Motor disorders

Motor disorders are characterized by the presence of some deficit in the development of motor skills or the appearance of stereotyped or repetitive non-adaptive movements. They manifest during the first years of life and reflect an alteration in the development of the nervous system. (Tellez, 2016) Tics are defined as repetitive, non-rhythmic and stereotyped movements resulting from sudden abrupt and involuntary muscle contractions, the most common affecting the head and neck, followed by those affecting the arms and hands.

People with motor disorders identify in them clumsy, jerky, uncoordinated movements, they find it difficult to do activities in daily life (dressing, writing, playing).

(Nieto-Pico AM., 2019) tell us that the diagnosis is eminently clinical, medical history and observation are required to make an adequate differential diagnosis with other hyperkinetic movement disorders.

The causes of these disorders are due to the dysfunction of the dopaminergic pathways in the basal ganglia, also in the pathways of the neuroinhibitor GABA, contributing to the dysfunction of the cortico-striatal and cortical thalamic circuits.

Developmental coordination disorders, according to DSM-5 criteria (Association, 2014)

  1. The acquisition and execution of coordinated motor skills is well below those expected for the chronological age of the individual and the opportunity for learning and use of the skills. Difficulties manifest as clumsiness (eg, dropping or colliding with objects) as well as slow and imprecise performance of motor skills (eg, picking up an object, using scissors or silverware, writing by hand , ride a bike or participate in sports).
  2. Criterion A motor activity deficit significantly and persistently interferes with chronological age-appropriate activities of daily living (e.g., self-care and maintenance) and affects academic / school productivity, pre-vocational and vocational activities, leisure and games.
  3. Symptoms begin early in the development period.
  4. Motor skill deficits are not better explained by intellectual disability (intellectual development disorder) or visual impairments, and cannot be attributed to a neurological condition that impairs movement (eg, cerebral palsy, muscular dystrophy, impaired degenerative).

Stereotypical movement disorder:

  1. Repetitive, apparently guided, and aimless motor behavior (eg, shaking or shaking hands, rocking the body, hitting the head, biting, hitting one’s own body).
  2. Repetitive motor behavior interferes with social, academic, or other activities and can lead to self-harm.
  3. It begins in the early stages of the development period.
  4. Repetitive motor behavior cannot be attributed to the physiological effects of a substance or a neurological condition and is not better explained by another neurodevelopmental or mental disorder (eg, trichotillomania (hair-pulling disorder), obsessive compulsive disorder).

Specify if:

With self-injurious behavior (or behavior that would lead to injury if preventive measures are not used).

No self-injurious behavior

Specify if:

Associated with a known medical or genetic condition, neurodevelopmental disorder, or known environmental factor) p. eg, Lesch-Nyhan syndrome, intellectual disabilities (intellectual development disorder), intrauterine exposure to alcohol).

Coding note: Use the additional code to identify the associated medical or genetic condition, or neurodevelopmental disorder.

Specify the current severity:

Mild: Symptoms disappear easily through sensory stimulation or distraction.

Moderate: Symptoms require explicit protective measures and behavior modification.

Severe: Continuous vigilance and protective measures are needed to prevent serious injury.

Tic disorders

Note: A tic is a loud, fast, recurring, non-rhythmic vocalization or movement.

Tourette’s disorder.

  1. Multiple motor tics and one or more vocal tics have been present at some point during the disease, although not necessarily on a recurring basis.
  2. Tics may appear intermittently in frequency, but persist for more than a year from the onset of the first tic.
  3. It starts before the age of 18.
  4. The disorder cannot be attributed to the physiological effects of a substance (eg, cocaine) or to another medical condition (eg, Huntington’s disease, postviral encephalitis).

Persistent (chronic) motor or vocal tic disorder

  1. Single or multiple motor or vocal tics have been present during the disease, but not both at the same time.
  2. Tics may appear intermittently in frequency, but persist for more than a year from the onset of the first tic.
  3. It starts before the age of 18.
  4. The disorder cannot be attributed to the physiological effects of a substance (eg, cocaine) or to another medical condition (eg, Huntington’s disease, postviral encephalitis).
  5. The criteria for Tourette disorders have never been met.

Transient tic disorder.

  1. Single or multiple motor and / or vocal tics.
  2. Tics have been present for less than a year since the first tic appeared.
  3. It starts before the age of 18.
  4. The disorder cannot be attributed to the physiological effects of a substance (eg, cocaine) or to another medical condition (eg, Huntington’s disease, postviral encephalitis).
  5. The criteria for Tourette’s Disorder or Persistent (Chronic) Vocal or Motor Tic Disorder have never been met.
Photo by Mikhail Nilov on Pexels.com

Bibliography

Association, A. P. (2014). Guía de Consulta de los Criterios Diagnósticos del DSM-5. Washintong: APA.

Nieto-Pico AM., R.-V. A.-B. (2019). Trastornos por tics en niños: un caso con retraso diagnóstico. Rev. CES Medicina, 126:133.

Tellez, M. G. (2016). Neuropsicología de los trastornos del neurodesarrollo. Bogotá D.C.: Moderna.

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