Application of Muscle spindle & GTO neurophysiology Flashcards
Neurophysiology underlying manual skills
*Muscle spindle psl: Quick muscle stretch & muscle tapping
*Muscle spindle psl: Vibration
GTO psl: Cross-fiber massage
Prolonged muscle stretch
1a phasic
1st into spinal cord and synapse directly to AMN to the mm with the msp. It ALSO branches to an interneuron (inhibitory neuron) which goes to antagonist mm (another muscle)
1a tonics
afferent sensory info- follows same path as phasic but also synapses with the ascending tract to the brain that brings proprioception to the brain-post central gyrus of the brain (area 312)
Ia phasics afferents
- primary annulospiral receptors
- arise from the dynamic nuclear bag central area
- sense both the rate of muscle lengthening (velocity) and muscle length changes
- facilitory [+] to the agonist through the alpha MN
- inhibitory [-] to the antagonist
Ia tonics afferents
- primary annulospiral receptors
- arise from the nuclear chain area
- sense muscle length changes
- facilitory [+] to the agonist through the alpha MN
- inhibitory [-] to the antagonist
Monosynaptic Reflex Arc
Receptor (muscle spindle) -> Ia afferents -> [+] alpha MN and contraction of extrafusal muscle fibers in the agonist/synergists muscles
Ia fiber branches -> inhibitory interneuron -> [-] antagonist muscles (reciprocal inhibition)
Muscle Spindles
Function: muscle spindle is to sense stretch (increase in muscle length) and elicit a reflex.
Deep tendon reflex (DTR)
especially activates Ia phasics (due to quick on/off of tendon tap)
Hypertonic
– uncontrolled or uninhibited reflex arc activity– overactive
- Hypersensitive to quick stretch
- CNS or UMN lesion
- Likely damaged INHIBITORY descending motor tracts
Hypotonic
– under facilitated reflex arc activity
- No response or very little response
- LMN lesion
- Likely damaged facilitatory descending motor tracts
Responsible for clonus
sustained monosynaptic reflex arc
***fast and effective reflex but not very flexible (“hard-wired)- monosynaptic reflex
Modified Ashworth Scale
numbers to scale someone’s hypertonicity in PROM–
normal= 0
Deep Tendon Reflex (test)
normal is 2
hypertonicity= 3-4
hypotonicity= 1-0
Hypotonicity
can be a result of a LMN or UMN injury
LMN = peripheral nerve (example: median nerve – carpal tunnel syndrome) LMN = nerve root at the spinal cord(in the intervertebral foramen) (example: L4 nerve root compression) UMN = damage to the spinal cord or cortex
Hypertonicity
always indicative of an UMN lesion
Uncontrolled reflex arc
TVR - tonic vibratory reflex
Vibrate skeletal muscle at a high frequency –> tonic contraction induced in muscle being vibrated
60 Hz effective on kids
100-120 Hz needed for adults
Selectively stimulates muscle spindle (Ia phasics).
Ia phasics fire at same frequency as the vibrator.
[+] agonist (facilitation) and [-] antagonist (reciprocal inhibition)
TVR
- progressively builds in strength and is maintained while vibration on muscle; gradually fades out (effects can last as much as 3 minutes) after vibrator is removed
- response is best on muscle belly or tendon? (Still unclear)
- Follow with resistance or active contraction to enhance muscle response and increase motor control/learning
If the biceps is hypertonic due to flexion synergy post stroke, what muscle would you vibrate?
Triceps
TVR Precautions
- Frequency over 200 Hz can damage skin or holding vibrator in one place too long can blister or bruise skin
- Be careful around head with a client with hydrocephalus (area of shunt)
- Be careful around carotid baroreceptors or major blood vessels around neck
GTO Physiology
- Cross fiber massage directly over the musculotendinous junction would cause firing of the GTO > Ib sensory nerve fiber firing
- Inhibition of the agonist
- Facilitation of the antagonist
If the biceps is hypertonic due to flexion synergy post stroke, what musculotendinous junction would you perform cross fiber massage on?
Biceps Tendon