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spasticity Flashcards

1
Q

definition: motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome

A

spasticity

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2
Q

spasticity is the increase in muscle response to ____ stretch, in a velocity-dependent manner.

A

phasic stretch

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3
Q

definition: exaggeration of the tonic component of the stretch reflex

A

intrinsic tonic spasticity

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4
Q

definition: : exaggeration of the phasic/quick component of the stretch reflex

A

intrinsic phasic spasticity

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5
Q

What does intrinsic tonic spasticity manifest as?

A

increased tone

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6
Q

What does intrinsic phasic spasticity manifest as?

A

hyerreflexia and clonus

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7
Q

What type of intrinsic spasticity responds as long as the stimulus is maintained?

A

intrinsic tonic spasticity

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8
Q

Which type of intrinsic spasticity responds to a quick stretch?

A

intrinsic phasic spasticity

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9
Q

(true/false) Spasticity will have both intrinsic phasic and tonic spasticity

A

true (tonic resistance to stretch + hyperreflexia)

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10
Q

definition: Adaptive changes within a muscle in response to changes in neuromuscular activity level and to prolonged positioning

A

myoplasticity

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11
Q

(spasticity/myoplasticity) Which one is commonly seen with neurogenic atrophy and contractures?

A

myoplasticity

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12
Q

Spasticity is commonly seen in disorders with (LMN/UMN) involvement.

A

UMN lesions

  • Stroke, MS, TBI, SCI, anoxia, neurodegenerative disease
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13
Q

Spasticity is a (delayed/immediate) consequence with over -activity of a muscle.

A

delayed

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14
Q

(true/false) you should assume that weakness and paralysis of the CNS system will stay that way

A

FALSE (can cause contractures –> increases spasticity)

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15
Q

Dysfunction of the _____ tract will provoke immediately a paralysis that will leave muscles immobilized, some of them in a shortened position. This will be chronologically the first factor of muscle shortening (contractures).

A

corticospinal tract

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16
Q

(true/false) The pathophysiology of spasticity is unknown

A

true

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17
Q

What are negative signs of UMN syndrome?

A

Fatigue
Impaired coordination
impaired motor control
impaired motor planning
muscle weakness

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18
Q

What are the positive signs of UMN syndrome?

A

Hyperkinetic movements
clonus
dystonia
rigidity
spasticity

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19
Q

definition: an ongoing random-appearing sequence of one or more discrete involuntary movements or movement fragments.

A

chorea

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20
Q

definition: a slow, continuous, involuntary writhing movement that prevents maintenance of a stable posture.

A

athetosis

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21
Q

definition: is a sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction or relaxation of one or more muscles.

A

myoclonus

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22
Q

definition: a rhythmic back-and-forth or oscillating involuntary movement about a joint axis.

A

tremor

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23
Q

definition: repeated, individually recognizable, intermittent movements or movement fragments that are almost always briefly suppressible and are usually associated with awareness of an urge to perform the movement.

A

tics

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24
Q

definition: repetitive, simple movements that can be voluntarily suppressed.

A

stereotypies

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25
Q

definition: Refers to a movement disorder in which “involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures or both.”

A

dystonia

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26
Q

(true/false) those with dystonia will not be able to ambulate and/or perform functional activities.

A

FALSE (some have volitional control)

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27
Q

Rigidity is commonly seen in those with ___.

A

PD

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28
Q

Spasticity occurs with (slower/faster) speeds and is velocity-dependent.

A

faster

29
Q

(true/false) Rigidity is velocity-dependent.

A

false

30
Q

Rigidity (does/does not) depend on imposed speed and (does/does not) exhibit a speed or angle threshold.

A

does not (x2)

31
Q

With rigidity, the limb (does/does not) commonly return to a particular fixed position or extreme joint angle.

A

does not

32
Q

(true/false) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen.

A

true

33
Q

definition: muscle contraction present at rest, influenced by tonic stretch

A

spastic dystonia

34
Q

definition: abnormal antagonist contraction present during voluntary agonist effort, dependent on tonic stretch on antagonist

A

spastic co-contraction

35
Q

definition: abnormal contraction distant from the muscles involved in a voluntary effort

A

extra-segmental co-contraction

36
Q

What is a significant source of disability that is commonly associated with spasticity?

A

Motor weakness

37
Q

(true/false) Spasticity results in limited functional capacity and increased inactivity.

A

true

38
Q

how long do neurolysis nerve blocks last when treating spasticity?

A

3-6 months

39
Q

How long does botulinum neurotoxin (NMJ blocker) last when treating spasticity?

A

3 months

40
Q

What are nerve blocks used for?

A

focal origin spasticity

41
Q

Chemodenervation injectable interrupts neuronal signals and is achieved with with the use of botox which inhibits ________ release.

A

acetylcholine

42
Q

What does neurolysis do when treating spasticity?

A

Causes nonselective tissue destruction in the injected area, including coagulation of nerves and muscle necrosis

43
Q

When is neurolysis used with spasticity?

A

When treating spasticity with large muscles

44
Q

What is the treatment of spasticity in children with CP?

A

Selective dorsal rhizotomy

45
Q

definition: Electrophysiologic guidance used to identify abnormal sensory nerve rootlets, which are then sectioned, leaving the motor nerves intact

A

selective dorsal rhizotomy

46
Q

What makes a candidate for selective dorsal rhizotomy?

A
  • good strength and balance
  • spasticity in either or both legs with minimal or no fixed contractures
  • no spasticity in the arms
  • strong motivation and support
47
Q

(true/false) duration of spasticity does not impact treatment goals and interventions

A

false

48
Q

What can increase spasticity?

A

Injury (decubitus, fractures)
Infections
Distended bowel or bladder
Noxious stimuli
Postural orientation

49
Q

What can be the only means of monitoring patient tolerance to medication when treating spasticity?

A

cardiovascular and pulmonary system

50
Q

(true/false) Poor positioning as a result of UMN lesion may impact pulmonary function

A

true

51
Q

What are measures of passive activity?

A

ashworth scale
modified ashworth scale (MAS)
Tardieu Scale

52
Q

Why is the tardieu scale preferred when measuring spasticity?

A

It addresses velocity unlike the MAS and it can be more effective in cases where contracture is present

–> includes velocity of stretch and angle of muscle reaction

53
Q

What measure of voluntary activity is sensitive enough to detect change in individuals with MS?

A

Box and Block test

54
Q

What allows the detection of muscle function patterns not detectable with isolated muscle testing and or passive resistance to motion measurements?

A

gait

55
Q

what type of scale is not optimal for functional measures?

A

visual analog scale (line scale)

56
Q

What functional measure assesses the difficulty in performing hygiene before and after intervention?

A

Likert scale

57
Q

(true/false) DRS is sensitive to changes in spasticity intervention

A

FALSE (it is not)

58
Q

What global functioning measure assesses functional independence in mobility and personal care?

A

Barthel Index

59
Q

What type of measures are less sensitive to subtle changes?

A

Functional measures

60
Q

What measures are primary areas of concern?

A

QoL and function

61
Q

What are frequently used in bed to assist with developing knee flexion contractures?

A

knee immobilizers

62
Q

What can be used initially to prevent a contracture and/or prevent contracture after ROM has been maintained?

A

Bivalves

63
Q

What is a great option for treatment when preventing and maintaining ROM?

A

splints

64
Q

(true/false) positioning can be a result of spasticity.

A

true

65
Q

Why is prone lying a good position when working on muscle length?

A
  • facilitates head control
  • promotes UE WB
  • good position to stretch ankle PF and maintain the stretch for a longer period of time while maintaining knee EXT
66
Q

What are the contraindications for casting?

A

Unhealed fractures
Acute phase of HO
Deep vein thrombosis (DVT)
Cast interferes with ability to monitor vital signs or administer drugs
Patient medically unstable

67
Q

Evidence only supports casting when improving ONLY ___.

A

PROM

68
Q

(true/false) Evidence shows that spastic muscles may also be weak muscles

A

true

69
Q

What type of training can improve weak, spastic muscles?

A

isokinetic strengthening

Neuro (45 decks)

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