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PHTY3130 M1 > M1-L9: Ax Neuro - Muscle Tone > Flashcards

M1-L9: Ax Neuro - Muscle Tone Flashcards

1
Q

What is the ICF body functions and structures as a neurological assessment items?

A
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2
Q

What is the definition of muscle tone?

A
  • “A slight constant tension of healthy muscles”
  • “Resistance offered by muscles to continuous stretch”
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3
Q

What are the 2 types of tone?

A
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4
Q

What is one part of teh first assessment of every newborn baby? What are the 2 types?

A

Apgar score - screening test used worldwide to quickly assess the health of an infant one minute and five minutes after birth.

  • 1 min score - measures how well the newborn tolerated the birthing process.
  • 5 min score - assesses how well the newborn is adapting to the environment.
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5
Q

What are 2 contributors to muscle tone?

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6
Q

What are 4 neural contributors of muscle tone?

A
  1. Stretch reflex
  2. Peripheral input
  3. Spinal circuitry
  4. Descending neural command
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7
Q

What are 3 characteristics of neural contributors of muscle tone?

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8
Q

What is a neuro-sensory neural contributor of muscle tone?

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9
Q

What is a neuro-motor neural contributor of muscle tone?

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10
Q

What is a neuro-cognitive neural contributor of muscle tone (eg. arousal, emotion)?

A
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11
Q

When do you want to test a baby for assessment (cognitive state)?

A

Physiotherapy Assessment: Want to test the baby when they are QUIET but ALERT (do not test when baby is ASLEEP)

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12
Q

What are 3 non-neural contributors of muscle tone?

A

(viscoelastic properties)

  1. Extracellular matrix
  2. Titin
  3. Dystrophin
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13
Q

What are 3 characteristics of non-neural (musculoskeletal) contributors of muscle tone?

A
  1. Muscle properties
    • Visco-elastic properties –> elasticity, viscosity, plasticity
    • Muscle Fibre Properties
    • Muscle Length / contracture
  2. Soft tissue properties
  3. Biomechanics
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14
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A
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15
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16
Q

What is actin?

A

Thin filament, attach at the Z line

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17
Q

What is myosin?

A

Thick filament, anchor at the M line in the centre of the sarcomere

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18
Q

What is titin?

A

Newly discovered elastic filament, anchors myosin to the Z line, contributes to passive force in muscle

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19
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A
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20
Q

What is dystrophin?

A

is protein located in the intercellular surface of muscle fibres.

Stabilises muscle fibres during contraction and relaxation by binding to other proteins within the ECM.

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21
Q

What are connective tissue contributors?

A
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22
Q

What is resting tone as a measurement state of muscle tone?

A

‘Resistance to passive stretch while a patient is attempting to maintain a relaxed state of muscle tone activity.’

  • Usually done later (after hands off assessment) –> need to build rapport with child
  • Quiet state
23
Q

What is active tone as a measurement state of muscle tone?

A

‘An individual’s ‘ability’ or ‘readiness’ to respond to environmental demands.’

24
Q

What is the measurement state of muscle tone?

A
25
Q

What are the observations (3), response to handling (2) and possibility (1) for assessment elements?

A

Observation

  1. Body positions
  2. Postures and patterns of movement during voluntary and reactionary movement
  3. Influence of gravity and weight-ˇbearing

Response to handling

  1. Resistance to passive movement
  2. Postures and movement patterns in response to facilitation or perturbation

Possibility for change

  1. Changes with change in level of support
26
Q

What are the tonal patterns for observation in the upper limb and lower limb?

A
27
Q

What does a flexor pattern look like?

A
28
Q

What isthe extensor pattern for the lower limb and the upper limb?

A
29
Q

What are the test items with sound validity and reliability?

A
30
Q

What is the resistance to passive motion in resting tone?

A
  1. This is the most common assessment of muscle tone reported in the literature.
  2. Contained in: e.g. NNNS (infants), ATNA and HINT (0-ˇ2y), NSMDA (up to 6 years)
31
Q

What is the range of motion in resting tone for the upper limb and lower limb?

A
32
Q

What is recoil in resting tone?

A

Lay baby’s arms on a support surface

  • Normal: will going into semi-flexed
  • Poor tone: no movements
  • High tone (flexor): flexor pattern
33
Q

What is the response to gravity for active tone?

A
34
Q

What cognitive state should the child be in for response to gravity for active tone?

A

Repeat resistance to passive movement –> but rather than child being QUIET and ALERT, they should be more ACTIVE this time (have a toy in hand, stimulus)

35
Q

Why should you not pull child up from hands, but rather by the shoulders?

A

Do not pull from hands but rather from SHOULDERS (scapula)

  • If they have low tone, can dislocate shoulders and hyperextend cervical spine (head lag)
36
Q

What are the new laboratory measures in resting tone?

A
37
Q

What is supersonic shearing imaging (SSI)?

A
  1. Higher muscle stiffness found in more affected limbs of children with CP
  2. Greater stiffness found in CP at all ankle angles, compared to typical children
38
Q

How can you judge the “type” of tone after assessment?

A
39
Q

What are the 4 types/distributions of tone?

A
  1. Quadriplegia
    • Involvement of all limbs
    • Upper limbs are equally or more affected than the legs
  2. Diplegia
    • Lower limbs are more severely affected than the upper limbs
    • In children born preterm, there is frequently hypotonia in the trunk
  3. Hemiplegia
    • One side of the body is affected
  4. Other
    • There is presently considerable discussion by the Australian Cerebral Palsy Register (ACPR) as to how to define asymmetric diplegia, spastic triplegia and spastic quadriplegia

See plasticity (brain will change function to accommodate)

Eg. brain injury at speech side –> speech side will go to the other side (but might take up motor space)

40
Q

What are the 3 changes in common tonal patterns?

A
  1. Previously
    • Observation of limb, girdle and truncal hypertonia
  2. Pre-term birth asphyxia
    • Tuncal hypotonia and limb & girdle hypertonia
  3. Extremely low birth weight (<1000g) + Intraventricular haemhorrage (IVH)
    • Spastic diplegia with a predominant pattern of LL ext and adduction and truncal hypotonia / inactivity
    • Very susceptible to bleeds in blood vessels
    • Low tone due to pre term
41
Q

What are the principles in the response to facilitation/position?

A

Want to be able to move in direction of pattern without being pulled by the pattern

42
Q

What are 4 characteristics of facilitation (eg. EXT-ABD-ER)?

A
  1. Counteracts F and E hypertonia
  2. Combination of 2 patterns
  3. LL –> Encourages acceptance of a BOS
  4. UL –> Encourages ability to place and support, or reach
43
Q

What is the application of facilitation.position?

A

May need to start with modification / part of the pattern e.g.: thumb position, limb rotation

44
Q

What are 6 conditions associated with hypotonia (low tone)?

A
  1. Often genetic
  2. Neurological insult / abnormality
  3. Autoimmune
  4. Infections
  5. Teratogens
  6. Metabolic & Endocrine
45
Q

What are examples of genetic conditions associated with hypotonia (low tone)?

A

e.g. Down Syndrome (Trisomy 21); Prader-ˇWilli Syndrome; CHARGE association (CHD7 gene); Fragile X (FMR-ˇ1gene);; Spinal muscular atrophy; Marfan’s syndrome; Myotonic dystrophy; Nemaline rod myopathy

46
Q

What are examples of neurological insult / abnormality conditions associated with hypotonia (low tone)?

A

Upper motor neuron lesion e.g. acquired brain injury; Cerebellar ataxia; Hypotonic Cerebral Palsy; Lower motor neuron injury – flaccid paralysis

47
Q

What are examples of autoimmune conditions associated with hypotonia (low tone)?

A

e.g. Myasthenia Gravis;; Celiac disease

48
Q

What are examples of infections conditions associated with hypotonia (low tone)?

A

e.g. Encephalitis;; Guillain-ˇBarré;; Sepsis;; Infant botulism;; Meningitis;; Poliomyelitis

49
Q

What are examples of Teratogens conditions associated with hypotonia (low tone)?

A

e. g. In utero benzodiazapines
* If mother had epilepsy (has to take medication)

50
Q

What are examples of metabolic and endocrine conditions associated with hypotonia (low tone)?

A

e.g. Kernicterus;; Rickets;; Hypothyroidism

51
Q

What are 6 conditions associated with hypertonia (high tone)?

A
  1. Upper Motor Neurone / Cerebral Insult
    • Most common = Cerebral Palsy (insult ≤2 years old)
  2. Traumatic Brain Injury (2+ years old)
  3. Stroke (ischaemic / bleed)
  4. Tumor -ˇ cerebral or spinal
  5. Spina Bifida
  6. Spinal cord injury
  7. Tetanus
52
Q

What is the most common condition associated with hypertonia?

A

Upper Motor Neurone / Cerebral Insult

  • Most common = Cerebral Palsy (insult ≤2 years old)
53
Q

What is the prevalence of atypical muscle tone?

A
  1. Not a diagnosis, rather it is a symptom.
  2. Collective prevalence: about 6%
  • For example …
    • Brain injury: 2.1/ 1000 (Cerebral Palsy)
    • Genetic disorders: 1.4/ 1000 (Down Syndrome)
    • Developmental Coordination Disorder: 6/100 (mild tonal problems)

PHTY3130 M1 (20 decks)

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