Lecture 3: BSF Exam- Muscle Tone

Question 1

Why is ROM important for a neuro exam?

Answer 1

will affect ACOM and affect activity

Question 2

What is muscle tone?

Answer 2

resistance of muscle to passive elongation or stretch

neurological ready state of muscle to act

Question 3

Why is muscle tone important?

Answer 3

supports posture, provides reflexive, energy efficient base for movement

Question 4

What is muscle tone influenced by?

Answer 4

intrinsic mechanical or elastic properties of muscle fibers and connective tissue

and spinal reflex muscle contractions

Question 5

What are two main types of muscle tone?

Answer 5

hypertonia- increase tone due to UMNL, hard resistance to passive stretch

hypotonia- decreased tone due to sometimes LMNL

Question 6

Where does an UMNL occur?

Answer 6

injury or lesion to brain, brainstem, descending motor or pyramidal tract

Question 7

Why does hypertonia happen?

Answer 7

increased excitability of alpha motor neurons (increased depolarization)

enhanced excitatory synaptic input (ms spindle or GTO)

Question 8

What are two types of hypertonia?

Answer 8

spasticity and rigidity

Question 9

What is spasticity?

Answer 9

an involuntary, velocity dependent, increased resistance to passive elongation

quick stretch results in increased resistance

Question 10

What type of lesions usually cause spasticity?

Answer 10

pyramidal tract lesions in diseases like CP, CVA, MS, TBI

Question 11

What is the clasp knife phenomenon?

Answer 11

strong resistance to initial passive movement followed by release of resistance

Question 12

What is clonus?

Answer 12

cyclical, spasmodic alternating muscle contraction in response to sustained stretch

Question 13

Why is spasticity a negative thing?

Answer 13

may lead to contracture, deformity, functional limitations, skin break down, weakness in both agonist and antagonist

Question 14

Why might spasticity be helpful?

Answer 14

passive postural suport, may contribute to function in presence of reduced motor control

Question 15

What factors will make spasticity worse?

Answer 15

infection, pressure sores, DVT, fatigue, bladder distention

Question 16

What is PT management?

Answer 16

modalities, stretching, splinting, casting

but only temporary effect

Question 17

What is rigidity?

Answer 17

increased resistance through range and not velocity dependent usually in both agonist and antagonist

Question 18

What will rigidity look like in basal ganglia lesion?

Answer 18

cogwheel or leadpipe

Question 19

What about brainstem lesions?

Answer 19

decerebrate or decorticate

Question 20

What is decorticate?

Answer 20

reflects loss of corticol control (lesion above red nucleus) with flexed UE and extended LE

Question 21

What is decerebrate?

Answer 21

reflects loss of inhibitory control of cortex and basal ganglia (below red nucleus) with full extension of all limbs and trunk

Question 22

What is dystonia?

Answer 22

involuntary painful muscle contraction or spasm causing repetitive twisting motions, abnormal posture

Question 23

What causes dystonia?

Answer 23

unknown currently, includes genetics, acquired, idiopathic

Question 24

What is hypotonia associated with?

Answer 24

LMNL- anterior horn or peripheral nerve damage

UMNL- spinal shock or cerebellar lesion

chromosmal abnormalities- downs, muscle disease- muscular dystrophy

Question 25

What else is associated with hypotonia?

Answer 25

reduced deep tendon reflexes

Question 26

What does hypotonia result in?

Answer 26

poor posture, weakness, decreased function, pain

Question 27

What will hypertonia look like?

Answer 27

increased muscle bulk, well defined and will feel taught and hard

Question 28

What will hypo look like?

Answer 28

less definition, mushy feel

Question 29

How to examine muscle tone?

Answer 29

lie pt in supine and perform PROM, don’t hold muscle belly, make sure pt is relax and note ROM and end feels

Question 30

How do you check for spasticity?

Answer 30

stretch the limb at full motion at a fast speed, unidirectional

Question 31

What is important to remember when testing rigidity?

Answer 31

it is not velocity dependent and and is bi directional

Question 32

What is a 0 on the MAS?

Answer 32

no increase in muscle tone

Question 33

What is a 1 on the MAS?

Answer 33

slight increase in muscle tone, manifested by catch at end range of motion and minimal resistance after

Question 34

What is 1+ on the MAS?

Answer 34

slight increase in muscle tone, catch in mid range of motion followed by resistance

Question 35

What is 2 on MAS?

Answer 35

more marked increase in tone through ROM

Question 36

What is 3 on MAS?

Answer 36

considerable amount of tone throughout motion, passive movement difficult

Question 37

What is a 4 on MAS?

Answer 37

affected parts rigid in flexion or extension

Question 38

What is V1-3 on Tardieu?

Answer 38

v1- very slow movement of body part
v2- speed of limb falling at gravity
v3- as fast as possible

Question 39

How do you score a Tardeiu?

Answer 39

x/y

x is 0-5 rating scale
y is degree of angle where muscle reaction occurs

Question 40

What is a 0 on Tardieu?

Answer 40

no resistance throughout course of passive movement

Question 41

What is 1 on Tardieu?

Answer 41

slight resistance, no catch

Question 42

What is 2 on Tardeiu?

Answer 42

clear catch at precise angle, interrupts movement followed by release

Question 43

What is 3 on Tardeiu?

Answer 43

fatiguable clonus less than 10 seconds when maintaining pressure and at precise angle

Question 44

What is 4 on Tardeiu?

Answer 44

clonus for more than 10 seconds at precise angle

Question 45

What is 5 on Tardeiu?

Answer 45

joint is immovable

Question 46

What is Babinski’s sign?

Answer 46

when stimulus applied to bottom of foot the toes will extend instead of flex

Question 47

What is Hoffman’s sign?

Answer 47

flicking of middle finger

abnormal thumb and index finger will adduct and flex

indicative of hyper reflexia