Dysdiadochokinesia (DDK) is the medical term used to describe difficulty performing quick and alternating movements, usually by opposing muscle groups. It’s pronounced “dis-di-ad-o-ko-ki-nee-ze-a.” DDK is not a disease itself, but rather a symptom of an underlying health problem.

DDK is often seen as a symptom of multiple sclerosis (MS) or other cerebral conditions.

Read on to learn more about DDK.

DDK may affect three major body areas:

  • muscles in the upper limbs
  • muscles in the lower limbs
  • muscles that control speech

That means you may have symptoms in one or more of those areas.

You may experience some or all of these symptoms if you have DDK:

  • a change in balance and walking, including slowness, or awkward or rigid movements
  • poor coordination of the arms, hands, or legs
  • inarticulate or incomprehensible speech
  • difficulty stopping one movement and starting another in the opposite direction

A person with DDK may have difficulty rapidly turning their hand over several times against a hard, flat surface, or screwing or unscrewing a light bulb. They may also have trouble rapidly repeating one to three syllables in a row, such as “pa-ta-ka.”

DDK most often comes from a disturbance in the cerebellum. The cerebellum is a large part of the brain that controls voluntary muscle movements, posture, and balance. It’s thought that people with DDK are unable to switch opposing muscle groups on and off in a coordinated manner.

DDK may be the result of an underlying cerebral condition, such as:

There are many physical tests a doctor can perform to observe the presence and extent of DDK.

In the early stages, your doctor may recommend physical tests to check your ability to rapidly alternate movements. These tests are typically done in the doctor’s office, often by a neurologist.

Other tests may include:

  • Rapidly alternating movement evaluation. You’ll hold the palm of one hand on a flat surface (often the upper thigh), and then continuously flip the hand palm side up, then back to palm side down as fast as possible.
  • Point-to point movement evaluation. You’ll be asked to touch your nose and then, using the same finger and as quickly as possible, touch the outstretched finger of the person doing the test.
  • Heel shin test. You’ll place one heel on one shin just below the knee, and then slide the heel down the shin to the foot. You should aim for rapid, coordinated movements.
  • Romberg test. You’ll stand still with your heels together and your eyes closed. If you lose your balance in this position, you may have some form of DDK.
  • Gait test. You’ll be asked to walk normally, and then walk heel to toe.

A person with DDK will be unable to perform these tests in a correct or coordinated way. Your movements may be clumsy, unusual, or slowed.

If symptoms are thought to be from a cerebral lesion, your doctor will order an MRI to detect and describe the lesion.

There are many causes of a cerebral lesion and of DDK, and the treatment may be both varied and challenging. A common approach is physical therapy to help assist with movement disorders.

If you have DDK, or any other balance or walking condition, always get a physical therapist’s permission before trying any exercise at home. Also, make sure to exercise in a safe environment. Avoid exercising on hard surfaces that could lead to injury if you fall.

Warm up your muscles before beginning these exercises. To warm up, do a continuous activity, such as jogging, using an arm bike, or using a treadmill, for at least five minutes. This increases the temperature of the muscles and body, which in turn helps:

  • increase the range of motion
  • decrease stiffness
  • dilate the blood vessels
  • improve mental focus

Romberg exercise

This exercise follows the same steps as the Romberg test. Stand still with your heels together. Keep your eyes open for 10 seconds while you catch your balance, and then close them for 10 seconds or until you begin losing your balance. Make sure you have something you can grab on to if you lose your balance.

Unilateral stance

Stand on one leg for up to 30 seconds, and then switch legs. This can be done over and over, and as you notice your balance improving, you can begin varying the surface and movements to train posture and balance strategies.

Other balance training

You can also try moving your arms and legs in a coordinated manner, while sitting or standing. One way of doing this is to try alternating heel and toe taps on the floor. By tightening the belly muscles and paying attention to posture, this exercise helps strengthen your core muscles, which are an important part of overall body strength.

Strengthening exercises

Muscle weakness is common in DDK and makes movement more difficult. Muscle strength also decreases with age. Exercises to help increase strength in the lower limbs 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.

DDK is a clinical symptom that something might be wrong with the part of your brain that controls muscle function. Treatment often depends on finding the underlying cause.

An important part of treatment is working with a physiotherapist, occupational therapist, or a speech pathologist. Although not necessarily a “cure,” the exercises prescribed by these medical professionals can help reduce symptoms to a manageable level.


Is DDK a symptom of Parkinson’s disease?

Anonymous patient


Dysdiadochokinesia is usually caused by multiple sclerosis or cerebellar abnormalities. Patients with Parkinson’s disease may have abnormal rapid alternating movement testing secondary to akinesia or rigidity, which creates a false impression of dysdiadochokinesia.

Gregory Minnis, DPTAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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