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Physical Agents > Motion Restriction & Muscle tone abnormalities > Flashcards

Motion Restriction & Muscle tone abnormalities Flashcards

1
Q

AROM may be restricted by:

A
  • Muscle weakness
  • abnormal muscle tone
  • pain originating from the musculotendinous unit or other local structures
  • inability or unwillingness of pt to follow directions
  • as the result of restrictions in PROM
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2
Q

PROM

A

movement of a joint produced by external forces without voluntary muscle contraction by the pt

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3
Q

PROM may be restricted due to:

A
  • shortening of soft tissues
  • edema
  • adhesion
  • mechanical block
  • Spinal disc herniation
  • adverse neural tension
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4
Q

Normal PROM > AROM when:

A
  • When limited by distension or approximation of soft tissues
    ex. GH flexion firm end feel
  • check rein: post band of coracohumeral lig, post jt capsule, post delt, teres minor/major, infraspinatus
    ex. external rotation with firm end feel
  • check reign: ant jt capsule, 3 bands of GH lig, coracohumeral lig, subscapularis, teres major, clavicular fibers of pec major
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5
Q

Normal PROM > AROM examples

A

Ex. GH flexion firm end feel
- check rein: post band of coracohumeral lig, post jt capsule, post delt, teres minor/major, infraspinatus
Ex. external rotation with firm end feel
- check reign: ant jt capsule, 3 bands of GH lig, coracohumeral lig, subscapularis, teres major, clavicular fibers of pec major
Ex. Wrist ulnar deviation with firm end feel
- check reign: radial collateral ligament, radial portion of jt capsule, tension in EPB and APL

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6
Q

Normal AROM=PROM when:

A

limited by approximation of bone

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7
Q

Normal AROM=PROM examples

A

Ex. wrist radial deviation with hard end feel
- contact between radial styloid and schapoid bone
-may be firm if limited by ulnar collateral lig., ulnocarpal lig., ulnar portion of jt capsule, tension in ECU, FCU
EX. Wrist pronation with hard end feel
- Contact between ulna and radius
- may be firm if limited by dorsal radioulnar lig, interosseous membrane, supinator

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8
Q

Physiological motion

A

motion of one segment of the body relative to another segment

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9
Q

accessory motion

A

motion that occurs between the joint surfaces during normal physiological motion

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10
Q

Capsular pattern of restriction

A

specific combo of motion loss caused by shortening of the joint capsule sourrounding a joint
- usually restricted in multiple directions

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11
Q

Noncapsular pattern of restriction

A

Combination of motion loss that does not follow a capsular pattern

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12
Q

noncapsular pattern of restriction caused by:

A
  • ligamentous adhesion
  • internal derangement
  • extraarticular lesion
    • muscle/tendon adhesion
    • hematomas
    • cysts
    • inflamed bursa
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13
Q

Ligamentous adhesion

A

Limit motion in direction that stretches adhered ligament

-ex. adhesion of wrist ulnar collateral lig will limit wrist radial deviation

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14
Q

Internal derangement

A

disruption of internal join anatomy ie loose body

- ex. torn labrum will limit ROM in direction that compresses labrum

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15
Q

Extraarticular lesions

A

May limit motion in either direction of compression of structure or tension to injured structure

  • Ex. subdeltoid bursitis limited ROM in direction of compression of bursa
  • Ex. EPB and APL tendonitis limit motion in direction of tension to tendons
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16
Q

Contractile tissue

A

composed of the musculotendinous junction , the tendon, and the tendon’s interface with bone
-injury and dysfunction can cause restriction in AROM

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17
Q

Noncontractile tissue

A

All tissues that are not components of musculotendinous unit, includes; skin, fascia, scar tissue, ligament, bursa, capsule, articular cartilage, bone, IV disc, nerve, and dura mater
- injury or dysfunction can result in restriction in PROM and may also contribute to restrictions in AROM

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18
Q

Response of myofascial tissue to immobilization

A

Loss of ground substance
- glycosaminoglycans (GAGs) and water
-loss of interfiber lubriciation
- loss of interfiber distance
- results in new cross links that adhere adjacent collagen fibers
**half life of collagen is 300-500 days half life of ground substance is 1.7-7 days
- constantly being turned over so immobilization causes
problems

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19
Q

Nontraumatized Connective Tissue

A

Results in fibrosis

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20
Q

Traumatized

A

Results in scar tissue formation and contracture

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21
Q

Contracute

A
  • Shortening of soft tissues
  • May be caused by:
    • immobilization
    • imbalance of muscle power
    • the result of a truama
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22
Q

Contracture: immobilization

A

Anomalous cross links develop between collagen fibers
- fibers remain in contact for long time periods and adhere at their point of interception
- cross links may prohibit normal collagen alignment when motion attempted
-increases stress required to stretch tissue
Fluid is lost from fibrous CT
-impairs normal fiber gliding
-fibrils have closer contact

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23
Q

Risk of contracture increases when immobilized tissue is injured because:

A

Scar tissue formation during proliferation stage of healing

  • poor fiber alignment
  • high degree of crosslinks between fibers
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24
Q

Intraarticular edema

A

Joint effusion: excessive fluid in joint capsule

  • joint capsule distended limiting ability to fold and distend
  • may limit both AROM & PROM
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25
Q

Extraarticular edema

A

Accumulation of fluid outside a joint

- may limit AROM and PROM due to soft tissue approximation sooner than normal

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26
Q

Adhesion

A

Abnormal jointing of parts to each other

  • during healing scar tissue can adhere to surrounding tissue
  • fibrofatty tissue inside joints can adhere to joint surfaces as scar tissue develops
  • immobilization: synovial memebrane may adhere to articular cartilage
  • can effect both quality and quantity of motion
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27
Q

Mechanical block

A
  • bone or fragments of articular cartilage
  • tears in intraarticular menisci or discs
  • DJD or malunion of healing fx
  • loose bodies
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28
Q

Spinal disc herniation

A
  • Can result in direct mechanical block

- indirect blockage due to inflammation of spinal nerve roots

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29
Q

Adverse neural tension

A
  • limited ROM of peripheral nerve

- can be the result of intraneural or extraneural adhesions

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30
Q

Extraneural adhesions can develop where:

A
  • Nerve passes through tunnels
  • nerves branch
  • nerve is relatively fixed
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31
Q

Intraneural adhesions develop:

A

Within connective tissue layers

  • mesoneurium
  • epineurium
  • perineurium
  • endoneurium
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32
Q

Fascicular arrangement and composition of nerve

A
  • Fascicular arrangement within nerve allows it to glide

- Fascicular composition of nerve protects it from compressive forces

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33
Q

Intraneural restriction responds to:

A

Tensor movements

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34
Q

Extraneural restriction responds to:

A

Slider movements

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35
Q

Testing precautions

A
  • active infection/inflammation in/ around joint
  • pt taking pain meds who may not be able to respond appropriately
  • osteoporosis or condition of bone fragility
  • hypermobile joints
  • painful conditions if techniques make symptoms worse
  • hemophilia
  • hematoma
  • boney ankylosis
  • myositis occificans
  • immediately after soft tissue lesion
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36
Q

Creep stretching

A

lengthening of tissue over time after the application of a constant load

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37
Q

Stress relaxation stretching

A

when a tissue is stretched to a specific length the force needed to maintain the length decreases over time

38
Q

Stretching- hysteresis

A
  • when force and length are measured as forced is applied and removed from a tissue the load deformation curve does not follow the same path
  • energy gained during lengthening (W=fxd) is not recovered 100% during shortening, some energy given off as heat
39
Q

to avoid injury total length change should not exceed:

A

2% to 6%

40
Q

Transverse friction massage (TFM)

A
  • STM

- mechanically teases apart adhesions

41
Q

Strain- counter strain (SCS)

A
  • STM

- de-activates muscle spindle thus muscle tension

42
Q

Myofascial release: functional release (FRT)

A
  • STM
  • apply direct pressure to muscle to deactiveate muscle spindle
  • uses functional movement pattern (FMP)
43
Q

Myofascial realease: fixed technique (MFR)

A
  • STM

- apply low load static stress to muscle/fascia unit to activate GTO to release muscle tension

44
Q

Augmentented STM

A
  • STM
  • uses a tool to identify restrictions and reduce tone
  • stimulates ruffini endings to decrease sympathetic activity
45
Q

Spray and stretch

A
  • STM

- deactivates muscle spindle and thus muscle tension

46
Q

Passive stretching

A

Low load, prolonged force

  • dense CT: >5mins
  • muscle/tendon- 30/60sec
47
Q

PNF stetching

A
  • inhibit contraction of muscle to be stretched while you facilitate contraction of the antagonist
  • contract relax
  • contract relax, antagonist contraction
48
Q

Motion

A
  • can inhibit contracture formation
  • disrupt adhesions between gross structures
  • limit intermolecular cross links
  • stretches tissues
  • promotes lubrication of tissue
49
Q

CPM- if AROM is contraindicated

A

Accelerate healing, improve orientation of collagen fibers, inhibit edema formation

50
Q

Surgery indications for motion restrictions

A
  • Mechanical block
  • increase tendon length reduced due to hypertonicity
  • Dupuytren’s contracture
51
Q

Role of phys agents: increase soft tissue extensibility

A
  • Thermotherapy: increase tissue temp to decrease viscoelasticity of tissue allowing plastic deformation to occur
  • stretching window after application 3-4 mins
52
Q

Role of phys agents: control edema and adhesion formation

A
  • Cryotherapy: limits secondary injury
  • E stim: control edema via muscle pumping
  • controlling edema formation during acute inflammatory stage limits immobilization
  • controling severity and duration of inflammation limits proliferation stage and adhesion formation
53
Q

Role of phys agents: control pain during stretching

A

Thermotherapy, cryotherapy, electrical currents

  • control pain
  • allow longer stretching
  • allow motion to begin sooner
54
Q

Role of phys agents: facilitate motion

A 
Electrical stimulation
- motor nerves-AC current
- muscle directly- DC current
water
- provides bouyancy to allow motion against gravity
55
Q

Muscle tone

A
  • Muscle tension at rest
  • readiness to move or hold a position
  • priming or tuning of a muscle
  • the degree of activation before a movement
  • def: passive resistance to the stretch of muscle
56
Q

Active muscle tone

A

Resistance generated through the activation of muscle fibers by their neural connections

57
Q

Passive muscle tone

A

biomechanical tension generated in the muscle and its CT at the length at which it is being tested

58
Q

Ex muscle tone

A

Quads in runner at starting blocks

  • active: neural input prepares the muscle by helping take up the slack
  • passive: quads are being stretched over bent knee
  • to assess tone muscle must be voluntarily quiet
59
Q

Flaccidity

A

total lack of tone or no resistance to passive stretch

60
Q

hypotonicity

A

decreased resistance to stretch

61
Q

hypertonicity

A

increased resistance to stretch

  • spastic: velocity dependent (quick stretch)
  • rigid: resistance to stretch not dependent on velocity of stretch
62
Q

Clonus

A

multiple rhythmic oscillations or beats in the resistance of a muscle responding to a quick stretch

63
Q

muscle spasm

A

involuntary contraction of a muscle usually associated with a painful state

64
Q

Dyskinesia

A

abnormal movement that is involuntary and has no purpose

65
Q

Measuring muscle tone: quantitative

A
  • hand held dynomometer
  • EMG: electrical activity generated when a muscle is stretched passively
  • pendulum test: usues electrogoniometer or isokinetic dynamometer
66
Q

Measuring muscle tone: Qualitative

A
  • 5 point ordinal scale
  • 0- no tone
  • 1+- hypotonia
  • 2+ normal tone
  • 3+ mod hypertonia
  • 4+ severe hypertonia
  • clinician passively moves muscle at varying speeds
67
Q

Muscle is composed of

A
  • Contractile elements
  • cellular elements
  • Connective tissue
  • Tendons
  • Calcium released from storage in SR allow actin and myosin to bind together
  • ATP provides energy source for muscle contraction
68
Q

Length tension relationship

A
  • length too long

- length too short

69
Q

Friction

A

between CT covering muscle fibers

- effected by viscosity of tissue and fluids in which they reside

70
Q

Elasticity

A

Results in varying responses to stretch

71
Q

Muscle tone can be generated by ____ elements alone

A

Passive

72
Q

Muscle activation

A

requires both active and passive elements

73
Q

Physical agents can change muscle tone and activation by

A
  • Altering accessibility of ATP through improved circulation
  • Changing elasticity of tissues
  • Changing viscosity thereby friction of tissues
74
Q

Alpha motor neuron

A
  • Cell body in anterior gray matter or anterior horn of spinal cord
  • transmits signals from CNS to muscle
  • Travels through ventral root
  • will innervate between 6 (eye muscles) and 2000 (calf) muscle fibers
  • one axon and its branches and all the muscle fibers it innervates compromise one motor unit
75
Q

Peripheral nervous system

A
  • Alpha motor neurons
  • gamma motor neurons
  • some autonomic system neurons
  • all sensory neurons
  • sensory neurons can stimulate alpha motor neurons in the spinal cord directly so they can respond rapidly to activation (reflex)
76
Q

Muscle spindle

A
  • sense organ in muscle lying parallel to muscle fibers
  • muscle stretch produces muscle spindle stretch
  • receptors at equatorial region of spindle sense stretch and activate type 1a sensory neurons that synapse on alpha motor neuron in spinal cord
77
Q

Techniques to use spindle activation to effect tone

A
  • Tapping
  • quick stretch
  • high-frequency vibration
78
Q

antagonist muscle

A
  • Type 1a sensory neurons also transmit signals to alpha motor neuron of antagonist muscle
  • provides inhibitory input (reciprocal inhibition)
  • muscle spindles register lengthening of muscle only if they are taught
  • because muscle fibers change length as muscle contracts, spindle must be reset
79
Q

Gamma motor neurons

A
  • innervate muscle spindles at their end regions
  • when stimulated cause spindle to tighten equatorial region
  • this sensitizes muscle spindle length
  • Alpha and gamma stimulation at the same time during voluntary movement is called alpha-gamma coactivation
  • gamma activation can occur alone
  • prepares the muscle spindle to sense expected changes in length
80
Q

Golgi tendon organs

A
  • sensory organ located at muscle tendon junction
  • function in series with muscle fibers
  • sense muscle stretch
  • protective mechanism for muscle
  • sensitive to activation of as few as one or two motor units that are in series with spindle
  • transmit signals via type 1b sensory neurons to alpha motor neuron pool
  • inhibitory to agonist (autogenic inhibition) and excitatory to antagonist muscle
  • prolonged stretch used to inhibit abnormally high tone
81
Q

cutaneous receptors

A
  • temp, pressure, touch, pain, texture
  • cutaneous reflex responses are complex but act to activate or inhibit a muscle
  • any phys agent that touches the skin can stimulate a cutaneous reflex response
82
Q

Central nervous system input

A
  • cerebellum
  • basal ganglia
  • motor cortex
  • limbic system
83
Q

Low tone

A

loss of normal alpha motor neuron input to normal muscle

84
Q

high tone

A
  • may result from peripheral stimulation due to pain, cold, or stress (muscle guarding)
  • generally the result of loss of inhibitory control centers in the CNS
85
Q

Consequences of abnormally low muscle tone

A

Difficulty developing adequate force for normal posture and movement

  • motor dysfunctions
  • secondary problems resulting from lack of movement
    • pressure sores
    • cardiorespiratory endurance problems
86
Q

Consequences of abnormally low muscle tone: poor posture

A 
Ligaments must perform work of muscles (static stabilizers)
- eventual stretching of ligaments
- slackening of joints
-pain
Appearance changes (cosmetically)
- slumped posture
- drooping facial muscles
Pain
87
Q

Treatment for low muscle tone

A
  • hydrotherapy
  • quick ice
  • estim
  • biofeedback
  • light touch
  • tapping
  • resistive exercises
  • ROM exercises
  • functional training
  • orthotics
88
Q

Consequences of abnormally high muscle tone

A
  • discomfort or pain from muscle spasm
  • contractures
  • abnormal posture
  • skin breakdown
  • increased effort by caregivers
  • development of specific movement patterns that may inhibit development of movement alternatives
  • may or may not inhibit function
89
Q

Treatment for high muscle tone associated with pain, cold, or stress

A 
Remove source
- eliminate pain
-warm pt
- alleviate stress
relaxation techniques
emg biofeedback
neutral warmth 
heat 
hydrotherapy
cold towels
stimulation of antagonists
- resisted exercises
- electrical stimulation
90
Q

Treatment for high muscle tone associated with spinal cord injury

A
  • selective ROM exercises
  • prolonged stretching
  • positioning
  • orthotics
  • meds
  • surgery
  • heat
  • prolonged ice
91
Q

Treatment for high muscle tone associated with cerebral lesions

A
  • Prolonged ice
  • inhibitory pressure
  • prolonged stretch
  • inhibitory casting
  • positioning
  • reeducation of voluntary movements
  • STM to contralateral muscle
  • general relaxation techniques
    • soft lighting/music
    • slow rocking
    • neutral warmth
    • slow stroking
    • hydrotherapy
    • rotation of the trunk
    • maintained touch
92
Q

Treatment of high muscle tone associated with rigidity

A
  • Positioning
  • ROM exercises
  • orthotics
  • serial casting following head injury
  • heat
  • meds
  • general relaxation techniques
  • STM to contralateral muscle

Physical Agents (21 decks)

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