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Year 2: Neuromuscular > Test 3: Spasticity > Flashcards

Test 3: Spasticity Flashcards

1
Q

what is muscle tone

A

resistance of muscle to passive stretch/elongation

amount of tension at rest

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2
Q

normal muscle tone

A

high enough to counter gravity but low enough to allow freedom of movement

balanced/isolated for smooth/coordinated movement

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3
Q

signs of UMN lesion

A

hypertonicity
clonus
babinski
abnormal synergy

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4
Q

LMN syndrome signs

A

peripheral nerves

reduced or absent reflexes

neurogenic atrophy, not disuse

hypotonia/flaccidity

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5
Q

describe hypotonia

A

decreased/absent tone

diminished/absent stretch reflex

neurogenic muscle atrophy

finding with LMN

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6
Q

how might acute UMN lesions present

A

can initially produce hypotonia due to spinal or cerebral shock

after shock period is over, UMN show UMN signs and development of spasticity

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7
Q

characteristics of hypertonia

A

increased tone

resistance to passive movement NOT dependent on velocity

can be with or without spasticity

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8
Q

what falls into the category of hypertonia

A

spasticity
rigidity
dystonia
decorticate and decerebrate rigidity

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9
Q

what is spasticity

A

increased, involuntary, VELOCITY DEPENDENT muscle tone

resistance to passive and active movement

faster the passive movement, the stronger the resistance

can occur as primary condition (i.e. degenerative) or secondary to stroke, TBI, SCI, inflammatory conditions like MS, etc

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10
Q

spasticity originates from injury to what

A

descending motor pathways (pyramidal tracts)

brain stem (medial/lateral vestibulospinal tracts, dorsal reticulosponal tract

results in lack of inhibition of spinal reflexes causing them to be hyperexcitable

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11
Q

can spastic muscle be manual muscle tested

A

no

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12
Q

describe the synergy patterns associated with synergy

A

appears when spasticity is present

primitive movements that dominate reflexes and voluntary effory

interferes with coordinated voluntary movements and functional tasks

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13
Q

Flexor synergy pattern of UE

A

scapular retraction and elevation

shoulder abduction and ER

elbow flexion

forearm supination

wrist and finger flexion

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14
Q

LE flexor synergy pattern

A

hip flexion, abduction, and ER

knee flexion

ankle DF and inversion

toe DF

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15
Q

UE extensor synergy pattern

A

scapular protraction

shoulder adduction and IR

elbow ext

forearm pronation

wrist and finger flexion

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16
Q

LE extensor synergy pattern

A

hip extension, adduction, and IR

knee extension

ankle PF and inversion

toe PF

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17
Q

dystonia is commonly seen from

A

lesion to basal ganglia

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18
Q

characteristics of dystonia

A

involuntary and sustained muscle contractions

can be twisting, writhing, and repetitive movements

cocontraction of agonist and antagonist

increased tone

can affect only 1 body part (focal dystonia) or multiple (segmental)

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19
Q

diseases that result in dystonia

A

primary idiopathic dystonia (hereditary)

wilson’s disease

parkinson’s disease with long term L-dopa therapy

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20
Q

what is dyskinesia

A

general term used for describing abnormal involuntary writhing movements of a body part including face, UEs, and LEs

can be smooth fluid involuntary writhing movements or rapid jerky type

can present like tics

can be a side effect of meds

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21
Q

common types of dyskinesia

A

athetosis
chorea
dystonia
parkinson’s disease
tardive dyskinesia
myoclonus

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22
Q

describe athetosis

A

most common with cerebral palsy

due to damage to basal ganglia

involuntary writhing slow/continuous

more twisting observed

affects face, mouth, trunk, and limbs

less jerky than chorea

can let go of hand after grabbing

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23
Q

describe dystonia

A

involuntary and sustained muscle contractions

can be twisting/writhing/repetitive

involves cocontraction of agonist and antagonist

cant let go of hand of they grab it

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24
Q

describe chorea

A

involuntary, rapid, abrupt twisting

writhing movements that may appear to jump form one extremity to another

25
Q

characteristics of rigidity

A

stiffness

resistacne to movement that is independent of velocity of movement

associated with lesions of basal ganglia

seen in parkinsons

result of excessive supraspinal drive on alpha motor neurons; not related to spinal reflex mechanisms

26
Q

leadpipe rigidity

A

constant increase in muscle tone and stiffness of affected muscles

27
Q

cogwheel rigidity

A

rigidity with tremor resulting in rachet like jerkiness when the extremity is moved

seen in UE at elbow and wrist

28
Q

what is decorticate rigidity

A

severe injury to cortex (higher corticospinal tract lesion)

UEs posture into shoulder IR/add, elbow flex, wrist flex, and fisted hands

LEs extended with severe PF contractures

long term impact = severe ROM contractures

29
Q

what is decerenrate rigidity

A

indicates injury at brain stem with poor outcomes

UEs posture in shoulder IR with full ext at elbow, flexion at wrist and fisted hand

LEs posture in ext with severe PF contracture

30
Q

what is opisthotonos

A

strong sustained muscle contraction of extensors of neck and trunk

rigid, hyperextended posture

31
Q

describe the re-emergence of primitive reflexes

A

often reemerge in neuro insult/disease

primitive reflexes fire rostrally to drive development of cortex

as cortex matures sufficiently it fires back to inhibit prim. reflexes

insult ot brain causes cortex to fail allowing these reflexes to reemerge

always want to check for them!

32
Q

what is ANTR

A

asymmetric tonic neck reflex
- extension of UE and LE on the side the head rotates to

  • flexion of UE and LE opposite of the side the head is turned to
33
Q

assessment for ANTR

A

severe brain injury clients have high tone everywhere

ANTR may not be obvious visually

palpate for change in mm tone with head RT to identify the reflex

34
Q

Intervention for ANTR

A

head position matters and is critical to reduce muscle tone that results from this reflex

35
Q

what is SNTR

A

symmetric tonic neck reflex

neck ext = UE ext and LE flex

neck flex = UE flex and LE ext

36
Q

assessment of STNR

A

move head into flexion and then to extension while palpate for change in muscle tone at elbow

37
Q

intervention of STNR

A

head position to neutral which may require good posture control and positioning of trunk and pelvis

38
Q

what is tonic labyrinthine

A

linked to vestibular system development and important precursor to development of posture reflexes

2 components:
- FWD TLR
- BWD TLR

assess how use of tilt-n-space influences this reflex

i.e. like babies; lay down supine and they extend, flex one part and they flex everything/curl into a ball

39
Q

bermuda triangle of spasticity

A

posturing/rigidity

TLR

STNR

40
Q

passive motion testing to examine muscle tone

A

ask pt to relax

move extremity in all directions

repeat specific motions with increased velocity

**the first quick motion/stretch will cause highest level of spasticity so pay attention

clonus = quick stretch; + spasmodic contraction of agonist; describe beats and if sustained

41
Q

0 on MAS

A

no increase in tonw

42
Q

1 on MAS

A

slight increase in tone

with catch and release or minimal resistance at end of ROM when affected part moving in flexion/ext

43
Q

1+ on MAS

A

slight increase in muscle tone, manifested as a catch

followed by minimal resistance through remainder (less than half) of ROM

44
Q

2 on MAS

A

marked increase in muscle tone throughout most ROM but affected parts still easily moved

45
Q

3 on MAS

A

considerable increase in tone

passive movement difficult

46
Q

4 on MAS

A

affected parts rigid in flexion or extension

47
Q

what to document with tone abnormalities

A

what segment involved

what type of abnormal mm tone is present

spasticity? which mm groups and MAS score

asymmetric or symmetric?

how is segment postured?

obligatory synergy pattern present with active movement?

what is the impact of abnormal tone on movement/posture/function

48
Q

outcomes of unmanaged spasticity

A

contractires

spinal deviation/scoliosis

wounds

inability to access active movement

49
Q

possible effects of structural spinal deformity

A

impacts organ systems

impairs breathing

increases skin breakdown risk

50
Q

wounds possible from PF/supinated feet

A

heel ulcers

5th Met head ulcers

lateral malleolus ulcers

51
Q

flexion of toes may result in what ulcer

A

PIP ulcer

52
Q

postural deviations/scoliosis may result in ulcers where

A

IT ulcers

GT ulcers

53
Q

PT interventions for abnormal tone

A

Wbing
prolonged stretch
static splint
synamic splint
serial casting
modalities
positioning

54
Q

benefits pf proper positioning

A

manages primitive reflexes
manage deviations
LE extensor tone and magic hip angle
reduce destructive hip position

55
Q

goal for dynamic splinting

A

low load prolonged stretch

goal is to increase time in splint and tolerance for increasing resistance for gaining ROM

56
Q

modalities for abnormal tone

A

goal = change motor neuron excitability

cryotherapy
heat*
US*
NMES
dry needling
etc

57
Q

what might you work on for spasticity management for a complex client

A

manage primitive reflexes

manage psoture deviations

LE extensor tone and magic hip angle

reduce destructive hip position

12-24 hour posture management

58
Q

what is magic hip flexion angle

A

reduces extensor tone

flex both hips together to find this angle

needed in WC seating intervention

59
Q
A

Year 2: Neuromuscular (20 decks)

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