Exam/Management of Muscle tone disorders Flashcards
What is muscle tone?
The amount of stiffness in resting muscle or resistance to stretch or passive elongation.
Hypotonia vs. Flaccidity?
hypotonia is decreased resistance to passive movement while flaccidity is complete loss of muscle tone.
What are the two types of hypertonia?
Spastic hypertonia and rigid hypertonia
What is dystonia?
A basal ganglia related disorder: involuntary contractions causing abnormal twisting movements or postures.
Not just a muscle tone disorder
Which patients do you usually see hypotonia in?
Pts with anterior horn cell pathology, partial peripheral nerve lesions, spinocerebellar lesions, basal ganglia CP
When do you usually see flacidity?
Spinal shock (diaschesis) right after SCI or CVA or complete LMN lesion
What is decorticate rigidity?
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
What is Decerebrate posturing?
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
Which is a better sign, Decorticate or Decerebrate posturing?
Decorticate. If you see decerebrate posturing it usually means there is severe damage to the brain.
Is posturing seen in one or both sides?
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
What is opisthotonic posturing?
Condition which the body is held in an abnormal posture usually involves rigidity and severe arching of the back with the head thrown backward
Who is opisthotonic posturing seen mostly in?
mostly in infants and is more exaggerated, but can be seen in adults
What are factors that influence muscle tone?
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.
How do you grade spasticity?
Modified ashworth scale
What is a 0 on the MAS?
no increase in muscle tone
What is a 1 on the MAS?
slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of ROM
What is a 1+ on the MAS?
slight increase in muscle tone, manifested by a catch and release followed by minimal resistance through the remainder of ROM
What is a 2 on the MAS?
More marked increase in tone through most of ROM but affected part can still be moved
What is a 3 on the MAS?
Considerable increase in tone; passive movement throughout the ROM difficult
What is a 4 on the MAS?
affected parts held “rigidly” in place (with relaxation or stretching, some passive ROM may be possible)
What is the problem with the drop arm test?
Difficult to conclude that a problem is due to muslce tone. Could be strength, motor control, coordination or inability to activate certain muscles
What are some activities to alter state of hypotonicity?
Activate sympathetic nervous system
- move pt to position against gravity
- bring to active area
- talk to pt
- put in weightbearing
What are some activities to alter state of hypertonicity?
Diminish sympatheic input, apply relaxation techniques, neutral warmth, quiet area, weightbearing
What is the goal of specific techniques to selectively inhibit muscle groups?
For spasticity the goal is to temporarily reduce Motor neuron excitability
What are some techniques to selectively inhibit certain muscle groups?
- 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
