Diadochokinesia: Definition, Causes, Symptoms, Diagnosis, Treatment and Prognosis

It is not a disease itself, but a symptom of an underlying health problem.

Diadochokinesia is the medical term used to describe difficulty in performing rapid, alternating movements, usually by opposing muscle groups.
Diadochokinesia is often seen as a symptom of multiple sclerosis or other brain conditions.

Causes of diadochokinesis

Diadochokinesis is believed to be caused by multiple sclerosis lesions in the cerebellum, a part of the brain.
The cerebellum is a large part of the brain that controls voluntary muscle movements, posture, and balance.
People with diadochokinesis are thought to be unable to turn opposing muscle groups on and off in a coordinated way.
Damage to fibers in the central nervous system can cause hypotonia or muscle weakness, which can contribute to the problem.
Diadochokinesis is also associated with a genetic mutation that affects neurotransmitters, the chemicals that communicate information throughout our brain and body.
Diadochokinesis most often comes from a disturbance in the cerebellum.
Diadochokinesis can be the result of an underlying brain condition, such as:
  • Multiple sclerosis.
  • Ataxia de Friedreich.
  • Ataxic dysarthria (a speech disorder).


Diadochokinesis typically affects the muscles of the arms, hands, legs, and feet, as well as the muscles of the larynx that control speech.
The symptoms of diadochokinesis fall into a category of neurological problems known as ataxia.
Another neurological sign that can appear in people with multiple sclerosis is called dysmetria, which refers to a person’s inability to judge distance.
Diadochokinesis can affect three main areas of the body:
  • Muscles in the upper extremities.
  • Muscles in the lower extremities.
  • Muscles that control speech.
That means you may have symptoms in one or more of those areas.
Some or all of these symptoms may be experienced when you have diadochokinesis:
  • A change in balance and gait, including slowness, or awkward or stiff movements.
  • Poor coordination of the arms, hands, or legs.
  • Inarticulate or incomprehensible speech and swallowing difficulties.
  • Difficulty stopping one movement and starting another in the opposite direction.
  • Tremors, weakness, spasticity, inability to move the eyes, and loss of sensation in the hands and feet.
A person with diadochokinesis may find it difficult to quickly turn their hand several times against a hard, flat surface, or to screw or unscrew a light bulb.
They may also have trouble repeating one to three syllables rapidly in a row, such as “pa-ta-ka.”

Diagnosis of diadochokinesis

There are many physical tests that a doctor can perform to observe the presence and extent of diadochokinesis.
In the early stages, your doctor may recommend physical tests to check your ability to alternate movements quickly.
These tests are typically done in the doctor’s office, often by a neurologist.
These tests can include:

Quickly toggle motion evaluation

You will hold the palm of one hand on a flat surface (often the top of the thigh), and then continuously flip the palm of the hand up and then return the palm of the hand down as quickly as possible.

Point-to-point evaluation of movement

The patient will be asked to touch their nose and then, with the same finger and as quickly as possible, touch the extended finger of the person performing the test.

Heel pimple test

A heel will be placed on a shin just below the knee and then the heel will slide down the shin to the foot. You should aim for fast, coordinated movements.

Romberg test

The patient will stay still with the heels together and the eyes closed. If you lose your balance in this position, you may have some type of diadochokinesis.

Walk test

The patient will be asked to walk normally and then walk from heel to toe.
  • Have the patient alternately move each hand from palm side to palm side down as quickly as possible on a stable surface such as a table
  • Ask the patient to demonstrate the movement of turning a knob or screwing in a light bulb
A person with diadochokinesia will not be able to perform the above tests in a correct and coordinated manner. Their movements may be slower, unusual, or clumsy.
If the symptoms are thought to be from a brain injury, the doctor will order an MRI scan to detect and describe the injury.


Diadochokinesia is a clinical symptom that something could be wrong with the part of the brain that controls muscle function. Treatment often depends on finding the underlying cause.
Treatment of diadochokinesis and cerebellar ataxia, in general, is challenging, and there are no specific strategies that are scientifically supported at this time.
Sometimes medications used to treat tremor, such as Neurontin (gabapentin) and Topamax (topiramate) are used to treat ataxia, and sometimes surgery may be considered.
One study found that physical therapy and occupational therapy may provide some benefit in patients with diadochokinesis.
An important part of treatment is working with a physical therapist, occupational therapist, or speech pathologist. Speech therapy can also be very helpful when there are problems in this area.
Although not necessarily a “cure,” the exercises prescribed by these medical professionals can help reduce symptoms to a manageable level.

Exercises for diadochokinesis

Muscle weakness is common in diadochokinesis and makes movement difficult.
There are many causes of brain injury and diadochokinesis, and treatment can be varied and challenging. A common approach is physical therapy to help with movement disorders.
Strength training, balance exercises, treadmill walking, and exercises to improve core strength can be helpful.
Muscle strength also tends to decline with age, and exercises to help increase strength in the lower extremities and upper body, especially the shoulders, are a good way to help improve or maintain balance and muscle strength.
Exercises to strengthen the core muscles can also be helpful.
When you have diadochokinesia, or any other balance condition, you should always consult a physical therapist before attempting any exercise at home.
In addition, the patient must ensure that they exercise in a safe environment, such as avoiding exercise on hard surfaces as injury could result if the patient falls.
The muscles should be warmed up before beginning these exercises.
To warm up, you should be engaged in a continuous activity, such as jogging, using an arm bike, or a treadmill, for at least five minutes.
This increases the temperature of the muscles and the body, which in turn helps to:
  • Increase range of motion.
  • Decrease stiffness.
  • Dilate the blood vessels.
  • Improve mental focus.
Romberg exercise
This exercise follows the following steps: stand still with your heels together.
Keep your eyes open for 10 seconds while you regain your balance, and then close your eyes for 10 seconds or until you begin to lose your balance.
The patient should make sure they have something to grab if they lose their balance.

unilateral posture

The unilateral pose involves standing on one leg for up to 30 seconds and then switching legs.
This can be done over and over again, and when balance is noticed improving, surface and movements can be varied to train posture and balance strategies.
Other balance workouts
You can also try moving your arms and legs in a coordinated way, while sitting or standing.
One way to do this is to try alternating heel and toe tapping on the ground.
By tightening your belly muscles and paying attention to posture, this exercise helps to strengthen your core muscles, which are an important part of your overall body strength.

Diadochokinesis prognosis

Living with diadochokinesis can be scary and unsettling. While there is no known ‘cure’ for this condition, medical advice should be sought, and working with physical and occupational therapists can help the patient keep symptoms at a manageable level.
Learning strategies for preventing falls and modifying the home (for example, installing grab rails, removing loose rugs, and laying down non-slip mats) can keep someone safe if they continue to struggle with the symptoms of diadokinesis.