Muscle Tone Assessment Flashcards
What does hypotonicity look like
- Lack of resistance to passive movement
- Decreased strength/poor mm def
- Decreased activity tolerance
- Decreased motor skill development
- Rounded shoulder posture with tendency to lean
- Hypermobile joints
- Increased muscle flexibility
- Poor attention and motivation
How do you examine hypotonicity
- Observation
- Palpation — soft pliable mms, excessive ROM
What is hypertonia
Abnormally increased resistance to externally imported movement about a joint
What are the subgroups of hypertonia
Spasticity
Dystonia
Rigidity
What are hyperkinetic movements
Any unwanted excess in movement
Typical with BG lesions
Pathophys of spasticity
No more inhibition of muscle tone bc RST is inhibited
Too much VST excitation of tone
= increased LE tone
What are some clinical measure to measure hypertonicity
Observation
Hypertonia assessment tool (HAT)
Modified ASH
Modified Tardieu Scale
Describe the Hypertonia Assessment Tool (HAT)
7 item tool used to differentiate the different forms of hypertonicity in children 4-19 years old
SCORING — presence of at least 1 HAT item in a subgroup of hypertonicity indicates the presence of that subtype
What is a position that you put children in before assessing tone with the HAT?
Supine, hooklying, pillow for head and roll under knees, hands gently on tummy
What muscles should really be considered when assessing tone?
Biarticular muscles
What is the Modified ASH
Clinical measure used to assess passive joint movement throughout ROM but not a true measure of spasticity because does not discriminate between dynamic and passive components of spasticity
Modified ASH scoring?
0 = no increase in muscle tone
1 = slight increase in muscle tone manifested by catch and release at end of ROM
1+ = slight increase in muscle tone (catch) followed by minimal resistance through the remaining 1/2 of ROM
2 = more marked increase in muscle tone through most of the ROM but the joint is still easily moved
3 = considerable increase in muscle tone and passive movement is difficult
4 = affected part is rigid in flexion or extension
What is the modified Tardieu scale?
Scale that assesses PROM at different speeds to determine dynamic tone
1. Measure end point ROM to slow velocity ROM after 3 reps = R2
2. Measure the angle where you feel catch on 3rd trial of high velocity = R1
How do you score on Modified Tardieu
R2-R1 = dynamic component of spasticity
Also want to quantify the quality of muscle reaction
0 = no resistance through passive movement t
1 = slight resistance through passive movement
2 = clear catch at precise angle followed by release
3 = fatigable clonus <10 seconds at precise angle
4 = unfatigable clonus >10 seconds at precise angle
