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NM 2 > lecture 5: managment of spasticity > Flashcards

lecture 5: managment of spasticity Flashcards

1
Q

what is mm tone

A

resistance to stretch in resting

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2
Q

MM tone exists on a continuum so what does these mean

  • flaccidicty
    -hypotonia
    -hypertonia
    -spasticity
    -rigidity
A
  • flaccidicty: complete lack of resistance

-hypotonia : abnormally low resistance

-hypertonia: abnormally high resistance to passive stretch

-spasticity : velocity dependent

-rigidity: velocity independent

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3
Q

what is spasticity

A

velocity dependent resistance to passive stertch

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4
Q

does spasticity affect people with UMN or LMN lesions

A

UMN

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5
Q

which condition is spasticity incidence the highest

A

CP

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6
Q

what is a chronic loss of PROM of a joint because of structural changes in non bony tissues

A

contractures

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7
Q

____ and ___ significantly contribute to contractures, but are not
the sole cause.

A

Spasticity and paralysis

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8
Q

what are 4 ways that spasticity may be helpful

A
  • assist patients w postural control and mobility
  • maintaining mm mass and bone mineralization
  • reduce dependent edema
  • prevent DVT
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9
Q

what are teh 5 clinical assessment measure of spasticity

A
  • Placing (NDT - see lab notes)
  • Modified Ashworth Scale
  • Tardieu Scale
  • Penn Spasm Scale
  • Patient Reported Impact of Spasticity Measure (PRISM
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10
Q

if a patient has a Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder
(less than half) of the ROM what grade is it on the modified asworht scale

A

1+

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11
Q

if a patient has a Considerable increase in muscle tone, passive movement is difficult what grade would that be on the modified ashworth scale

A

3

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12
Q

if the patient has no increase in tone what is the grade on the modified ashworth scale

A

0

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13
Q

what is the velocity of stretch for the tardieu scale to measure spasticity and what is V1-V3 used for

A

v1: as slow as possible (passive)
v2: speed of limb fallling w gravity
v3: as fast as possible

V1 used for PROM
V2 & 3 for spasticity

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14
Q

what is the angle of mm reaction for the tardieu scale

A

measured from 0° position

R1= PROM will catch point
R2: full PROM

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15
Q

for the QUality of mm reaction of the tardieu scale what would a patient be graded if there was a clear catch at precise angle , followed by a release ?

A

grade 2

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16
Q

for the QUality of mm reaction of the tardieu scale what would a patient be graded if there was a fatigable clonus at precise angle

A

3

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17
Q

what is the patient reported impact of spasticity measured ?

A

self report measure of impact of spasticity on numerous things

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18
Q

what are the 7 medical management of spasticity

A
  • botulinum toxin A
  • baclofen (oral or intrathecal pump)
  • nerve or motor point block
  • spinal or cerebral electrical stimulation
  • peripheral neurotomy
  • rhizotomy
    -tendon release w/without transfer
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19
Q

what is the only strain of Neuroparalytic toxin produced by clostridium botulinum bacteria avaiable for clinical use

A

type A

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20
Q

what are the brand names of botulinum toxin A

A

botox, dysport , xeomin

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21
Q

how does botox work for spasticity

A

blocks acetylcholine relseae at the NM junction , autonomic ganglia and posthganglionic parasympathetic and sympathetic nerve endings

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22
Q

for botox does slow twitch fibers recover then fast twitch ? or slower ?

A

faster

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23
Q

how do you use BOTOX and how do u dose it

A

inject directly into the MM BELLY

dose based up body weight , size of the mm , client activity levels , and levels of spasticity

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24
Q

• Can be injected for selective muscle
paralysis
• No dysesthesia
• Less muscle irritation
• Minimal pain (done in MD office)
• Graded degree of weakening
• Frequently used during growth
spurts

these are advantages for what

A

botox

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25
Q

• Costs
• Limits in amount of drug that can
be administered at one time
• Not permanent, and can develop
decreased response, because of
antibody production
• Re-injected no more frequently
than once per 3 months
• Muscle can be overstretched
• Side effects: can produce fever,
swelling, hives.

what is this disadvantages to

A

botox

26
Q

what are contraindications of BOTOX

A
  • NM trasnmission disease
    -inflammation at projected injection site
  • preganancy
  • children under 2 years of age
27
Q

what oral medication can be used for systemic effect for generalized spasticity

A

baclofen , tizanidine, dantrolene, clonidine, diazepam

28
Q

topical anesthesia is applied to entire extremity except what surfaces

A

extensor surfaces over lower leg and forearm

29
Q

what can be given oral bs intrathecal and is effective in reducing spasticity

A

baclofen

30
Q

what is the mechanism of action of baclofen

A

not fully understood

inhibits reflexes at the spinal cord level
possibly inhibits excitatory NT relsease (looks like inhibitory NT GABA)

31
Q
  • Does not reach the systemic circulation or brain in appreciable amounts
    • Fewer systemic side effects as stays in area of the cord rather than circulating in the
    bloodstream
    • Provides a mechanism for patients who otherwise would not tolerate oral baclofen
    • Can be used for the management of spinal (SCI, MS) and supraspinal (CP,
    CVA, TBI) spasticity
    • Can positively affect pain in these populations
    • Improvements in voluntary muscle control

what does this relate to

A

INTRATHECAl BACLOFEN PUMP ( I T B )

32
Q

what are contraindications for intrathecal baclofen pump

A

-* Allergy or hypersensitivity to baclofen
* Active infection

33
Q

what are teh adverse effects of intrathecal baclofen pump

A

-risk of pump malfunction or tip displacement
- overdose if pump malfunctions causes sedation , respiratory depression , decreased cardiac function
- rapid cessation causing withdrawal syndrome
-risk of disinhibition

34
Q

what is the implantation of the intrathecal baclofen pump

A

• Catheter is inserted into subarachnoid space at L3-4 with catheter tip extending to T12-L1.
• Pump is implanted in abdomen

35
Q

what are the short and long term effects of nerve or motor point blocks

A

short term is similar to local anesthetic , directly proportional to thickness of fibers

long term casues protein denaturation

36
Q

what is a advantage difference between botox and nerves or motor point blocks for spasticity

A

botox does not cause dysesthesias when nerve block does

botox casues less mm irritation as compared to nerves block

nerve block last longer then botox

37
Q

spinal cord stimulation=

A

dorsal column stimulation

38
Q

what is the advantage of spinal stimulation

A

better tone management of UEs then baclofen pump

39
Q

what is the cerebral electrical stimulation

A
  • sensory stimulation of sensory nuclei of thalamus for pain control
  • cerebellar stimulation for movement disorders
40
Q

what is a rhizotomy

A

certain % of sensory nerve root lets are cut

41
Q

where is a rhizotomy usually performed and what does it require

A

performed in lower thoracic or lumbar regions and requires laminectomy or laminotomy

42
Q

are there more advantages or disadvantages for a rhizotomy

A

disadvantages

43
Q

what tendons are most commonly released for a tendon release

A

hamstrings and heel cord (achilles)

44
Q

does a tendon release a change the mechanism for how mm adn tendon lost original length

A

NOOOO

45
Q

what is SPLATT

A

split anterior tibialis tendon transfer

lateral aspect attached to cuboid ,
frequently after heel cord lengthening

46
Q

for the tendon release with transfer the ___ ___ tendon transfer from ___ surface of ___ cuneiform to dorsum of ____

A

Peroneus longus tendon transfer from plantar surface of medial cuneiform
to dorsum of navicular

47
Q

• Passive stretch
• Electrical stimulation
• EMG biofeedback
• Temperature
• Casting and splinting
• Medications

what kind of treatments are these for reduction of spasticity

A

non invasive

48
Q

what is the physcial therapy management of spasticity

A

-objective assessment
-stretching and range of motion exercises
-strength training

49
Q

from stretching and range of motion exercises for PT management of spasticity how long wold u have to stretch

A

long time 20-30 years

50
Q

what is functional/ neuromuscular electrical stimulation

A
  • antagonist stimulation to increase reciprocal inhibition of spastic mm and increase strength of antagonist
51
Q

what are contraindications to TES ( 4 )

A

• Primary muscle disorder
• Degenerative disease
• Behavioral disorders

• Medical complications (strict)
Arrhythmia
Pacemaker
Pregnancy

• Growth complications
Obesity
Fixed contractures

52
Q

what do u use therapeutic electrical stimulation for

A

general spasticity that interferes with function

53
Q

when do u use Therapeutic electrical stimulation (TES)

A

• Used at night during peak secretion of growth hormone to prevent disuse
atrophy

54
Q

what electrical stimulation is used to treat pain associated with spasticity to break spasticity pain cycle

A

TENS

55
Q

what do u use EMG biofeedback to promote

A
  • To promote voluntary relaxation, keeping readings below threshold
  • To promote voluntary active efforts, in combination with
    FES/NMES when threshold reached
56
Q

what nonremoveable cast is more successful wehn contracture present < 6 months adn when patient is able to use extremity

A

serial cast

57
Q

are cast and AFOs static or dynamic

A

static

58
Q

what splint is very good with painful/hypersensetive patients , holds limb in inhibited posture ,and applies deep pressure stimulation acts on proprioceptors

A

air filled pressure splint

59
Q

what is used for general relaxation , hot or cold ?

A

hot

60
Q

what is used to numb skin receptors (hot or cold)

A

collie

NM 2 (13 decks)

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