Ch 12 - Spasticity Flashcards
What is spasticity?
Velocity-dependent increase in the tonic stretch reflexes with exaggerated phasic stretch reflexes resulting from hyperexcitability of the stretch reflex
What is rigidity?
Resistance to stretch that is not velocity dependent
Describe MAS 0.
No increase in tone
Describe MAS 1.
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
Describe MAS 1+.
Slight inc in muscle tone, manifested by a catch followed by min resistance throughout
Describe MAS 2.
Marked inc in tone throughout most ROM but easily moved
Describe MAS 3.
Considerable inc tone, passive ROM difficult
Describe MAS 4.
Affected parts rigid in flexion or extension
MOA of Baclofen.
GABA-B receptor agonist reducing Ca influx and supresses excitatory NT release
MOA of Diazepam.
GABA-A rec agonist
MOA of Dantrolene.
Blocks Ca+ release from sarcoplasmic reticulum
MOA of Clonidine.
Central acting alpha-2-adrenergic agonist with effects in locus ceruleus
MOA of Tizanidine.
Central acting alpha-2-adrenergic agonist
What does Phenol cause?
Transient, anesthetic effect due to demyelination with little axonolysis for >6 mo
MOA of botox
Block the presynaptic release of ACh primarily at the terminal portion of a motor nerve
What is the initial safe dose for first botox treatment?
400 units total or 6 units/kg for an adult
What are typical doses of botox for adults?
25 to 200 units per muscle
What are typical doses of botox for children?
4 to 8 units per kg
400 units max body dose
When is the peak effect of botox?
Peak effect: 4 to 6 weeks
Effects last 2 to 6 months
What are signs of baclofen overdose?
- Hypotonia/severe weakness
- Drowsiness/somnolence
- Lightheadedness
- Nausea/vomiting
- Bradycardia
- Hypotension
- Seizures
- Respiratory depression
- LOC to coma
What is the treatment of baclofen overdose?
Anticholinesterase physostigmine 2 mg IV to reverse the respiratory depression
What are signs of baclofen withdrawal?
- 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
What is a Split Anterior Tibial Tendon Transfer (SPLATT) used for?
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
