Exam/Management of Muscle tone disorders

Question 1

What is muscle tone?

Answer 1

The amount of stiffness in resting muscle or resistance to stretch or passive elongation.

Question 2

Hypotonia vs. Flaccidity?

Answer 2

hypotonia is decreased resistance to passive movement while flaccidity is complete loss of muscle tone.

Question 3

What are the two types of hypertonia?

Answer 3

Spastic hypertonia and rigid hypertonia

Question 4

What is dystonia?

Answer 4

A basal ganglia related disorder: involuntary contractions causing abnormal twisting movements or postures.
Not just a muscle tone disorder

Question 5

Which patients do you usually see hypotonia in?

Answer 5

Pts with anterior horn cell pathology, partial peripheral nerve lesions, spinocerebellar lesions, basal ganglia CP

Question 6

When do you usually see flacidity?

Answer 6

Spinal shock (diaschesis) right after SCI or CVA or complete LMN lesion

Question 7

What is decorticate rigidity?

Answer 7

Sustained contraction and posturing of the trunk and lower limbs in extension and upper limbs in elbow flexion with clenched wrists and fingers.
-Lesions ABOVE the middle of Midbrain with damage to corticospinal tract

Question 8

What is Decerebrate posturing?

Answer 8

Sustained rigid muscle contractions of the trunk and limbs in full extension
-occurs with lesions Below the middle of the midbrains usually at brainsetm. requires immediate medical attention

Question 9

Which is a better sign, Decorticate or Decerebrate posturing?

Answer 9

Decorticate. If you see decerebrate posturing it usually means there is severe damage to the brain.

Question 10

Is posturing seen in one or both sides?

Answer 10

You can see decorticate/decerebrate posturing in one or both sides. As a patients neurological status fluctuates, you may see each side in a different posture

Question 11

What is opisthotonic posturing?

Answer 11

Condition which the body is held in an abnormal posture usually involves rigidity and severe arching of the back with the head thrown backward

Question 12

Who is opisthotonic posturing seen mostly in?

Answer 12

mostly in infants and is more exaggerated, but can be seen in adults

Question 13

What are factors that influence muscle tone?

Answer 13

Body positions and interaction of tonic reflexes
stress/anxiety
volitional effort/movement
medications
general health
Temperature (environment)
CNS alertness/arousal
fevers, infections, bladder fullness, pain etc.

Question 14

How do you grade spasticity?

Answer 14

Modified ashworth scale

Question 15

What is a 0 on the MAS?

Answer 15

no increase in muscle tone

Question 16

What is a 1 on the MAS?

Answer 16

slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of ROM

Question 17

What is a 1+ on the MAS?

Answer 17

slight increase in muscle tone, manifested by a catch and release followed by minimal resistance through the remainder of ROM

Question 18

What is a 2 on the MAS?

Answer 18

More marked increase in tone through most of ROM but affected part can still be moved

Question 19

What is a 3 on the MAS?

Answer 19

Considerable increase in tone; passive movement throughout the ROM difficult

Question 20

What is a 4 on the MAS?

Answer 20

affected parts held “rigidly” in place (with relaxation or stretching, some passive ROM may be possible)

Question 21

What is the problem with the drop arm test?

Answer 21

Difficult to conclude that a problem is due to muslce tone. Could be strength, motor control, coordination or inability to activate certain muscles

Question 22

What are some activities to alter state of hypotonicity?

Answer 22

Activate sympathetic nervous system

• move pt to position against gravity
• bring to active area
• talk to pt
• put in weightbearing

Question 23

What are some activities to alter state of hypertonicity?

Answer 23

Diminish sympatheic input, apply relaxation techniques, neutral warmth, quiet area, weightbearing

Question 24

What is the goal of specific techniques to selectively inhibit muscle groups?

Answer 24

For spasticity the goal is to temporarily reduce Motor neuron excitability

Question 25

What are some techniques to selectively inhibit certain muscle groups?

Answer 25

• EMG biofeedback, TENS< heate, cryotherapy, vibration
• Prolonged stretch (manual, tilt table, or prolonged assisted standing)
• Positioning techniques
• Use of robotic aids to facilitate strengthening of muscles