Neurological physiotherapy soft tissue stretching Flashcards
basic principles for the management of abnormal tone (high tone)
to maintain soft tissue length, to maintain joint alignment, to prevent muscle shortening//lig/ capsule, to regain muscle length/ alignment
treatment options
passive and active stretching- PNF, passive movement, positioning, massage- including soft tissue mobilisation, medication, heat therapy, hydrotherapy
what is stretching
the process of elongating tissues muscles and other tissues
stretching
prevention of MSK injuries, used prior to vigorous exercise to minimise post exercise muscle soreness, ROM is limited due to soft tissue restrictions, muscle weakness and shortening of opposing tissues
however some studies show these may be inconclusive
spasticity in neurological patients
17-43% of people post stroke, 41-66% with MS and 13% with TBI, after a stroke 5% of patients affected within 10 days, 80% children with cerebral palsy, 67% SCI
what does an effective stretch need- elasticity
ability of soft tissue to return to its pre stretch resting length directly after a stretch ahs been removed
what does an effective stretch need- plasticity
need plastic changes not elastic changes- long term effect rather than short term
plasticity- tendency of the muscle to assume a greater length after the stretch has been removed
what does an effective stretch need- microfracture of collagen fibres
stimulation of GTO: tension passes certain length and muscles relaxes; autogenic inhibition
what does an effective stretch need- time
in order to reach plastic changes there needs to be hours of stretching- achieved through passive methods such as positioning and splinting- not always comfortable
what does an effective stretch need- force and speed
force- large enough to produce plastic changes- splint produces good force for long periods of time
speed- slow to prevent the muscle spindle reflex response
mechanical effects of stretch on connective tissue
increase load for a certain amount of time- if load is insignificant or not held for long enough- wont get plasticity
contradictions- block, fracture, inflammatory
bony block, recent fracture- healing process, acute inflammatory process (heat/swelling)
contradictions-acute pain, hypermobility, shortened soft tissue
acute pain- stretching pain in normal (ache), hypermobility- shouldn’t be be stretching them especially past normal range, shortening soft tissues enable a patient with paralysis to perform specific functional skills otherwise not possible
examples of soft tissues allowing patient to perform specific function
high SCI- tightness in finger flexors- use as functional grip- use wrist extension and tightness in finger flexors- don’t want to lose functional ability
patients with MS- develop high tone in adductors- bilateral- use high tone to walk with due to lack of movement in other muscles- provide stability
precautions stretching
do not passively force a joint beyond its normal ROM, suspected osteoporosis, newly united fractures, oedematous tissue- sensitive and fragile skin, if patient experiences pain lasting more than 24 hours- too much force has been used causing an inflammatory response
short term effect of stretching
helps produce more biomechanically normal movement, routinely in preparation for movement neuro therapists will stretch tight muscles prior to functional movement, allow patients to learn how to move more effectively
upper and lower limb stretching
LL- gastroc and soleus, quads, hip flexors and adductors- retrain brain how to walk- neuroplasticity
UL- wrist and finger flexors, elbow flexors, pect major, upper traps
influencing muscle tone- environment and therapist approach
high tone- environment- quite/warm/ relaxing, therapist approach- gentle, quite, calming
low tone- environment- stimulating cool, therapist approach- fun, loud, firm
influencing muscle tone- base of support, COG, therapeutic handling
BOS- high tone- large, COG- low, therapeutic handling- firm, slow, calming
low tone- BOS- Small, COG- high, therapeutic handling- brisk, stimulating
influencing muscle tone- support, speed of movement, reinforcement
high tone- supports lots, speed of movement- slow, reinforcement- firm but clam
low tone- support- minimal, speed of movement- fast, reinforcement- over the top
psychosocial issues
motivation, depression, anxiety, if they are given loads of stretches to do for long periods of time= negative effect
what is PNF
proprioceptive neuromuscular facilitation, is a method used by physiotherapists to promote or hasten the response of the neuromuscular mechanism through stimulation of the proprioceptors
what do you need to do to make PNF effective
the strength of PNF to stimulate correct output relies on correct sensory input from therapist
PNF procedures
resistance, reinforcement, body position and body mechanics, vision, stretch, overflow, manual contact, verbal commands, traction or approximation, timing
stretching techniques
contract/ relax, contract/relax/contract, reciprocal inhibition
