such as depression. In certain cases, antidepressants may be a necessary complement to therapy and other measures to promote mental and emotional wellbeing.
• Anti-inflammatory medications: Anti-inflammatories can be used to manage pain symptoms in people with motor disorders.
• Muscle relaxants: These can treat spasticity, increase range of motion, and inhibit excessive muscle contractions. Two very important muscle relaxants are botox and baclofen. Botox is injected by a medical professional and can be effective for several months before an additional injection is needed. Baclofen (Lioresal) can be taken orally, transdermally, or through an intrathecal baclofen pump.

Although motor impairments like cerebral palsy are not curable, there are many surgeries that can improve health and quality of life. It is important to note that some of these surgeries require extensive post-operative rehabilitation and care in order for the patient to reap the benefits of the procedure itself. Therefore, surgical intervention should be considered a complement to, rather than a replacement for, other forms of treatment and therapy.

Some types of surgery that may benefit people with motor disorders include the following:

• Insertion of intrathecal baclofen pump: Please see “medications.”
• Gastroenterology surgery: Some people with motor disorders struggle with chewing, swallowing, or digesting food. In certain cases, gastroenterologic surgery may be necessary to alleviate these issues.
• Neurosurgery: There are certain procedures that can improve the symptoms of motor disorders by addressing the root neurological problems. These surgeries involve modifying connections in the nervous system. One example is selective dorsal rhizotomy (SDR), which is a surgery that may help people with spastic cerebral palsy.
• Orthopedic surgery: Orthopedic surgeries can help to improve musculoskeletal abnormalities. For example, some children need muscle release procedures to treat hip subluxation.
• Pulmonary surgery: Pulmonary surgeries can improve issues with breathing, swallowing, and/or drooling.