spasticity Flashcards
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
spasticity
spasticity is the increase in muscle response to ____ stretch, in a velocity-dependent manner.
phasic stretch
definition: exaggeration of the tonic component of the stretch reflex
intrinsic tonic spasticity
definition: : exaggeration of the phasic/quick component of the stretch reflex
intrinsic phasic spasticity
What does intrinsic tonic spasticity manifest as?
increased tone
What does intrinsic phasic spasticity manifest as?
hyerreflexia and clonus
What type of intrinsic spasticity responds as long as the stimulus is maintained?
intrinsic tonic spasticity
Which type of intrinsic spasticity responds to a quick stretch?
intrinsic phasic spasticity
(true/false) Spasticity will have both intrinsic phasic and tonic spasticity
true (tonic resistance to stretch + hyperreflexia)
definition: Adaptive changes within a muscle in response to changes in neuromuscular activity level and to prolonged positioning
myoplasticity
(spasticity/myoplasticity) Which one is commonly seen with neurogenic atrophy and contractures?
myoplasticity
Spasticity is commonly seen in disorders with (LMN/UMN) involvement.
UMN lesions
- Stroke, MS, TBI, SCI, anoxia, neurodegenerative disease
Spasticity is a (delayed/immediate) consequence with over -activity of a muscle.
delayed
(true/false) you should assume that weakness and paralysis of the CNS system will stay that way
FALSE (can cause contractures –> increases spasticity)
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).
corticospinal tract
(true/false) The pathophysiology of spasticity is unknown
true
What are negative signs of UMN syndrome?
Fatigue
Impaired coordination
impaired motor control
impaired motor planning
muscle weakness
What are the positive signs of UMN syndrome?
Hyperkinetic movements
clonus
dystonia
rigidity
spasticity
definition: an ongoing random-appearing sequence of one or more discrete involuntary movements or movement fragments.
chorea
definition: a slow, continuous, involuntary writhing movement that prevents maintenance of a stable posture.
athetosis
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.
myoclonus
definition: a rhythmic back-and-forth or oscillating involuntary movement about a joint axis.
tremor
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.
tics
definition: repetitive, simple movements that can be voluntarily suppressed.
stereotypies
definition: Refers to a movement disorder in which “involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures or both.”
dystonia
(true/false) those with dystonia will not be able to ambulate and/or perform functional activities.
FALSE (some have volitional control)
Rigidity is commonly seen in those with ___.
PD
Spasticity occurs with (slower/faster) speeds and is velocity-dependent.
faster
(true/false) Rigidity is velocity-dependent.
false
Rigidity (does/does not) depend on imposed speed and (does/does not) exhibit a speed or angle threshold.
does not (x2)
With rigidity, the limb (does/does not) commonly return to a particular fixed position or extreme joint angle.
does not
(true/false) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen.
true
definition: muscle contraction present at rest, influenced by tonic stretch
spastic dystonia
definition: abnormal antagonist contraction present during voluntary agonist effort, dependent on tonic stretch on antagonist
spastic co-contraction
definition: abnormal contraction distant from the muscles involved in a voluntary effort
extra-segmental co-contraction
What is a significant source of disability that is commonly associated with spasticity?
Motor weakness
(true/false) Spasticity results in limited functional capacity and increased inactivity.
true
how long do neurolysis nerve blocks last when treating spasticity?
3-6 months
How long does botulinum neurotoxin (NMJ blocker) last when treating spasticity?
3 months
What are nerve blocks used for?
focal origin spasticity
Chemodenervation injectable interrupts neuronal signals and is achieved with with the use of botox which inhibits ________ release.
acetylcholine
What does neurolysis do when treating spasticity?
Causes nonselective tissue destruction in the injected area, including coagulation of nerves and muscle necrosis
When is neurolysis used with spasticity?
When treating spasticity with large muscles
What is the treatment of spasticity in children with CP?
Selective dorsal rhizotomy
definition: Electrophysiologic guidance used to identify abnormal sensory nerve rootlets, which are then sectioned, leaving the motor nerves intact
selective dorsal rhizotomy
What makes a candidate for selective dorsal rhizotomy?
- 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
(true/false) duration of spasticity does not impact treatment goals and interventions
false
What can increase spasticity?
Injury (decubitus, fractures)
Infections
Distended bowel or bladder
Noxious stimuli
Postural orientation
What can be the only means of monitoring patient tolerance to medication when treating spasticity?
cardiovascular and pulmonary system
(true/false) Poor positioning as a result of UMN lesion may impact pulmonary function
true
What are measures of passive activity?
ashworth scale
modified ashworth scale (MAS)
Tardieu Scale
Why is the tardieu scale preferred when measuring spasticity?
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
What measure of voluntary activity is sensitive enough to detect change in individuals with MS?
Box and Block test
What allows the detection of muscle function patterns not detectable with isolated muscle testing and or passive resistance to motion measurements?
gait
what type of scale is not optimal for functional measures?
visual analog scale (line scale)
What functional measure assesses the difficulty in performing hygiene before and after intervention?
Likert scale
(true/false) DRS is sensitive to changes in spasticity intervention
FALSE (it is not)
What global functioning measure assesses functional independence in mobility and personal care?
Barthel Index
What type of measures are less sensitive to subtle changes?
Functional measures
What measures are primary areas of concern?
QoL and function
What are frequently used in bed to assist with developing knee flexion contractures?
knee immobilizers
What can be used initially to prevent a contracture and/or prevent contracture after ROM has been maintained?
Bivalves
What is a great option for treatment when preventing and maintaining ROM?
splints
(true/false) positioning can be a result of spasticity.
true
Why is prone lying a good position when working on muscle length?
- 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
What are the contraindications for casting?
Unhealed fractures
Acute phase of HO
Deep vein thrombosis (DVT)
Cast interferes with ability to monitor vital signs or administer drugs
Patient medically unstable
Evidence only supports casting when improving ONLY ___.
PROM
(true/false) Evidence shows that spastic muscles may also be weak muscles
true
What type of training can improve weak, spastic muscles?
isokinetic strengthening
