What is the Difference Between Dyskinesia and Dystonia?

While dystonia and dyskinesia have similarities, it is important for physical therapists to know the differences.

Dystonia and dyskinesia are two involuntary movement disorders familiar to most physical therapists. Both are often associated with neurological diseases such as Parkinson’s or Huntington’s.

While dystonia and dyskinesia have similarities, it is important for physical therapists to know the differences when treating these diagnoses. This ensures that PTs can create the best treatment plan to properly manage their patients’ symptoms and improve their functional mobility.

Recommended course: Evaluation of Global Movement Dysfunction through NeuroFascial Patterns

What is dystonia?

According to the National Institute of Neurological Disorders and Stroke, dystonia is a neurological disorder causing involuntary muscle contractions. These contractions cause slow, repetitive movements or postural abnormalities. These contractions can be painful for patients. Dystonia may affect only one muscle, a group of muscles or most of the muscles throughout the body. These symptoms can appear early in childhood or be adult onset. Symptoms can often be very mild and only present with stress or fatigue. These symptoms do have the ability to worsen or progress. Symptoms can include foot drag, worsening handwriting, neck twitching, rapid blinking, tremors, spasms, or irregular speech.

Types of dystonia

Dystonia is classified in two different ways: Axis 1 & Axis 2.

Axis I is categorized by clinical presentation, such as age of onset, specific features, body region(s) affected, etc. Examples include:

• General dystonia: affecting most or all body segments
• Focal or multifocal dystonia: affecting a specific part of the body or, in the case of multifocal, two more unrelated body parts
• Segmental dystonia: two or more adjacent parts of the body
• Hemi-dystonia: affects only one side of the body

Axis II is categorized by the cause of dystonia, including genetics, brain injury or unknown causes. Scientists do not yet know the exact cause of dystonia.

Researchers believe it may involve alterations to several regions of the brain and the communication pathways between those regions. Causes of dystonia break down into three categories:

• Idiopathic dystonia refers to dystonia that does not have a clear root cause
• Genetic dystonia refers to a condition inherited via gene abnormality. The severity of disease can vary amongst family members and some people who have the gene abnormality do not develop dystonia.
• Acquired (secondary) dystonia results from a secondary cause, such as environmental factors, brain damage, or certain medications. Acquired dystonia often achieves plateau and does not spread. Diseases such as Parkinsons can cause dystonia in certain areas of the body, such as the foot.

What is dyskinesia?

Tardive Dyskinesia (TD) is a movement disorder characterized by uncontrollable, abnormal, and repetitive movements. Extended use of medications called neuroleptics typically causes TD. These medications can result in irregular dopamine signaling towards the region of the brain in control of movement. These symptoms can look like fidgeting, writhing, or wriggling body movements. Like dystonia, feelings of stress or excitement can exacerbate dyskinesia. While it can be difficult to differentiate between dystonia and TD, TD patients typically demonstrate more “jerky” movements of the body.

How can physical therapy help?

Physical therapy is important and arguably necessary for managing any type of movement disorder. Physical therapists can teach patients how to manage their symptoms to improve overall quality of life. While all PTs can help with balance, strength, and motor control, you may want to find a PT who specializes in neurologic or vestibular therapy. Specifically, physical therapists who are certified in LVST BIG are best equipped to help patients with these disorders move their body more normally. This treatment approach helps increase strength, improves motor learning, and ultimately reteaches patients how normal movement feels.