Movement Disorders
Movement Disorder Care at UVM Health
Movement disorders happen when the areas of your brain that control your body's movement don't function as they should. Abnormal signals from the brain may cause your movements to become faster, slower, uncoordinated, uncontrollable or different than usual.
At University of Vermont Health, our board-certified neurology specialists at the Frederick C. Binter Center provide comprehensive evaluation and treatment of patients with movement disorders, including dystonia, essential tremor, Huntington's disease and Parkinson's disease. The Binter Center at UVM Medical Center is our health system's specialty clinic for movement disorders, offering advanced diagnostics and the latest treatment options to help you achieve a better quality of life.
Why Choose UVM Health?
We are working to develop educational programs to serve patients, families and the medical community and also to facilitate evidence-based study of movement disorders. At the Binter Center, we offer:
- Multi-disciplinary approach: Motor control and non-motor symptoms may present a barrier to care, leaving many Parkinson's disease and movement disorder patients undertreated with limited access to services. We believe the best care can only be accomplished through an integrated team-based approach.
- Center of Excellence: We are a designated Huntington's Disease Society of America (HDSA) Center of Excellence. Patients benefit from expert neurologists, psychiatrists, social workers, therapists, counselors and other professionals who have extensive experience working with families affected by HD and who work collaboratively to help families plan the best HD care program throughout the course of the disease.
Types of Movement Disorders
We provide comprehensive, compassionate care for people with all types of movement disorders, including:
Dystonia is a movement disorder that causes muscles to contract. This can cause twisting motions or other movements that happen repeatedly and aren’t under a person’s control. There are several types of dystonia:
- Focal Dystonia is when the condition affects one part of the body
- Segmental Dystonia is when the condition affects two or more areas of the body next to each other
- General Dystonia is when the condition affects all parts of the body.
While the exact cause of dystonia is unknown, there are some forms of the condition that are passed down in families. Early symptoms of dystonia are often mild, occasional, and linked to a specific activity. Schedule an appointment with a member of your care team if you’re having muscle contractions that you can’t control.
Essential tremor is an involuntary, rhythmic, oscillatory movement around a body part. Essential tremor can affect almost any part of the body, but mainly involves the hands, head and voice. For more information or additional resources, please visit International Essential Tremor Foundation.
Huntington's disease (HD) is a progressive genetic disorder that causes degeneration of nerve cells in the brain that leads to a decline in a person’s physical, mental and emotional abilities. Symptoms can develop at any time, but often begin with people who are in their 30’s or 40’s. When the disease develops before the age of 20 it is called Juvenile Huntington’s Disease.
HD affects the whole brain; however certain areas are more vulnerable than others. Symptoms of HD can vary from person to person but usually cause movement disorders, mental health conditions and trouble with thinking and planning.
Normal Pressure Hydrocephalus (NPH) is a condition caused by cerebrospinal fluid builds up inside the skull and presses on the brain causing disruption in brain function. NPH can affect memory, thinking and concentrating, and movement.
Symptoms of NPH include:
- Unsteady gait
- Urinary incontinence
- Cognitive functions
Parkinson’s Disease (PD) is a neurodegenerative disorder that affects the dopamine producing neurons in a specific area of the brain call substantia nigra. PD occurs when brain cells that make dopamine stop working or die. Dopamine helps to relay messages between areas of the brain that control body movement. When the neurons die, abnormally low levels of dopamine are produced, which makes it difficult to control muscle tension and muscle movement. Symptoms can start slowly with a barely noticeable tremor in one hand, foot or even the jaw.
The condition often leads to:
- Tremors
- Stiffness
- Impaired balance and coordination
- Slow movement
- Speech problems
- Dementia
Parkinsonism vis a group of neurological disorders that produces movement and function problems similar to those of Parkinson's disease. Examples include:
- Lewy body dementia
- Multiple system atrophy (MSA)
- Progressive supranuclear palsy (PSP)
- Vascular Parkinsonism
- Drug-induced Parkinsonism
Tourette syndrome (TS) is a condition in which a person has spasms, also called tics, that typically include blinking, frowning, jerking the head, and raising the arms or shoulders. A person may also make sounds, such as sniffing, throat clearing, or coughing, or say words.
Diagnosing Movement Disorders
At the Binter Center, we provide comprehensive initial evaluations to address your neurological movement disorder concerns. Our team of movement disorder experts is dedicated to delivering personalized care, utilizing the latest advancements in diagnostic and therapeutic medicine.
During your initial visit, we will:
- Conduct a thorough assessment of your medical and neurological history
- Discuss symptoms you may be experiencing
- Perform a detailed neurological examination
Our goal is to develop an accurate diagnosis and create a tailored treatment plan to improve your quality of life. Whether you are dealing with a common neurological disorder or rare and/or complex conditions, our multidisciplinary approach ensures you receive the highest standard of care. We are committed to supporting you every step of the way on your journey to better neurological health and overall well-being.
Diagnostic tests can help identify your movement disorder type and determine a treatment plan. These include:
Certain substances in your blood or urine can help diagnose movement disorders or rule out other conditions.
Some movement disorders are inherited (passed down in families). Genetic testing can help inform your treatment options and determine if your family members are at risk for disease.
A neurological exam assesses how well your brain communicates with your body. Your doctor checks your muscle function, reflexes, speech and senses.
Neuropsychological testing involves a series of tests to check your brain's ability to process information. Your doctor may ask you to remember words or do simple math problems. During a conversation, your doctor observes you closely to gauge your mood, attention level and reasoning ability.
An EEG can reveal the area of the brain causing your movement disorder. Your provider will place small electrodes on your head that measure your brain's electrical impulses. They may record you on video to correlate the brain activity seen on the EEG with your body's actions. You can have an EEG in the hospital or at home. If you have an at-home EEG, our registered technologists provide all necessary equipment and instructions.
An EMG evaluates how well your muscles and nerves work. Your provider inserts a tiny needle conducting an electric current into your muscle. As you contract your muscle, a machine records its electrical activity.
Advanced imaging allows us to take photos of your brain. We use the latest technology, including:
- Computed tomography (CT) scan: X-rays and advanced computers create 3D pictures of cross-sections of your brain.
- Magnetic resonance imaging (MRI): Magnets and a computer work together to provide clear and detailed brain images.
- Positron emission tomography (PET) scan: You receive a small and safe amount of a radioactive substance (tracer) that collects in areas of high cell activity or binds to accumulated disease-specific proteins. The tracer allows us to see brain activity or if certain proteins have accumulated in the brain.
- Single-photon emission computerized tomography (SPECT) scan: Similar to a PET scan, you receive an intravenous tracer that allows us to evaluate the health of the dopamine-producing areas of the brain that are affected in Parkinson’s disease and related conditions.
We take small samples of the skin around your neck, thigh and ankle. A specialist checks these skin samples for protein changes common in people with Parkinson’s disease and Parkinsonism.
If your doctor suspects you have normal pressure hydrocephalus, you may undergo one of these two options for spinal fluid removal. In this test, a neurologist or neurosurgeon inserts a needle or drain in your spinal canal to remove some cerebrospinal fluid. If symptoms improve after the fluid is drained, your doctor may recommend surgically placing a shunt for ongoing spinal fluid drainage.
Movement Disorder Treatment
You and your neurologist work together to develop a customized treatment plan. Your care may include one or more advanced therapies, including:
Medications can help control your movement disorder symptoms. Your doctor may recommend medicines you take by mouth, injection or surgically implanted baclofen pump.
Botulinum toxin is a treatment that helps muscles relax to reduce abnormal movements, postures or muscular pain.
Deep brain stimulation is a minimally invasive surgical treatment that uses electrical impulses to change your brain's activity. Your neurosurgeon implants small electrodes in specific areas of your brain. A device is implanted in your upper chest and connected to the electrodes by wires under the skin.
The device sends electric currents to the electrodes and can also report ongoing brain activity to your doctor.
Removing excess cerebrospinal fluid from your brain can improve symptoms of normal pressure hydrocephalus. Our neurosurgeons insert a tube (shunt) in the brain to drain extra fluid to your abdomen, where your body absorbs it.
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Clinical Trials & Research
University of Vermont Medical Center in partnership with University of Vermont, is currently involved in more than 1,000 active clinical research trials in various specialty areas. This allows us to offer our patients immediate access to treatments not available anywhere else. Our discoveries not only improve care for our patients at UVM Medical Center, but across the country and around the world.
Any research opportunity that we offer to our patients has been approved by our Institutional Review Board which demands the highest level of ethical behavior, transparency and protection of patient safety and privacy.
Ask your doctor if there are any available research studies for your condition. Every clinical trial has specific safety criteria that define which patients can participate in the trial.
Thank you to everyone who is currently participating in one of our studies or has in the past. We couldn’t move our understanding of movement disorders and therapies forward without you.
If you have questions about research opportunities, please contact our Research Supervisor:
Emily Houston at 802-656-8974 or email emily.houston@med.uvm.edu.
- ORMIS-PD: This is a pilot research study of a novel data and machine learning tool, designed to diagnosis PD and predict the course of an individual's progression based on signs and symptoms. The study only requires one visit at the UVM Medical Center Neurology clinic. People who have been diagnosed in the last four years may qualify. We are no longer recruiting for this study.
- Pyridostigmine for the Treatment of Constipation in PD: This trial aims to determine if Pyridostigmine, a drug used "off-label" for constipation, is a useful treatment for infrequent bowel movements in PD. The study lasts 13-15 weeks, with three in-person study visits that take place at the UVM Medical Center Neurology clinic. People with PD and less than three bowel movements per week may qualify.
- PASADENA: A Phase II study of prasinezumab, a therapy that is being studied for its potential to slow the progression of PD. There have been two years of blinded treatment, and current participants are in a five-year extension period of the study. We are no longer recruiting for this study. Learn more
- PADOVA: A second multicenter Phase II study of prasinezumab versus placebo for people with early PD. Study participants are currently in the open label extension period of the study, which goes for two years. We are no longer recruiting for this study. Learn more
- PARAISO: A Phase III multicenter study of prasinezumab versus placebo for a larger number of people with early PD. Primary outcome is efficacy of the study drug, prasinezumab. We are enrolling people with early PD (within 3 years from diagnosis) who are taking a levodopa-containing medication. Learn more
- BouNDless: This is a Phase III trial to investigate how effective, safe, and well-tolerated the study drug, ND0612, is compared to oral PD medications. ND0612 is delivered subcutaneously by a 24-hr pump system. We are no longer recruiting for this study. Learn more
- ORCHESTERA and ORCHESTRA XT: This trial and extension study are testing the safety of a study drug, Minzasolmin, a small molecule that is designed to prevent alpha-synuclein proteins from folding into the wrong shape and building up in the brain. We are no longer recruiting for this study. Learn more
- exPDite-2: This Phase III multicenter study is evaluating the efficacy and safety of a one-time investigational cell therapy, bemdaneprocel, in improving movement, balance, motor symptoms and quality of life in adults with Parkinson’s disease. Bemdaneprocel is designed to be implanted into the brain to replace dopamine-producing neurons lost due to PD. As part of the study, participants will undergo either actual brain surgery to implant these cells or a simulated procedure for comparison. Learn more
- BHV-8000: This trial is hoping to test the efficacy of BHV-8000, an oral therapy, in slowing the progression of Parkinson’s disease symptoms. BHV-8000 is thought to reduce inflammation in the brain, which scientists believe may play a role in the worsening of PD symptoms. People diagnosed with early Parkinson’s who are not yet receiving any PD medications, including dopaminergic therapies, may qualify. Learn more
- Enroll-HD: An observational study for people with HD and their families. Participants have one visit each year at our Neurology clinic. This helps researchers learn more about HD and find effective treatments for HD. Learn more
Support Groups
The Binter Center collaborates with local facilitators to provide a wide range of virtual and in-person support groups for people living with Parkinson’s disease and Huntington’s disease in Vermont and New Hampshire.
If you are interested in starting a support group please contact Binter Center Social Worker, Lucas Kovacevich at lucas.kovacevich@uvmhealth.org.
Patient Resources
We help you manage the everyday lifestyle changes that come with a movement disorder diagnosis. Join our mailing list to stay connected and receive information from the Binter Center tailored to your needs.
Throughout the year we work with local and national partners to provide high-quality educational events on movement disorders. Explore our calendar of events.
Developed in the late 1980’s, LSVT BIG exercise is a specialized therapy designed to improve movement in people with Parkinson’s disease. The program is tailored to individual needs and relies on intensive training and feedback to help patients integrate larger movements into daily life.
LSVT BIG is currently offered at Central Vermont Medical Center.
Movement for Parkinson’s is a Dance for PD ® certified program that engages people with Parkinson’s in a research-backed dance class. The program’s mission is for people with PD to enjoy and benefit from specialized live and virtual dance instruction and to provide transformative, life-enhancing opportunities that celebrate creativity, community, movement and music.
Classes are held in person and via Zoom by Dance for PD-certified teaching artist Sara McMahon. For more information, please contact Sara at movement.for.parkinsons@gmail.com.
Occupational and physical therapies for those living with a movement disorder can help increase strength and balance, relieve pain and help maintain usual activities. The Binter Center is proud to work closely with the occupational therapists, physical therapists and speech language pathologists across UVM Health.
PushBack at Parkinson’s Disease ™ also known as “PushBack” is a registered trademark of the Frederick C. Binter Center for Parkinson’s Disease and Movement Disorders at UVM Medical’s Center. PushBack is a medically advised, community supported group exercise program designed by physical therapists to help improve the strength, flexibility and agility of those living with PD. It brings together local exercise facilities, professionals and volunteers who are compassionate, enthusiastic and knowledgeable about helping people with this disease through exercise strategies.
PushBack is currently offered at the following locations:
Chittenden County
- Colchester Parks & Recreation: Classes are Tuesdays and Thursdays from 11 am-12 pm.
- CrossFit Burlington: Classes are Wednesdays from 2:15-3:15 pm and Fridays from 1:15-2:15 pm.
Rutland County
- CrossFit Rising Star: Classes are Mondays, Wednesdays and Fridays from 10:45-11:45 am.
Washington County
- The RehabGYM-Barre: Classes are Tuesdays and Thursdays from 11 am-12 pm and 1-2 pm.
Additional locations for PushBack-Trained physical therapy
- UVM Medical Center Rehabilitation Therapy Center-Fanny Allen
- Porter Medical Center Rehabilitation Therapies
- Central Vermont Medical Center Rehabilitation Therapy-Berlin
- Northwestern Medical Center Rehabilitation Services: 802-524-1064
- Barre Rehab Gym (Barre): 802-479-4000
- Connective Physical Therapy (Sierra Martin, South Burlington): 802-448-0877
PushBack™ is also offered online in partnership with the Rehab Therapies Department at UVM Medical Center. All PushBack™ classes require a physical therapy referral prior to participation. Schedule time with a local PT by calling UVM Medical Center Rehab Therapies at 802-847-1902. These appointments are billable to your insurance. For more information, please contact the Binter Center bintercenter@uvmhealth.org.
Rock Steady Boxing® is a non-contact, boxing-based fitness program that aims to improve the quality of life of people with Parkinson’s Disease.
Classes are currently held in St. Albans, Williston and Lyndonville.
For more information, please contact:
- St. Albans: Emily Houston emily.houston@med.uvm.edu
- Williston: Sydney Swindell sydney.swindell@gmail.com
- Lyndonville: Joe Allard 802-535-4520
Chronic illness can cause frustration and make day-to-day life more challenging for the individual and family. Working with a licensed, trained professional to better understand the problem and learn effective coping strategies can bring needed relief to everyone.
Family support services available with social work:
- Individual and family counseling
- Interdisciplinary clinic
- Huntington’s disease pre-symptomatic clinic
- Mindfulness for People with PD
- Mindfulness for Caregivers
- TEACH Program
- Reitman Centre CARERS Program
- HDSA Regional Support & Education Series
Possible counseling topics:
- Healthy coping strategies
- Care partner support
- Relationship changes
- Identification of community resources
- Disease-specific education
- Grief/loss adjustment issues
- Future care planning and decision-making
- Behavioral strategies
- Respite
How can I receive Social Work services?
In addition to your appointments with a neurologist, utilizing social work support services may be suggested. Utilizing these services is always the choice of the individual and family.
For more information, please contact:
Binter Center’s Mental Health Clinician and Care Coordinator
Lucas Kovacevich, MSW
802-847-9788
lucas.kovacevich@uvmhealth.org
SPEAK OUT! ® Therapy Program developed by Parkinson Voice Project aims to help people with Parkinson’s regain and retain speech and swallowing. SPEAK OUT!® is currently offered at UVM Medical Center - Fanny Allen Speech Language Pathology.
LOUD Crowd® Therapy Program developed by Parkinson Voice Project is a weekly program for those who have completed the SPEAK OUT!® program. LOUD Crowd ® is currently offered at the University of Vermont Eleanor M. Luse Center.
Seated Tai Chi incorporates many principles of Tai Chi: continuous and flowing movements; awareness of body alignment and position in space. Classes are held in person and are taught by Adina Panitch, a certified Tai Chi instructor. For more information, please contact Adina at apanitch@aol.com.
Our History
"Being his only daughter, I have always seen my father as larger than life and he was my inspiration. What we are doing with this center speaks to the essence of my father as I knew him and what he taught me. His steadfast belief that all things are achievable with hard work, science and ethics applies to every part of life and certainly applies to this effort in his name. He had faith that while the results might not be visible today, they would be in the future as long as we keep working.
The son of an immigrant German printer, he put himself through college dipping ice cream, loving research and the field of medicine. Financially unable to afford medical school, he became an organic chemist and then started his own chemical company which he appropriately named "Independence Chemical Company". Successful in business, he also loved to ski and we made the family pilgrimage to Vermont every Christmas.
He was diagnosed with Parkinson's disease in the late 1970s. If he could see the multidisciplinary approach with applied science and compassion that this center embodies, he would be very proud of us all."
- Nancy E. Binter, MD
Awards & Certifications
Center of Excellence
The Huntington's Disease Society of America (HSDA) has designated our center as an HSDA Center of Excellence, signifying the highest standards of care and access to clinical research.
Locations Near You
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111 Colchester Avenue
Main Campus, East Pavilion, Level 5
Burlington, VT 05401-1473
111 Colchester Avenue
Main Campus, East Pavilion, Level 5
Burlington, VT 05401-1473
15 Degrandpre Way
Plattsburgh, NY 12901
111 Colchester Avenue
Main Campus, East Pavilion, Level 4
Burlington, VT 05401-1473
1 South Prospect Street
Arnold, Level 2
Burlington, VT 05401-5505
130 Fisher Road
MOB-A Suite 1-6
Berlin, VT 05602-9000
