Spasticity

Question 1

What is Spasticity?

Answer 1

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

Question 2

Cause(s) of Spasticity =

Answer 2

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

Question 3

Symptoms of Spasticity =

Answer 3

Hypertonicity
Clonus
Exaggerated DTRs
Muscle spasms

Secondary:
> Scissoring (involuntary crossing of the legs)
> contractures

Question 4

The amount of tension in resting muscle:
Contributing factors =

Answer 4

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

Question 5

Stretch following immobility =

Answer 5

feel increased resistance

Question 6

Stretch following a prolonged contraction =

Answer 6

feel increased resistance

Question 7

Slow, gentle stretch =

Answer 7

gentle detachment

Question 8

Fast stretch =

Answer 8

remain attached contributing to increased stiffness

Question 9

Titin =

Answer 9

Elastic properties provide mobility AND resistance

Question 10

Joint resistance to movement =

Answer 10

elastic + contractile muscle forces

Question 11

Cocontraction =

Answer 11

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

Question 12

Muscle Synergies =

Answer 12

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)

Question 13

Pathologic synergies
Example: Patient post TBI or CVA

Answer 13

UMN lesion

Voluntary flexion of shoulder is accompanied by unwanted, simultaneous, obligatory flexion of the elbow

Question 14

Associated Reactions =

Answer 14

Spontaneous movement = Involuntary movement when something else happens (yawn, strain, etc.)

Question 15

Hypertonia =

Answer 15

Abnormal resistance to passive stretch

Occurs in UMN and some basal ganglia lesions

2 Types

Question 16

2 types of hypertonia =

Answer 16

Spasticity
Rigidity

Question 17

Spasticity =

Answer 17

velocity dependent hypertonia

CVA or TBI (cerebrum injury)

May present with clasp-knife response

Question 18

Rigidity =

Answer 18

constant resistance/velocity independent hypertonia

Decerebrate and decorticate rigidity

Cogwheel or lead-pipe rigidity in basal ganglia lesion

Question 19

Hyperreflexia =

Answer 19

Exaggerated DTRs

Abnormal cutaneous reflexes

Question 20

Babinski Sign in Adults =

Answer 20

normal response (-)

abnormal response (+)
> normal in infants <7 months

Question 21

Clonus =

Answer 21

Involuntary, repeating, and rhythmic muscle contractions

Question 22

Unsustained clonus =

Answer 22

fades after a few beats, even with maintained muscle stretch

Question 23

Sustained clonus =

Answer 23

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

Question 24

Clinical Assessment of Spasticity =

Answer 24

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

Question 25

Modified Tardieu Spasticity Scale - 0

Answer 25

no resistance throughout the course of passive movement

Question 26

Modified Tardieu Spasticity Scale - 1

Answer 26

slight resistance throughout the course of passive movement, with no clear catch at precise angle

Question 27

Modified Tardieu Spasticity Scale - 2

Answer 27

clear catch at precise angle, interrupting the passive movement, followed by release

Question 28

Modified Tardieu Spasticity Scale - 3

Answer 28

Fatigable clonus (<10 seconds when maintaining pressure) occurring at precise angle

Question 29

Modified Tardieu Spasticity Scale - 4

Answer 29

Infatigable clonus (>10 seconds when maintaining pressure) occurring at precise angle

Question 30

Modified Ashworth Scale - 0

Answer 30

no increase in muscle tone

Question 31

Modified Ashworth Scale - 1

Answer 31

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

Question 32

Modified Ashworth Scale - 1+

Answer 32

slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

Question 33

Modified Ashworth Scale - 2

Answer 33

more marked increase in muscle tone through most of the ROM, but affected part(s) easily moved

Question 34

Modified Ashworth Scale - 3

Answer 34

considerable increase in muscle tone, passive movement difficult

Question 35

Modified Ashworth Scale - 4

Answer 35

affected part(s) rigid in flexion or extension

Question 36

Modified Modified Ashworth Scale - 0

Answer 36

No increase in muscle tone

Question 37

Modified Modified Ashworth Scale

Answer 37

doesn’t have a 1+