From speech to motor skills, see how a therapy team supports those with bipolar disorder facing movement issues.
Key Takeaways
- Specialized therapy complements medical treatment to boost day-to-day functioning and independence.
- If you’re choking or having swallowing trouble, get a prompt speech-language pathologist evaluation to reduce serious risks.
- Simple adaptations (weighted tools, steady posture) can improve control for tasks like eating and writing.
- Keep your prescriber and therapy team aligned so your plan stays coordinated and tailored to your movement challenges.
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A diagnosis of tardive dyskinesia means learning to expect the unexpected, accepting what you can’t control, and working skillfully within those parameters.
As the National Institute of Neurological Disorders and Stroke (NINDS) explains, this movement disorder is characterized by uncontrollable, abnormal, and repetitive movements of the face, torso, and other parts of the body. Tardive dyskinesia results from prolonged use of medications that block the brain’s dopamine receptors. These may include antipsychotics that treat mental health conditions such as schizophrenia, bipolar disorder, and depression, as well as some antinausea medications.
After talking with your doctor to identify the cause of your condition and discussing effective treatments — including VMAT-2 inhibitor medications like deutetrabenazine (Austedo) and valbenazine (Ingrezza) — it’s often beneficial to also seek advice from qualified professionals, such as physical, speech, and occupational therapists.
Including these specialists in your care team can assist you in addressing various aspects of your condition and improve your overall quality of life:
How Speech-Language Pathologists Assist With Communication
Speech therapists, or speech-language pathologists, are professionals trained to assess, diagnose, and treat communication and swallowing challenges. They can play a critical role in managing tardive dyskinesia, as the condition can affect speech, facial expressions, and swallowing. Speech therapists can:
- Evaluate and treat speech and language difficulties, such as articulation challenges, slurred speech, or difficulty with the rhythm and flow of speech (dysarthria).
- Address challenges with facial expressions and oral movements, which can affect communication and social interaction.
- Develop strategies and exercises to improve oral motor control, helping you better manage involuntary facial and tongue movements.
- Assess and treat swallowing difficulties (dysphagia).
Supporting Independence With Occupational Therapy
Occupational therapists focus on helping you regain, maintain, or improve your ability to perform daily activities and achieve a higher level of independence. When it comes to managing tardive dyskinesia, occupational therapists can:
- Provide strategies to manage involuntary movements during daily tasks.
- Assess and modify the home or work environment to ensure safety and accessibility.
Managing Physical Limitations With Physical Therapy
Physical therapists specialize in assessing and treating movement-related challenges, pain, and physical limitations. They play a role in managing the symptoms of tardive dyskinesia by:
- Developing individualized exercise programs to improve muscle strength, flexibility, and overall fitness, which can help counteract the effects of tardive dyskinesia on the body.
- Implementing techniques to manage and reduce the severity of involuntary movements, such as relaxation exercises, stretching, and postural training.
- Providing pain-management strategies to alleviate the discomfort resulting from repetitive or prolonged muscle contractions.
- Educating individuals on how to prevent falls and maintain balance in daily activities, as tardive dyskinesia can affect coordination and increase the risk of injury.
Coordinating Your Care Between Neurologists and Therapists
Your journey to stability is most effective when your medical and therapy teams work in tandem. While a neurologist or psychiatrist manages your VMAT2 treatment and medication adherence, therapists provide the “boots-on-the-ground” strategies for living. It’s helpful to allow your therapist to coordinate with your prescribing physician to ensure your daily symptom impact is monitored from both clinical and functional perspectives.
The Role of Professional Therapists in Managing Daily Symptoms
Individuals living with tardive dyskinesia may experience a range of involuntary movements that can impact their ability to carry out everyday activities. These challenges can vary depending on the severity and specific symptoms of the individual’s condition.
Addressing Speech Challenges
Tardive dyskinesia can affect the muscles used for speech, resulting in slurred speech, stuttering, or difficulty articulating words. Involuntary facial movements can also impact nonverbal communication, such as facial expressions or eye contact, making it challenging for others to understand your emotions or intentions.
Compromised speech challenges fall into a broader category called hyperkinetic dysarthria, says Heather M. Clark, PhD, chair of the Division of Speech Pathology in Mayo Clinic’s Department of Neurology and a professor in its College of Medicine.
The term hyperkinetic dysarthria refers to abnormal involuntary movements affecting the respiratory, phonatory, or vocal tract, and structures that articulate speech and swallowing, according to a review published in Tremor and Other Hyperkinetic Movements.
“Tardive dyskinesia does not tend to be under a speaker’s control, with few options to change the movement, but it’s rare to find anyone completely unintelligible from this disorder,” says Dr. Clark. “So, we focus on making communication as effective as possible. We know, for example, that being anxious makes movements more obvious, as does lack of sleep.”
With tardive dyskinesia, speech may sound like the person has food in their mouth, like they’re pushing food out of the way, she says.
“So, to optimize speech, we focus on good communication strategies,” Clark explains. “Speech requires very rapid transitions of movements, so we start with slowing your speaking rate. Take more time to get your mouth into the right position for each sound. Taking that time also gives the listener extra time to determine what you’re saying.”
Give your speech your full attention, she says. That means avoiding multitasking when communicating and being more intentional.
Managing Chewing and Swallowing Challenges
Involuntary movements of the jaw, tongue, or facial muscles can make chewing and swallowing difficult, leading to choking hazards, malnutrition, or dehydration. People with tardive dyskinesia may also struggle to hold and manipulate utensils due to spontaneous hand or arm movements.
“Food not staying in the mouth is a main concern,” says Clark. “If tongue protrusion occurs as an involuntary movement, that’s embarrassing and inefficient but not unsafe.”
A person’s tongue normally pushes food in the mouth back into the throat to trigger the swallow reflex, which closes the airway for food to enter the esophagus and not the trachea.
Clark explains: “For example, if we haven’t yet triggered the swallow reflex, and the airway is ‘sitting open’ as we breathe, while trying to hold water in the mouth, if the tongue moves uncontrollably, food and liquid could go into the throat too soon, causing aspiration or choking if it goes into the airway.”
She recommends that you have your swallowing evaluated regularly so that therapy matches the specific difficulty. “Be more purposeful and attentive, with small sips and small bites, and avoid tipping the head back, while also alternating solids and liquids,” she adds.
Occupational therapists recommend that, when eating, people sit at a table or counter where they can use proper posture and body positioning, says Krista Mandler, an occupational therapist at Mayo Clinic in Rochester, Minnesota.
Mandler offers these strategies for mealtime:
- Stabilize your elbows: Placing your elbows on a chair’s armrests or the tabletop helps you gain better control of your hands when manipulating silverware.
- Weighted silverware: Using weighted utensils can provide further stabilization and control if your hands are trembling.
- Nonslip material: Use these materials to hold plates or cookware in place.
- Adaptive tools: Using weighted cups, rocker knives, and plate guards helps compensate for upper-extremity incoordination.
Overcoming the Obstacles of Dressing
Involuntary movements in the limbs can sometimes make it difficult to complete everyday tasks. Activities like buttoning, zipping, or tying shoelaces can become challenging, requiring additional time or assistance from others.
“If individuals have trouble manipulating buttons, occupational therapists often recommend a button hook, a tool that can help compensate for decreased coordination and dexterity,” says Mandler.
“We also recommend people sit, ideally in a chair with armrests, so they can rest and stabilize their elbows and hold their wrists and forearms against their body to have more control over fingers while manipulating buttons. Using a mirror can also be helpful to provide visual feedback on their movements.”
Regaining Writing Control and Fine Motor Skills
Tardive dyskinesia can affect fine motor skills, leading to difficulties with writing, drawing, or other tasks that require precise hand movements. Involuntary hand or arm movements may result in illegible handwriting or an inability to maintain a steady grip on a pen or pencil.
Fine motor skills involve the use of smaller muscle groups for precise movements, such as grasping objects, writing, or buttoning clothes. In contrast, gross motor skills involve larger muscle groups for more extensive, coordinated movements, like walking, jumping, or throwing a ball. While fine motor skills focus on intricate tasks, gross motor skills are responsible for overall body movement and coordination.
“When writing, it is important that people consider their body positioning to maximize upper-extremity control,” Mandler says, adding that occupational therapists often recommend the following:
- Body positioning. Sit at a table to stabilize your elbows and forearms on the table’s surface.
- Hand-over-hand: Grasp one hand over the other to provide further hand stabilization.
- Weighted pens: Use weighted or felt pens to slow down the writing process.
Navigating Daily Movement Challenges
These everyday challenges can significantly impact the quality of life of people with tardive dyskinesia.
“If your abdomen or legs are involved, you may find you are more unsteady,” says Sarah Boyd, a physical therapist at Mayo Clinic. “Using a walking device, like a walker, or wearing a weighted vest, can help control movements.”
Connect with a physical therapist specializing in neurologic conditions to assess the safest adaptive options for you. They can also develop an exercise program of weight-bearing exercises to improve your strength and balance to help with daily activities, Boyd advises.
When to Ask Your Doctor for a Therapy Referral
If you’re noticing that movements are interfering with your ability to live well, it’s time to speak up. Consider asking for a referral if you experience:
- Social withdrawal because you’re embarrassed by facial or speech changes.
- Frequent near-misses with tripping, falling, or dropping items.
- Difficulty eating or a noticeable change in how you swallow liquids.
- Frustration with basic self-care, like brushing your teeth or getting dressed.
Editorial Sources and Fact-Checking
UPDATED: Originally published April 21, 2023