Contraindications for stretching
bony block recent # acute inflammatory process of the joint sharp or acute joint pain hematoma or tissue trauma contracture or soft tissue is providing stability to area or function (ex tenodesis grip)
PNF indications
increase ROM and strength in multi-joint/muscle involvement, used to ax abnormal movement patterns
PNF D1
- shoulder ER (consider feeding, upper cut) - IR with elbow extension
- hip IR - ER (cross leg/kick ball)
PNF D2
- shoulder ER- IR (reach and pick apple and then put in bag)
- hip IR- ER (fire hydrant)
Can you add resistance to PNFs?
yes
Why would you add quick stretch at the beginning of a PNF movement
to elicit contraction of a weak muscle
What are PNF Contraindications
The same as resistance exercises
PNF Precautions
avoid quick stretch on hypertonic muscles
gentle stretch and care on hypotonic muscles
care to not promote invariant movement patterns
watch for substitution
What are UE and LE flexor synergies
UE = flexion of elbow, ER and ABD of shoulder, flex of wrist
LE = hip flex, knee flex, DF and INV of foot
What are UE and LE extensor synergies
UE = shoulder adducts and internally rotates, elbow extends and pronates, wrist extends
LE = hip extends and internally rotates, knee extends, ankle PF and inverts
What is muscle tone
Resistance force in response to lengthening (stiffness), a continuum
Does tone occur from neural or non-neural factors
both
What causes non-neural ton
muscle length thixotrophy (extra CT between muscles) CT and muscle fiber changes immobilization weakness abnormal postures abnormal movement patterns
What causes neural tone
Inc. input to alpha motor neuron emotion, fear pain infection full bladder altered excitability of alpha motor neurons loss of functioning motor units altered motor unit firing rate Loss of orderly recruitment impaired motor unit synchronization (inappropriate co- contraction of agonist/antagonist
What is spasticity
Velocity dependent increase in resistance to passive stretch
What is rigidity?
When do you normally see rigidity
- velocity independent resistance to passive stretch
- usually seen with a head injury (decorticate or decerebrate rigidity)
LMN Lesions
- Hypotonia or Hypertonia?
- Hyporeflexia or hyperreflexia?
Hypotonia
Hyporeflexia
UMN Lesions
- Hypotonia or Hypertonia?
- Hyporeflexia or hyperreflexia?
hypotonia and hyperreflexia
OR
hypertonia and hypereflexia
Tone + Spasticity assessment
modified Ashworth scale: 0=5 scale
ask them to AROM, feel muscle, then PROM, then PROM with quick stretch, then reflexes DT and long tract
What are exaggerated proprioceptive reflexes
Clonus, tendon jerk, and pendulum test
What are exaggerated cutaneous reflexes
- touch to palmar and plantar surfaces
- Babinski response
Tone and spasticity treatment
- postural control
- prevent and treat biomechanical limitations (positioning, ROM, mobility, etc.)
- promote strength, endurance, and coordination
- maintain extensibility/PROM
- address potential factors contributing to tone (agitation, motivation, pain, infection, full bladder)
- provide sustained pressure on tendons
- referral to health care team (meds, Botox, etc.)
Treatment for clonus
teach them to contract the muscle with the clonus then relax
Treatment for cutaneous hyperreflexia
Desensitize, promote active movements within limits of individual’s capacity, strap legs when in wheelchair to prevent falling
