SCI 7 - Tone Management Flashcards
is tone conscious
no
does tone define ms power and strength
no - can mask strength
is ms tone present all the time
yes - resting tone
how can tone impact functional mobility
inc tone –> help w balance and transfers
impact stability –> feed on floor allows stability in sitting
how are corticospinal tracts impacted in a SCI
impaired in incomplete
absent in complete
does the reflex arc below NLI remain intact
yes - there doesn’t have to be mediation from brain, reflex is separate from the brain
what impact does a SCI have on reflex arc
reflex arc firing w/o modification from higher centers in cortex
–> results in spasticity (spastic hypertonia)
where and what input does reflex arc receive
from ms spindle & GTOs
enhanced excitatory synaptic input
what are disadvantages to spastic hypertonia
dec ROM
inc pain
unwanted bowel/bladder release
dec postural control
dec skin integrity
inc healthcare costs
dec ability to perform ADLs, functional mobility, and leisure activities
what are advantages to spastic hypertonia
maintain ms tone & mass
dec bone loss
inc metabolic requirements
inc bowel/bladder function
inc ability perform ADLs
inc detection of impairments
how could spastic hypertonia inc detection of impairments in body systems
autonomic dysreflexia can notify someone they have UTI or skin breakdown
how can spastic hypertonia dec risk of osteoporosis
ms contraction creates tendon pull on bone
how can spastic hypertonia dec skin integrity
drive bony prominences into surfaces
what are exacerbating factors for tone
infections
pressure sores
DVT
temp
fatigue
positioning
bladder distention
bowel impaction
what are 4 medical management options for spastic hypertonia
pharmacological mgmt
motor point block injections
surgical procedures
intrathecal pump (ie baclofen)
when are surgical procedures seen to manage spastic hypertonia
last resort
- nothing else has worked
what is a consideration with the use of baclofen to manage spastic hypertonia
systemic
- too much = hypotonic
- have to balance how much
what is a good PT strategy if a pt starts experiencing clonus
approximation or tendon pressure can stop the beating
what are 7 PT interventions/strategies to managing spastic hypertonicity
stretching/PROM
wt bearing / approximation
modalities (heat, ice, estim)
paraffin
serial casting / splinting
positioning
apply tendon pressure
what are 5 principles of compensatory strategies
head hips relationship
momentum
ms substitution
task modification
work in and out of task
what is the head hips relationship
head opposite to direction you want to move so hips can move over
head opposite way offloads hips to move them over
what is an example of ms substitution in someone w no triceps
closed chain ant delt and ERs
how does ms substitution work
use of neuroplasticity teaching ms how to work differently than before
