exam 3: abnormal muscle tone

Question 1

resistance of muscles to passive stretch or elongation
amount of tension a muscle as at rest

Answer 1

muscle tone

Question 2

normal muscle tone is high enough to ______ yet low enough to _____

Answer 2

counter the effects of gravity
allow freedom of movement

Question 3

hypotonia is:
- ____ or _____ muscle tone
- stretch reflexes _____
- _____ resistance to passive movement
- results in ___
- a finding with ______ syndrome
- what are 2 other synonymous terms?

Answer 3

• decreased or absent
• diminished or absent
• little to no
• neurogenic muscle atrophy
• lower motor neuron
• flaccidity, low tone

Question 4

true or false. acute UMN lesions can initially produce temporary hypotonia due to spinal or cerebral shock.

Answer 4

true

Question 5

hypertonia is:
- ______ muscle tone
- resistance to passive movement that (is/is not) dependent on velocity
- can be with or without _____

Answer 5

• increased
• is NOT
• spasticity

Question 6

what are the 4 types of hypertonia?

Answer 6

• spasticity
• rigidity
• dystonia
• decorticate and decerebrate rigidity

Question 7

increased, involuntary, velocity-dependent muscle tone
the faster the passive movement, the stronger the resistance

Answer 7

spasticity

Question 8

spasticity originates from injury to ____
and as a result, what happens?

Answer 8

descending motor pathways or brainstem
lack of inhibition of spinal reflexes causing them to be hyperexcitable

Question 9

can a spastic muscle be manual muscle tested?

Answer 9

no - you need isolated, graded movement to perform MMTs

Question 10

what is the most common flexor synergy pattern? extensor?

Answer 10

flexor: UE
extensor: LE

Question 11

• involuntary and sustained muscle contractions (can be repetitive movements)
• increased muscular tone
• can affect one or more body parts
• commonly seen from lesion to the basal ganglia

Answer 11

dystonia

Question 12

what are 3 diseases that result in dystonia?

Answer 12

• primary idiopathic dystonia
• wilson’s disease
• parkinson’s disease

Question 13

dystonia is a type of _____ _which is?

Answer 13

dyskinesia
–> abnormal involuntary writhing movements of a body part (face, UEs, LEs)
–> can be smooth, rapid jerking, or tics

Question 14

identify these common types of dyskinesia:
1. most commonly seen in CP, involuntary writhing movement that is slow and continuous, more twisting movements, less jerky
–> ability to let go of hand

2. involuntary and sustained muscle contractions, twisting writhing repetitive movements, involving co-contraction of agonist and antagonist
   –> unable to let go of hand
3. involuntary, rapid, abrupt twisting, writhing movements that may appear to jump from one extremity to another
   –> dance like movements

Answer 14

1. athetosis
2. dystonia
3. chorea

Question 15

stiffness
resistance to movement that is independent of velocity of movement
associated with lesions of basal ganglia
not related to spinal reflex mechanisms

Answer 15

rigidity

Question 16

two types of rigidity:
1. constant increase in muscular tone and stiffness of affected muscles

2. rigidity w/ tremor resulting in ratchet-like jerkiness when moved, seen in UE at elbow and wrist

Answer 16

1. leadpipe rigidity
2. cogwheel rigidity

Question 17

posturing with elbows, wrists and fingers flexed and legs extended and rotated inward

Answer 17

decorticate rigidity

Question 18

decorticate rigidity:
- severe injury to ___
- long term impact is ___

Answer 18

• cortex
• severe ROM contractures

Question 19

posturing with lots of extension –> shoulder IR, full ext at elbow, flexion at wrist and fisted hand.
LEs in extension with severe PF contracture

Answer 19

decerebrate rigidity (lots of e’s)

Question 20

what is opisthotonos?

Answer 20

strong, sustained, muscle contraction of the extensors of the neck and trunk
rigid, hyperextended posture

Question 21

your patient has a severe neurologic disease including neurodegeneration and trauma to the CNS rostral to the spinal cord. what should you check for?

Answer 21

primitive reflexes

Question 22

what is the primitive reflex ATNR?

Answer 22

asymmetric tonic neck reflex
ext. of UE and LE side head rotates to
flx. of UE and LE occiput side

Question 23

how do you assess for ATNR and what is your intervention?

Answer 23

palpate for change in mm tone with head rotation
head position matters and is critical to reduce muscle tone that results from this reflex

Question 24

what is the primitive reflex STNR?

Answer 24

symmetric tonic neck reflex
neck extension = UE ext and LE flx
neck flx = UE flx and LE ext
** legs opposite arms

Question 25

how do you assess for STNR and what is your intervention?

Answer 25

move head into flx and then ext while palpate for change in muscle tone at elbow
head position to neutral which may require good postural control and positioning of trunk and pelvis

Question 26

tonic labyrinthine is linked to _______ development and important precursor to development of _____

Answer 26

vestibular system
postural reflexes

Question 27

forward TLR:
backward TLR:

Answer 27

• neck flexes –> arms + legs flex
• neck ext –> arms + legs ext

Question 28

what makes up the bermuda triangle of spasticity and what do they have in common?

Answer 28

posturing/rigidity
TLR
STNR
–> all deal w extension

Question 29

how do you examine muscle tone?

Answer 29

passive motion testing –> repeat specific motions with increased velocity
clonus –> quick stretch of mm + when spasmodic contraction of antagonist mm

Question 30

what scale is used to measure spasticity? what is a high and low score?

Answer 30

Modified Ashworth Scale (MAS)
0 = no increase in muscle tone
4 = affected part(s) rigid in flexion or extension

Question 31

what are results of unmanaged spasticity?

Answer 31

joint contractures
spinal deviation/scoliosis
wounds
inability to access active movement

Question 32

what are some PT interventions for managing spasticity?

Answer 32

WB
prolonged stretch
static splinting (prolonged stretch & maintain ROM)
dynamic splinting (low load prolonged stretch)
serial casting
modalities (goal is to change motor neuron excitability)
positioning (in treatment, bed and wheelchair)

Question 33

where do you start to manage spasticity?

Answer 33

manage primitive reflexes (address head position in bed and sitting)
manage postural deviations
manage LE extensor tone
reduce destructive hip position