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PT755 > Muscle Overactivity > Flashcards

Muscle Overactivity Flashcards

1
Q

What is muscle tone

A

Muscles resistance to being passively lengthened that is not influenced by pain or orthopedic condition
At rest!

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2
Q

Tone spectrum (scale)

A

Flaccid - hypotonic - normal - hypertonic - ridgid

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3
Q

Upper motor neuron excessive signs (positive)

A

Hyper reflexia
Clounus
Spasticity
Spasms
Co-contractions
Associated reactions

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4
Q

Upper motor neuron insufficient signs (negative)

A

Weakness
Impaired motor planning
Impaired motor control
Fatigue

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5
Q

What is spasticity

A

Increase in muscle tone due to hyper excitability of the stretch reflex
Velocity dependent!

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6
Q

Why is muscle overactivity a problem

A

Muscle shortening
Atrophy
Decreased extensibility
Increased muscle sensitivity
Decreased ability to isolate muscle contraction
Increased co-contraction

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7
Q

Decorticate

A

both UEs in flexion, LE in extension

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8
Q

Decerebrate

A

Upper and lower in extension
(E’s in the word = ext)

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9
Q

Assessment components

A

Posture at rest
PROM with varying speeds
Active movements
Standardized assessment tool (modified ashworth)

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10
Q

Modified Ashworth scale

A

0 - normal, no increase in muscle tone
1 - slight increase at the end of the ROM
1+ - Slight increase w/ less than half the ROM
2 - more marked increase throughout most of the ROM
3 - Considerable increased in tone, PROM difficult
4 - affected part rigid in flex or ext

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11
Q

Tardieu scale

A

Mostly used in research
Three velocities that are standardized

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12
Q

What can impact muscle over activation

A

Fatigue
Pain
May only occur in certain postures/positions
Underlying medical condition may produce changes

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13
Q

UE fixed posture implications

A

Decreased hygiene
Wounds from fingernails
Decreased ADL’s
Decreased balance reactions
Decreased use of assistive devices

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14
Q

LE fixed posture implications

A

Decreased positioning in WC
Abnormal pressure spots
Decreased mobility for transfers and ambulation
Decreased balance in sitting and standing

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15
Q

What can poor positioning lead to

A

Contractures
Skin breakdowns
Changes in muscle composition

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16
Q

Treatment considerations

A

Time of injury, severity, and nature of deformity
Cognitive status
Risks/benefits
Effect on functional status
Concurrent impairments

17
Q

Heterotopic Ossification

A

Abnormal formation of new bone around joints
Commonly forms in one well-defined plane
Prevalence: 10-20%
Often occurs in areas with spastic muscles

18
Q

Diagnosising HO

A

Physical exam
Elevated SAP
X-rays
CT scan

19
Q

Treating HO

A

PT: increase/maintain ROM
Medications: Didronel, indocin
Manipulation
Surgical incision: ~12-18 months after injury
Radiation

20
Q

Active goals

A

Improve:
AROM, mobility, ADL’s and QOL

21
Q

Passive goals

A

Decrease:
Pain and spasms

Improve:
PROM, positioning and ease of care

22
Q

Treatment options

A

Weight bearing
Heat/Ice
Stretching/splinting
Functional Estim
TEN
Strengthening and neuromuscular reeducation
Serial casting

23
Q

Weight bearing

A

Provides long duration stretch
Places muscles in anti reflex positions making it less likely to cause spasms

24
Q

Stretching/Splinting

A

Maintain joint ROM
Increase ROM
Joint protection in a functional position
Rate of stretch is slow to prevent activation of reflex arc

25
Q

Serial casting

A

Used in conjunction with nerve/motor blocks
Changed every 2-4 days

26
Q

Indications for serial casting

A

Decreased ROM
Muscle overactivity/spasticity
Unstable weight bearing

27
Q

Contraindications of serial casting

A

HO (Acute phase)
DVT
Acute fractures
Major open wounds
Sensory defects
Interferes with obtaining vital signs or administering medication

28
Q

Medical treatments

A

Oral medications
Nerve/motor point blocks
ITB (intrathecal baclofen therapy)
Surgery

29
Q

Oral medications

A

Works best for generalized spasticity

30
Q

Nerve/motor block

A

Works best for peripheral spasticity

Short acting:
Onset: 3-15min
Duration: hours
Can also diagnosis which muscle is spastic

Long acting:
Onset: 24-72 hours
Duration: 3-6 months

31
Q

Intrathecal Baclofen Therapy

A

Used for diffuse spasticity when oral medications are not effective
Pump placed surgical in abdomen - medication directly delivered to CSF

32
Q

Neurosurgery

A

Selective peripheral neurotomy: lesion 50-80% of nerve

Selective dorsal rhizotomy: lesion nerve root (most common)

33
Q

Orthopedic surgery

A

Tendon lengthening
Tendon transfer
Osteotomy: cutting or repositioning a bone

34
Q

Deep brain stimulation

A

Used as an alternate intervention when others have been exhausted

PT755 (11 decks)

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