Spasticity Flashcards
What is Spasticity?
Condition in which there is abnormal increase in muscle tone or stiffness of muscle
might interfere with movement, speech, or be associated with discomfort or pain
Velocity dependent
Cause(s) of Spasticity =
Usually damage to UMN pathways within the brain, brainstem, or spinal cord
Associated with SCI, MS, CP, CVA, TBI, ALS, hereditary spastic paraplegias, and some metabolic disorders
Symptoms of Spasticity =
Hypertonicity
Clonus
Exaggerated DTRs
Muscle spasms
Secondary:
> Scissoring (involuntary crossing of the legs)
> contractures
The amount of tension in resting muscle:
Contributing factors =
Assessed by PROM and normally minimal
Intrinsic and passive stiffness of the muscle provide normal muscle resting tone
Descending motor commands
Level of background excitability in spinal cord
Proprioceptive information
At rest, there are weak bonds between actin and myosin (without power stroke) - Immobility facilitates these bonds
Stretch following immobility =
feel increased resistance
Stretch following a prolonged contraction =
feel increased resistance
Slow, gentle stretch =
gentle detachment
Fast stretch =
remain attached contributing to increased stiffness
Titin =
Elastic properties provide mobility AND resistance
Joint resistance to movement =
elastic + contractile muscle forces
Cocontraction =
Simultaneous contraction of agonist and antagonist muscles
Frequently used for functional stability
> Wrist for distal movement
> LEs for standing
> Commonly see with new motor learning
Muscle Synergies =
Coordinated muscular action
> Normal function
Type II afferents (muscle spindles, joint receptors, cutaneous and subcutaneous touch and pressure)
Interneurons connect to motor neurons for muscles at other joints for spinal cord regulated coordinated function (frequently used patterns)
Pathologic synergies
Example: Patient post TBI or CVA
UMN lesion
Voluntary flexion of shoulder is accompanied by unwanted, simultaneous, obligatory flexion of the elbow
Associated Reactions =
Spontaneous movement = Involuntary movement when something else happens (yawn, strain, etc.)
Hypertonia =
Abnormal resistance to passive stretch
Occurs in UMN and some basal ganglia lesions
2 Types
2 types of hypertonia =
Spasticity
Rigidity
Spasticity =
velocity dependent hypertonia
CVA or TBI (cerebrum injury)
May present with clasp-knife response
Rigidity =
constant resistance/velocity independent hypertonia
Decerebrate and decorticate rigidity
Cogwheel or lead-pipe rigidity in basal ganglia lesion
Hyperreflexia =
Exaggerated DTRs
Abnormal cutaneous reflexes
Babinski Sign in Adults =
normal response (-)
abnormal response (+)
> normal in infants <7 months
Clonus =
Involuntary, repeating, and rhythmic muscle contractions
Unsustained clonus =
fades after a few beats, even with maintained muscle stretch
Sustained clonus =
is always pathologic in origin and is produced when a lack of UMN modulation allows the activation of oscillating neural networks in the spinal cord
In people with chronic SCI or other MT lesions, sustained clonus of the soleus muscle may be triggered by placement of a foot on a wheelchair footrest
Clinical Assessment of Spasticity =
Observation for posturing at rest
Resistance to PROM
Passive drop into gravity
Voluntary activation followed by passive drop into gravity
Easy movement
> ? Associated reaction
Challenging movement
> ? Associated reaction
Observation for impact on function
Modified Tardieu Spasticity Scale - 0
no resistance throughout the course of passive movement
Modified Tardieu Spasticity Scale - 1
slight resistance throughout the course of passive movement, with no clear catch at precise angle
Modified Tardieu Spasticity Scale - 2
clear catch at precise angle, interrupting the passive movement, followed by release
Modified Tardieu Spasticity Scale - 3
Fatigable clonus (<10 seconds when maintaining pressure) occurring at precise angle
Modified Tardieu Spasticity Scale - 4
Infatigable clonus (>10 seconds when maintaining pressure) occurring at precise angle
Modified Ashworth Scale - 0
no increase in muscle tone
Modified Ashworth Scale - 1
slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension
Modified Ashworth Scale - 1+
slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
Modified Ashworth Scale - 2
more marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
Modified Ashworth Scale - 3
considerable increase in muscle tone, passive movement difficult
Modified Ashworth Scale - 4
affected part(s) rigid in flexion or extension
Modified Modified Ashworth Scale - 0
No increase in muscle tone
Modified Modified Ashworth Scale
doesn’t have a 1+
