spasticity Flashcards by Colleen Caribardi

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

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

phasic stretch

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definition: exaggeration of the tonic component of the stretch reflex

intrinsic tonic spasticity

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

intrinsic phasic spasticity

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What does intrinsic tonic spasticity manifest as?

increased tone

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What does intrinsic phasic spasticity manifest as?

hyerreflexia and clonus

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

intrinsic tonic spasticity

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Which type of intrinsic spasticity responds to a quick stretch?

intrinsic phasic spasticity

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

true (tonic resistance to stretch + hyperreflexia)

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

myoplasticity

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

myoplasticity

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

UMN lesions

Stroke, MS, TBI, SCI, anoxia, neurodegenerative disease

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

delayed

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

FALSE (can cause contractures –> increases spasticity)

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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

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(true/false) The pathophysiology of spasticity is unknown

true

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What are negative signs of UMN syndrome?

Fatigue
Impaired coordination
impaired motor control
impaired motor planning
muscle weakness

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What are the positive signs of UMN syndrome?

Hyperkinetic movements
clonus
dystonia
rigidity
spasticity

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

chorea

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

athetosis

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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

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

tremor

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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

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

stereotypies

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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 ___.

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