Ch 12 - Spasticity

Question 1

What is spasticity?

Answer 1

Velocity-dependent increase in the tonic stretch reflexes with exaggerated phasic stretch reflexes resulting from hyperexcitability of the stretch reflex

Question 2

What is rigidity?

Answer 2

Resistance to stretch that is not velocity dependent

Question 3

Describe MAS 0.

Answer 3

No increase in tone

Question 4

Describe MAS 1.

Answer 4

Slight inc in muscle tone, manifested by a catch and release or minimal resistance at the end ROM when the affected part(s) is moved in flexion and extension

Question 5

Describe MAS 1+.

Answer 5

Slight inc in muscle tone, manifested by a catch followed by min resistance throughout

Question 6

Describe MAS 2.

Answer 6

Marked inc in tone throughout most ROM but easily moved

Question 7

Describe MAS 3.

Answer 7

Considerable inc tone, passive ROM difficult

Question 8

Describe MAS 4.

Answer 8

Affected parts rigid in flexion or extension

Question 9

MOA of Baclofen.

Answer 9

GABA-B receptor agonist reducing Ca influx and supresses excitatory NT release

Question 10

MOA of Diazepam.

Answer 10

GABA-A rec agonist

Question 11

MOA of Dantrolene.

Answer 11

Blocks Ca+ release from sarcoplasmic reticulum

Question 12

MOA of Clonidine.

Answer 12

Central acting alpha-2-adrenergic agonist with effects in locus ceruleus

Question 13

MOA of Tizanidine.

Answer 13

Central acting alpha-2-adrenergic agonist

Question 14

What does Phenol cause?

Answer 14

Transient, anesthetic effect due to demyelination with little axonolysis for >6 mo

Question 15

MOA of botox

Answer 15

Block the presynaptic release of ACh primarily at the terminal portion of a motor nerve

Question 16

What is the initial safe dose for first botox treatment?

Answer 16

400 units total or 6 units/kg for an adult

Question 17

What are typical doses of botox for adults?

Answer 17

25 to 200 units per muscle

Question 18

What are typical doses of botox for children?

Answer 18

4 to 8 units per kg

400 units max body dose

Question 19

When is the peak effect of botox?

Answer 19

Peak effect: 4 to 6 weeks

Effects last 2 to 6 months

Question 20

What are signs of baclofen overdose?

Answer 20

• Hypotonia/severe weakness
• Drowsiness/somnolence
• Lightheadedness
• Nausea/vomiting
• Bradycardia
• Hypotension
• Seizures
• Respiratory depression
• LOC to coma

Question 21

What is the treatment of baclofen overdose?

Answer 21

Anticholinesterase physostigmine 2 mg IV to reverse the respiratory depression

Question 22

What are signs of baclofen withdrawal?

Answer 22

• Fever
• Nausea
• Dizziness
• Hyperthermia
• Pruritis/itching
• Insomnia
• Altered mental status
• Hallucinations
• Seizures
• Exaggerated rebound spasticity and muscle rigidity that can lead to rhabdomyolysis and multiple organ-system failure

Question 23

What is a Split Anterior Tibial Tendon Transfer (SPLATT) used for?

Answer 23

Equinovarus deformity of the foot. Spasticity in TA muscle provides an inverting and supinating force on the foot while spastic gastrocnemius and soleus muscles provide a plantar flexing force