ms 5 - neuro

Question 1

muscle ton

Answer 1

Basic/resting muscle tone = seen and felt as the resistance to passive movment when child is at rest – ALERT, AWAKE AND NOT MOVING
Active/dynamic = “” when the child is engaging in quiet activity

Question 2

Neuro abnormal =

Answer 2

hypo. (NO res. At rest or PROM), hyper (incrs. )resistance at both PROM and rest), contracture, rigidity (persistant tightness) – cogwheel, clasp knife, rigid (slow giving), fluctuating/altering resistance with mvmts, spasticity (release at EOR, velocity dependant), resistance altered with head movement (may indicate prolonged ATNR, STN, TLR patterning)

Question 3

AX for RESTING MUSCLE TONE

Answer 3

. 1. Resistant to passive stretch = do bilaterally to check diff then unilaterally to confim findfings
Additional information: It can be helpful to (i) assess response to ‘flapping’ or gentle loose shaking of the limb or (ii) perform a leg drop test
2. Scarf sign and popliteal angle tests
3. Limb recoil – extent LL onto bed then let go > should recoil into some Flx. Abnormal = no recoil or exaggerated response – do bilaterally

Question 4

Ax for ACTIVE MT

Answer 4

= 1. Resistance to PM when active – same as above however child engaging in quiet activity (playing with something in hands) but The therapist must stabilise the proximal joint to ensure the child’s posture/balance is not disrupted.

2. response to gravity – pull to sit: pull behind scapulae > child should recrit neck flexors and hold up against gravity. Pause momentarily at position where the infants head should move up, if moves appropriately continue into sit, if not discontinue – DON’T WANT HEAD LAG
3. RESPONSE TO GRAVITY – PRONE SUSPENSION: baby is supported, but the arms and legs are free to move. Normal = recruitment of extensor muscles of the neck, trunk and shoulder and hip girdles so that the head and limbs are raised past the neutral position of the body (‘skydive’ position). Posture feels STRONG and flFLEXIBLEexible, NOT STIFF

Question 5

RESPONSE TO GRAVITY – PRONE SUSPENSION:

abnorm

Answer 5

• Hypotonia (low tone) – minimal or no extension against gravity. Child feels ‘floppy’ like a ‘jellyfish’. (see picture)
• Flexor Hypertonia – if the child has strong flexor tone and/or a persistent TLR, they may remain rigidly in flexion, or pull into flexion
• Extensor Hypertonia -­‐ if the child has strong extensor tone, they may arch up into extension. They feel stiff like a ‘starfish’.

Question 6

Spasticity

Answer 6

= velocity-dependant increase in tonic stretch reflex

• Clasp knife, cog wheel, rigid (slow-giving), fluctuating or variable
• PROP INPUT = stretching muscle through PROM stims. Muscle spindle
• Afferent > SC> abnormal processing > inc. excitability of efferent response > increase tone in muscle
• Not length and velocity
• Length of muscle influences spasticity as stretch increases excitability of spasticity

Question 7

Reflexes = GO FROM INNER > OUTER RANGE at speeds V1, V2, V3

Answer 7

Record range at where muscle reaction first felt
If increase tone = assess influence of different positions eg prone, side lye, supported sitting.
Rate from 0(no reflex, 1 = only visible contracture, 2= contracture with small catch, 3= contract < few seconds / clonus fatigable, 4 = contract > few secs/infatiguable clonus

Question 8

Deep tendon reflexes

Answer 8

= muscle spindle stim > aff. Info to sc > synapse with a motor neuron (monosynaptic) > contraction of agonist + interneuron for inhibition of antagonist

• Prop, pain, tactile can stimulate reflexes
• Reflexes: do 3 – 6 times, compare sides
• Patella = relaxed quads on mild stretch * DON’T SUPPORT UNDER HAMMIES IN BABIES
• Achilles – don’t touch sole of foot, calf mild stretch, IF VERY BRISK CHECK FOR CLONUS
• Biceps

Question 9

Clonus =

Answer 9

Clonus is when a DTR keeps firing and is an abnormal response in children >6m.
- Proprioceptive stretch reflex > No reflex inhibition of UMN tract (reticulobulbar) > hyperactive phasic stretch reflex
Ax = supine, knee on therapist knee. Knee and ankle relaxed, give tap to under ball of foot + maintain light pressure. Count the number of rhythmic beats of clonus that occur (persistent >6beats, fatigueable <6beats, no clonus). In infants <6m a few beats of clonus (<8) can be normal. However, sustained, easily elicited or persistent clonus is usually associated with increased muscle tone.