spasticity Flashcards
what is spasticity?
velocity dependent resistance to passive stretch
-overactive neural inputs to mm causes excessive mm contraction
what is mm tone?
resistance to stretch in resting
hypotonia or flaccidity or hypertonia or spasticity/rigidity
penn spasm scale is a
self report measure
0 No spasms
1 No spontaneous spasms (except with vigorous motor stimulation)
2 Occasional spontaneous spasms and easily induced spasms
3 More than 1 but less than 10 spontaneous spasms per hour
4 More than 10 spontaneous spasms per hour
what are other measures of spasticity?
Timed 10 rapid alternating movements
Time required to walk a specified distance or perform a specific task
H-reflex
EMG (level of muscle activity only)
Placing (NDT - see lab notes)
medical management of spasticity: botox
botulinum toxin A
neuroparalytic toxin made by clostridium botulinum bacteria that BLOCKS ACH RELEASE at neuromm junction, autonomic ganglia, postganglionic parasympathetic and sympathetic nerve endings
slow twitch recover faster than fast twitch
botox is injected where?
what is the dose?
directly into mm belly,
does depends on body weight, mm size, activity level, and spasticity level.
when does botox start being effective
24-72 hours with peak effects at 4-5 days, lasts 8-12 weeks
start casting 2-4 days after injections
reduces spasticity
baclofen is administered
orally and intrathecally
-inhibits reflexes at spinal cord level: GABA agonist
baclofen pump adverse effects
risk of pump malfunction or tip displacement not delivering into subarachnoid space
overdose pump malfunction signs
sedation, respiratory depression, decreased cardiac function, hypotonia, muscle weakness, confusion or disorientation, nausea/vomiting and coma
What is Heterotopic Ossification?
abnormal formation of bone in extraskeletal soft tissue where bone does not usually exist/should not be.
Most often in soft tissues surrounding joints (peri-articular)
neurogenic HO
patients with traumatic CNS injuries: TBI, SCI
