Neurological physiotherapy soft tissue stretching

Question 1

basic principles for the management of abnormal tone (high tone)

Answer 1

to maintain soft tissue length, to maintain joint alignment, to prevent muscle shortening//lig/ capsule, to regain muscle length/ alignment

Question 2

treatment options

Answer 2

passive and active stretching- PNF, passive movement, positioning, massage- including soft tissue mobilisation, medication, heat therapy, hydrotherapy

Question 3

what is stretching

Answer 3

the process of elongating tissues muscles and other tissues

Question 4

stretching

Answer 4

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

Question 5

spasticity in neurological patients

Answer 5

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

Question 6

what does an effective stretch need- elasticity

Answer 6

ability of soft tissue to return to its pre stretch resting length directly after a stretch ahs been removed

Question 7

what does an effective stretch need- plasticity

Answer 7

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

Question 8

what does an effective stretch need- microfracture of collagen fibres

Answer 8

stimulation of GTO: tension passes certain length and muscles relaxes; autogenic inhibition

Question 9

what does an effective stretch need- time

Answer 9

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

Question 10

what does an effective stretch need- force and speed

Answer 10

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

Question 11

mechanical effects of stretch on connective tissue

Answer 11

increase load for a certain amount of time- if load is insignificant or not held for long enough- wont get plasticity

Question 12

contradictions- block, fracture, inflammatory

Answer 12

bony block, recent fracture- healing process, acute inflammatory process (heat/swelling)

Question 13

contradictions-acute pain, hypermobility, shortened soft tissue

Answer 13

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

Question 14

examples of soft tissues allowing patient to perform specific function

Answer 14

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

Question 15

precautions stretching

Answer 15

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

Question 16

short term effect of stretching

Answer 16

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

Question 17

upper and lower limb stretching

Answer 17

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

Question 18

influencing muscle tone- environment and therapist approach

Answer 18

high tone- environment- quite/warm/ relaxing, therapist approach- gentle, quite, calming
low tone- environment- stimulating cool, therapist approach- fun, loud, firm

Question 19

influencing muscle tone- base of support, COG, therapeutic handling

Answer 19

BOS- high tone- large, COG- low, therapeutic handling- firm, slow, calming
low tone- BOS- Small, COG- high, therapeutic handling- brisk, stimulating

Question 20

influencing muscle tone- support, speed of movement, reinforcement

Answer 20

high tone- supports lots, speed of movement- slow, reinforcement- firm but clam
low tone- support- minimal, speed of movement- fast, reinforcement- over the top

Question 21

psychosocial issues

Answer 21

motivation, depression, anxiety, if they are given loads of stretches to do for long periods of time= negative effect

Question 22

what is PNF

Answer 22

proprioceptive neuromuscular facilitation, is a method used by physiotherapists to promote or hasten the response of the neuromuscular mechanism through stimulation of the proprioceptors

Question 23

what do you need to do to make PNF effective

Answer 23

the strength of PNF to stimulate correct output relies on correct sensory input from therapist

Question 24

PNF procedures

Answer 24

resistance, reinforcement, body position and body mechanics, vision, stretch, overflow, manual contact, verbal commands, traction or approximation, timing

Question 25

stretching techniques

Answer 25

contract/ relax, contract/relax/contract, reciprocal inhibition