Neural System 3: Spasticity Flashcards
What is spasticity?
caused by a lesion on the spine or brain which leads to reduced neural innervation and increased tone
Spasticity is synonymous with _________
hypertonicity
What is muscle tone?
continuous tension in muscle
- normal tone enables motor function
- low tone = flaccid
- high tone = excessive muscle tension
spasticity is ___________ resistance to ________ stretch
velocity-dependent
passive
What scale measures spasticity?
Ashworth Scale (0-4)
Hypertonicity can lead to impairment with:
- ROM
- coordination
- skin hygiene
- pain
- functional mobility
- ADLs
What are muscle spasms?
increased muscle tension following musculoskeletal injury and inflammation
no damage to brain or spinal cord
What overall drug class is used to treat spasticity and muscle spasms?
Muscle Relaxants
and
Antispasticity meds
Drug list for treating muscle spasms and spasticity
- Tizanadine
- Cyclobenzaprine (Flexaril)
- Diazepam (Valium)
- Botox (botulinum toxin)
- Baclofen (Lioresal)
- ITB pump (intrathecal baclofen)
What type of drug is tizandine?
alpha-2 agonist
MOA of tizanadine
bind to alpha-2 receptors to decrease excitatory NTs which decrease excitability to post synaptic neurons
tizanadine instructions for use
2-3x/day
PO at night
must tritate to find correct dosage
tizanadine AEs
- drowsiness
- dizziness
- asthenia
- sedation (within 30 min, peaks 1.5 hrs after dose)
- hypotension (within 1 hr, peaks 2-3 hrs after dose)
what type of drug is cyclobenzaprine (Flexaril ) and diazepam (Valium)?
Centrally acting antispasmodic
MOA of centrally acting antispasmodics
Unknown
might inhibit polysnaptic reflex in spinal cord
possible GABA and serotonin effects
instructions for use of cyclobenzaprine (Flexaril)
onset: 1 hr
peak: 3-8 hrs
duration: 12-24 hr
AEs of cyclobenzaprine (Flexaril)
- sedation
- dizziness
- **on the Beers list
Note on Benzodiazepines (aka Valium)
Schedule IV drug
Sedation and respiratory depression when used with opiods
how does botox work?
works at the neuromuscular junction to block the release of ACh
T/F: botox has decreased efficacy with longterm use
TRUE
instructions for Botox use
onset: 1-3 days
duration 3-6 months
Botox (botulinum toxin) AEs
Boxed warnings!
may spread to distal tissues causing issues = distant paralysis
what type of drug is Baclofen (Lioresal)?
Ethyl Alcohol and Phenol Direct Acting Agent
Baclofen MOA
inhibits excitatory neurons = decreased NT release and K+ influx to increase inhibition
Use of Baclofen (Lioresal)
PO
intrathecal pump (ITB)
baclofen (Lioresal) AEs
- CNS depression
- muscle weakness
- memory and cognitive impairments in adults with TBI
why would someone use an ITB?
better results with less AEs
generally need smaller doses
PT notes for post-implantation of ITB?
- assess changes in motor skills due to muscle tone changes
- equipment modifications
- no modalities near pump site
- refill is needed every 3 months
- battery must be replaced every 4-5 years
Complications of an ITB pump
- infection
- dislodgement
- kinking and blocking
- failure
- observe for signs of withdrawl or overdose
Boxed warnings for ITB
abruptly stopping meds can cause:
- fever
- altered mental status (AMS)
- exaggerated rebound spasticity/rigidity
- in extreme cases
- rhabdomyolysis
- organ failure
Therapeutic concerns for pts on muscle relaxants and antispastic meds
- sedation and weakness are biggest AEs
- can result in limited participation in PT
- requires intensive PT to develop new motor patterns and functional abilities
- must assess equipment
- be aware of ITB pump malfunctions
