Move­ment Dis­or­der Clinic Handbook

MUHC/​CUSM, 2007

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I. Intro­duc­tion
II. Move­ment Dis­or­ders
III. Diag­no­sis of a Move­ment Dis­or­der
IV. Our Team
V. Move­ment Dis­or­der Clinic
VI. Addi­tional Resources and Information

I. Intro­duc­tion

ImageThis brochure describes the ser­vices avail­able at the Move­ment Dis­or­ders Clinic. It also aims to answer some of the ques­tions you may have when com­ing to the clinic.

The Move­ment Dis­or­der Clinic has two loca­tions:
The sec­ond floor of the Mon­treal Neu­ro­log­i­cal Hos­pi­tal, room 201, as well as the Mon­treal Gen­eral Hos­pi­tal, room L7-​312.

Our ser­vices are avail­able to patients through­out the McGill Uni­ver­sity Health Cen­tre (MUHC).
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II. Move­ment disorders

Move­ment dis­or­ders are a group of dis­eases and syn­dromes that cause abnor­mal or invol­un­tary move­ment. Move­ment dis­or­ders affect the abil­ity to pro­duce and con­trol move­ments. The move­ments may be too weak, too force­ful, too unco­or­di­nated, or too poorly con­trolled for the task at hand.

Abnor­mal move­ments can be caused by these dis­eases and syndromes:

  • Ataxia
  • Chorea
  • Cor­ti­cobasal Degeneration
  • Dysk­i­ne­sias (Paroxysmal)
  • Dys­to­nia (gen­eral, seg­men­tal, focal) including:
    • Ble­pharospasm
    • Spas­modic Tor­ti­col­lis (Cer­vi­cal Dystonia)
    • Writer’s Cramp (Limb Dystonia)
    • Laryn­geal Dys­to­nia (Spas­modic Dysphonia)
    • Oro­mandibu­lar Dystonia
  • Essen­tial Tremor
  • Huntington’s Dis­ease
  • Mul­ti­ple Sys­tem Atrophy
  • Myoclonus
  • Parkinson’s Dis­ease
  • Parkin­son­ism
  • Pro­gres­sive Supranu­clear Palsy
  • Rest­less Legs Syndrome
  • Tar­dive Dyskinesia/​Dystonia
  • Tics/Tourette’s Syn­drome
  • Wilson’s Dis­ease

There are gen­er­ally two types of move­ment disorders

  1. Exces­sive or dis­or­dered move­ments.
    This is called hyper­ki­ne­sia or dysk­i­ne­sia. Tremor and tic are exam­ples of hyperkinesia.
  2. Slow move­ments or a lack of move­ment.
    This is called hypoki­ne­sia, bradyki­ne­sia or aki­ne­sia. Parkinson’s Dis­ease is hypo­ki­netic because of the slow delib­er­ate move­ments or even a “freez­ing” in place.

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III. Diag­no­sis of a move­ment disorder

ImageThe Move­ment Dis­or­der Clinic has neu­rol­o­gists with spe­cial train­ing in move­ment disorders:

  • They can assess your symp­toms to iden­tify the move­ment disorder.
  • They can arrange for tests, such as neu­roimag­ing like Com­put­er­ized Tomog­ra­phy (CT) scan and Mag­netic Res­o­nance Imag­ing (MRI) and blood tests. These tests will help deter­mine your diagnosis.
  • They can advise you on the course of ther­apy to follow.
  • They can refer you to other mem­bers of our team of health care professionals.

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IV. Our team

ImageAt the MUHC, we pro­vide a mul­ti­dis­ci­pli­nary approach to the treat­ment and care of our patients. A mul­ti­dis­ci­pli­nary approach means that each mem­ber brings a dif­fer­ent pro­fes­sional back­ground to the team. The team includes doc­tors, a clin­i­cal nurse spe­cial­ist, a phys­io­ther­a­pist, an occu­pa­tional ther­a­pist and a speech pathol­o­gist. Health care pro­fes­sion­als such as a neu­ropsy­chi­a­trist, a neu­ro­sur­geon or a geri­a­tri­cian may be consulted.

The ner­vous sys­tem includes the brain, spinal cord and spinal col­umn, as well as the nerves that travel through all parts of the body (to reach the hands, legs, arms, and face). Neu­rol­o­gists are doc­tors who are trained to exam­ine the ner­vous sys­tem, make a diag­no­sis and plan the treat­ment of neu­ro­log­i­cal dis­eases and disorders.

Neu­rol­o­gists who work in the clinic have spe­cial train­ing in move­ment disorders.

Clin­i­cal Nurse Spe­cial­ist (CNS)
Image The clin­i­cal nurse spe­cial­ist in the Move­ment Dis­or­der Clinic is a resource per­son for you and your fam­ily. She looks after the qual­ity of your care and helps you and your fam­ily with sup­port and infor­ma­tion. Your nurse can help you learn about your move­ment dis­or­der. She can explain the symp­toms of the dis­ease and how to man­age them. She can give you infor­ma­tion on your med­ica­tion. She can also let you know about resources in your com­mu­nity. Between vis­its to your neu­rol­o­gist you can call the nurse if you have any ques­tions about your med­ica­tion. Tel: 5143986644 exten­sion 00615# and also 5149341934 exten­sion 42944.

Phys­io­ther­a­pist (PT)
Image The phys­io­ther­a­pist will help you become as mobile and inde­pen­dent as pos­si­ble. She will give you and your fam­ily advice for safe trans­fer tech­niques (like mov­ing from bed to chair). Your ther­a­pist can exam­ine your gait (how well you are able to walk) and your bal­ance. She may rec­om­mend an aid such as a cane, walker, or brace to help you be more independent.

If you are inter­ested in exer­cises, your phys­io­ther­a­pist can tell you about exer­cise you may do at home. This home exer­cise pro­gram will:

  • Increase your mus­cu­lar strength
  • Improve your flexibility
  • Decrease your pain
  • Improve your car­dio­vas­cu­lar fitness
  • Reduce stress

If you can­not do a home exer­cise pro­gram, the phys­io­ther­a­pist may refer to you a reha­bil­i­ta­tion cen­tre or CLSC.

Occu­pa­tional Ther­a­pist (OT)
Image The occu­pa­tional ther­a­pist (OT) will help you become as autonomous (inde­pen­dent) as pos­si­ble. He will study how well you are able to do your activ­i­ties of daily liv­ing. For instance, are you able to brush your hair, wash your­self, and get dressed? Are you able to cook for your­self, work, or drive? Through a pro­gram designed espe­cially for you, he will help you become as inde­pen­dent as possible.

The occu­pa­tional ther­a­pist will eval­u­ate your abil­ity to swal­low and eat safely. He may give you spe­cial instruc­tions on how to eat and drink. This may mean sug­gest­ing you fol­low a spe­cific diet or sug­gest­ing food choices.

The OT may sug­gest that you use some equip­ment at home to help you stay inde­pen­dent and safe. For exam­ple, he may rec­om­mend the use of a wheel­chair. Also, he may sug­gest that some changes be made in your home to make liv­ing at home safe for you. The OT can also refer you for dri­ving eval­u­a­tions and to other com­mu­nity resources.

Speech-​Language Pathol­o­gist
Your speech-​language pathol­o­gist will assess how well you can com­mu­ni­cate. She will exam­ine the strength, move­ment, and coor­di­na­tion of the mus­cles that help you speak. The speech­language pathol­o­gist will then be able to give you and your fam­ily ways to help make your speech as clear as pos­si­ble. She may sug­gest a home exer­cise pro­gram and/​or a com­mu­ni­ca­tion aid (such as a voice ampli­fier) and/​or refer you for reha­bil­i­ta­tion services.

You may also be seen by these health professionals:

Some­times a per­son with a move­ment dis­or­der devel­ops prob­lems with men­tal health. In this case, you will be referred to the neu­ropsy­chi­a­trist for diag­no­sis. The neu­ropsy­chi­a­trist will also rec­om­mend treat­ment if needed.

Neu­ro­sur­geons spe­cial­ize in surgery on the brain, spine and other parts of the ner­vous sys­tem. Your neu­rol­o­gist will refer you to a neu­ro­sur­geon if it seems that your move­ment dis­or­der can be treated with surgery. For exam­ple, hav­ing deep brain stim­u­la­tion surgery can help some peo­ple with Parkinson’s Dis­ease.
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IV. Move­ment dis­or­der clinic

Mon­treal Neu­ro­log­i­cal Hos­pi­tal
2nd Floor, Room 201
3801 Uni­ver­sity Street
Mon­treal, Que­bec H3A 2B4
Tel: (514) 3984691
Fax: (514) 3988540
Mon­treal Gen­eral Hos­pi­tal
7th Floor Liv­ingston Hall, Room L7.312
1650 Cedar Avenue
Mon­treal, Que­bec H3G 1A4
Tel: (514) 9348026
Fax:(514) 9348265

The Clinic Visit – what to bring Image

  • Please bring a fam­ily mem­ber with you if possible.
  • Please bring all the med­ica­tions you are tak­ing to the clinic. If you pre­fer, you may bring an up-​to-​date list with the names and doses of all the med­ica­tions you are taking.
  • Bring a list of ques­tions you have for your neu­rol­o­gist. This list will help you remem­ber your ques­tions at the time of your clinic visit. Your ques­tions might include:
    • What type of move­ment dis­or­der do I have?
    • What are my treat­ment choices? Which do you rec­om­mend for me? Why?
    • What are the ben­e­fits of each kind of treatment?
    • What are the risks and pos­si­ble side effects of each treatment?
    • How will treat­ment affect my nor­mal activities?
    • Would a clin­i­cal trial (research study) be appro­pri­ate for me? Can you help me find one?

The Clinic Visit

  • Your first visit at the Move­ment Dis­or­der Clinic may take 12 hours.
  • Dur­ing your first visit, the doc­tor will do a full assess­ment and med­ical his­tory. The doc­tor may sched­ule you for other tests such as a Com­put­er­ized Tomog­ra­phy (CT) Scan or a Mag­netic Res­o­nance Imag­ing (MRI). These tests will be done before your next appoint­ment at the clinic.

If you need more sup­port, the nurse and other health care pro­fes­sion­als are avail­able to lis­ten and answer your questions.

To go to the Move­ment Dis­or­der at the Mon­treal Neu­ro­log­i­cal Hospital:

By Metro: Image The near­est metro sta­tion is McGill on the green line, which is located at the cor­ner of Uni­ver­sity Street and de Maison­neuve Boule­vard. The McGill metro will allow you to get out on Uni­ver­sity Street. If you decide to take the metro, there is a 1015 minute walk up a hill to get to the hos­pi­tal. If you have dif­fi­culty walk­ing, you may want to take a taxi up the hill. You could also get off at the Atwa­ter or Sher­brooke metro sta­tions and take bus #144.

By Bus: Image

  • #144 at Pine Avenue and Uni­ver­sity Street
  • #107 at Pine Avenue and Doc­tor Pen­field Street.
  • For the most direct route, con­tact the STM (Société des Trans­ports de Mon­tréal), Tel: (514) 2886287 (A-​U-​T-​O-​B-​U-​S)
  • Web site: www​.stm​.info

By car: Image By Decarie autoroute and from the South Shore fol­low the signs “Mon­tréal – Cen­tre Ville – Autoroute Ville Marie” and exit at Uni­ver­sity Street. Con­tinue North on Uni­ver­sity. Park­ing for a fee is avail­able on site. Entrances are located on Uni­ver­sity Street.

Park­ing: Park­ing near the hos­pi­tal is lim­ited. Lim­ited metered park­ing is avail­able on Uni­ver­sity Street.

Hand­i­capped Access
Image Hand­i­capped entrances are North of the main entrance on Uni­ver­sity Street, or through the ambu­lance entrance at the rear of the hospital.

Wash­rooms that are acces­si­ble with a wheel­chair are located on the 1st floor in room 186 and at the clinic on the 2nd floor.

To go to the Move­ment Dis­or­der Clinic at the Mon­treal Gen­eral Hospital:

Image By Metro: The near­est metro sta­tion is Guy/​Concordia on the green line, located at the cor­ner of Guy Street and de Maison­neuve Boule­vard. Take the # 165 bus up the hill to the hospital.

By Bus: Image The most con­ve­nient stops are:

  • #165 – At the hos­pi­tal, Cote des Neiges entrance
  • #144 – Guy Street and Doc­teur Pen­field Street
  • For the most direct route call STM (Société des Trans­ports de Mon­tréal). Tel: (514) 2886287 (A-​U-​T-​O-​B-​U-​S)
  • Web site: www​.stm​.info

By Car: Image By Decarie autoroute and from the South Shore fol­low the signs “Mon­tréal – Cen­tre Ville – Autoroute Ville Marie” and exit at Uni­ver­sity Street. Turn right onto Réné Lésvesque and turn left at Guy Street. Con­tinue up the hill to the hos­pi­tal. Park­ing for a fee is avail­able on site. Entrances are on Cote des Neiges and Cedar Avenue.

Park­ing: Free park­ing near the hos­pi­tal is lim­ited and the metered park­ing is avail­able on Cedar Avenue.


Hand­i­capped Access
Both entrances to the Mon­treal Gen­eral Hos­pi­tal are hand­i­cap acces­si­ble.
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VI. Addi­tional Resources and Information

Infor­ma­tion about InfoNEURO
The Neuro-​Patient Resource Cen­tre of the Mon­treal Neu­ro­log­i­cal Insti­tute and Hos­pi­tal will help you by pro­vid­ing the fol­low­ing services:

  • Books, pam­phlets and arti­cles about your condition
  • Research on your ques­tions by a med­ical librarian
  • Com­mu­nity resources
  • Com­put­ers with inter­net access for your needs

All our ser­vices are free and con­fi­den­tial
We invite patients and their fam­i­lies to come and visit us!

Mon­treal Neu­ro­log­i­cal Hos­pi­tal (room 354)
3801 Uni­ver­sity Street, Mon­treal H3A 2B4
Tel: (514) 3985358
Email: infoneuro@​muhc.​mcgill.​ca
Web­site: http://​infoneuro​.mcgill​.ca


Dis­claimer Infor­ma­tion
IMPOR­TANT. Mate­ri­als pro­vided by the Resource Cen­tre are for edu­ca­tional pur­poses only, they are not intended to replace the advice or instruc­tion of a pro­fes­sional health­care prac­ti­tioner, or to sub­sti­tute for med­ical care.
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