Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds Neuro > Measuring Muscle Tone in Children > Flashcards

Measuring Muscle Tone in Children Flashcards

1
Q

Characteristics of hypotonia

A

 Lack of resistance to passive movement
 Decreased strength/Poor definition of muscles
 Decreased activity tolerance
 Decreased motor skill development
 Rounded shoulder posture with a tendency to lean onto supports
 Hypermobile joints
 Increased muscle f lexibility
 Poor attention and motivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How to examine hypotonia?

A

Subjective in nature/process of exclusion following muscle biopsies and imagine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Examining hypotonia - Observation

A
  • Do they look floppy?
  • Do they have anti-gravity movements of the head and limbs (prone, vertical, supine)?
  • Do they have a frog-legged posture? (hips abducted and externally rotated)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Examine hypotonia - Palpation

A
  • Soft, pliable musculature
  • Excessive ROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypertonic –>

A

spasticity, dystonia, rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hyperkinetic –>

A
  • Chorea
  • Dystonia
  • Athetosis
  • Myoclonus
  • Tremor
  • Tics
  • Stereotypies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Negative –>

A
  • weakness
  • Selective Motor Control
  • Ataxia
  • Dyspraxia
  • Bradykinesia
  • Balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is hypertonia?

A

Abnormally increased resistance to externally imposed movement about a joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are hyperkinetic movements?

A

Any unwanted excess movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Negative motor signs in CP

A

Insufficient muscle activity or insufficient control of muscle activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Movement Disorders in CP

A
  • Hypertonia
  • Hyperkinetic Movements
  • Negative Motor Signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Spasticity Definition

A

 Velocity-dependent resistance of a muscle to stretch presenting with one or both of the following clinical signs
 Resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement
 Resistance to externally imposed movement rises rapidly above threshold speed or joint angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Review physiology of spasticity on slides 16 and 17

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Reticulospinal Tract

A

Inhibits muscle tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Vestibulospinal tract

A

Excites muscle tone of antigravity/extensor muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Damage to corticobulbar tracts in CP:

A
  • Loss of reticulospinal inhibition of muscle tone
  • Continued vestibulospinal excitation –> increased lower extremity extensor tone
17
Q

Definition of Dystonia

A

 Involuntary sustained or intermittent muscle contractions resulting in twisting and repetitive
movements and/or abnormal postures

18
Q

What is hypertonic dystonia?

A

 Resistance to externally imposed movements at low speeds (not dependent on velocity)
 Simultaneous co-contraction (observed in rapid reversal)
 Limb returns toward fixed involuntary posture
 Triggered/worsened by voluntary movements of other body parts
 Varies with level of arousal
 No other detected spinal cord or peripheral lesion

19
Q

Rigidity

A

 Rarely reported in children
 “Joint cannot be moved”
 Resistance to passive movement is independent of posture and speed of movement
 “Lead-Pipe”
 Not specific to task or posture

20
Q

4 Clinical Measures of Hypertonicity

A
  • Observation
  • Hypertonicity Assessment Tool
  • Modified Ashworth
  • Modified Tardieu
21
Q

What is the Hypertonicity Assessment Tool?

A

 7 item tool incorporating tasks of the bilateral upper and lower extremities
 Developed for children 4-19 y/o
 Purpose: to differentiate the different forms of
hypertonicity

22
Q

How is the hypertonicity Assessment Tool Scored?

A

The presence at least one HAT item per
hypertonia subgroup (spasticity, dystonia, rigidity) confirms the presence of the that subtype
 The presence of more than one subgroup confirms the presence of mixed tone

23
Q

How is the Hypertonicity Assessment Tool Administered?

A

 Position the child in supine
 Child wears comfortable, unrestrictive, clothing
 Hands placed gently on upper abdomen
 Place roll under knees and pillow under head

24
Q

What muscles should you consider when evaluating tone in the lower extremities?

A
  • Hamstrings
  • Gracilis
  • Rectus Femoris
  • Gastrocnemius
25
Q

Modified Ashworth Scale

A
  • Used most in pediatric research
  • Many variations (Bohannen, Other formates score for hypotonia)
  • Standard test positions for children
26
Q

Modified Ashworth Grading

A

0: No increase in muscle tone
1: Slight increase in muscle tone (catch or minimal resistance) at end of ROM
1+: Slight increase in muscle tone (catch) followed by minimal resistance throughout the
remainder (< half ) of the ROM
2: More marked increase in muscle tone through most of ROM, but affected part easily
moved
3: Considerable increase in muscle tone, passive movement difficult
4: Affected part rigid in flexion or extension (immobile)

27
Q

Validity of Modified Ashworth Scale

A
  • Correlates with other measures of hypertonicity (Tardieu), function (GMFM), isokinetic
  • High scores of scale do correlates with isokinetic measurements of resistance to stretch
28
Q

Is Modified Ashworth Scale a TRUE measure of spasticity

A

Nope!
Does not discriminate dynamic versus passive components of spasticity/hypertonicity

29
Q

Reliability of Modified Ashworth Scale

A

 Reliability not well demonstrated in children; children with CP
 inter-rater in elbow flexors and hamstrings (ICC > .75)
 Intra rater in hamstrings (ICC >.75)
 Other studies have lower inter and intra rater
reliability
 Test-retest reliability varied greatly
 Low to average reliability for elbow, wrist, hip add, hamstrings, plantar flexors of children with CP

30
Q

Is Modified Ashworth Scale sensitive enough to measure smaller differences in Spasticity?

A

Nope

31
Q

Modified Tardieu Procedure

A

 Measure end-point range of motion to slow
velocity ROM after 3 reps=R2
 Measure angle when feel “catch” on 3rd trial of
high velocity ROM = R1

32
Q

Modified Tardieu Scoring

A

R2-R1 = dynamic component of spasticity
mTS = quantify quality of muscle reaction

33
Q

Tarieu Quantification of Quality of Reaction

A

0 = No resistance throughout passive movement
1 = Slight resistance throughout passive measurement
2 = Clear catch at precise angle, interrupting passive movement and followed by release
3 = Fatigable clonus (<10 secs.) at precise angle
4 = Unfatigable clonus (>10 secs.) at precise angle

34
Q

What does Modified Tardieu Scale do??

A

Assesses passive joint ROM at different speeds. to determine dynamic tone

35
Q

Tardieu Scale Validity

A
  • Implied in MAS studies
  • Responsive to change
36
Q

Tardieu Scale Reliability

A

 Reliability = .70 or greater = acceptable measure in children with CP
 Improves after training

37
Q

Other frequently used measures of “spasticity/hypertonicity”

A

 Palpation –firm feel to mm belly
 Quantification of DTR
 Reflex testing Measures hyperactive stretch reflex
 NOT velocity dependent
 Quantification of Clonus
 Measures neuro hyperexcitability of mm
 NOT velocity dependent

38
Q

Considerations for measuring “tone”

A

 Dynamic component (response to mm stretch)
 Best done with Tardieu scale
 Passive component –changes in tissue mechanics
 Resting state of the muscle
 Environment, time of day, behavioral state, level of
excitement, amount of effort

Peds Neuro (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions