TI For Alteration In Muscle Tone (2) Flashcards
How can you measure flaccidity/hypotonia?
PROM with palpation for contraction (move slowly first then quickly)
What are the scales used to measure spasticity?
Modified ashworth scale (0=normal)
Tardieu scale (R1 and R2)
What is R1 in the tardieu scale?
First catch in motion
What is R2 in the tardieu scale?
Max range after catch occurs
What does it mean in the tardieu scale if there is a large difference between R1 and R2?
More severe spasticity
What does it mean in the tardieu scale if there is a small difference between R1 and R2?
More MSK tightness
What are the affects of flaccidity/hypotonia on body structure?
Over stretching
Loss of muscle bulk
Loss of ROM
What are the effects of flaccidity/hypotonia on function?
Can’t move correctly (development of compensations)
What are the safety issues of flaccidity/hypotonia?
MSK damage
Swallowing and respiration
Pain
Balance and falls
What is important in interventions for flaccidity/hypotonia?
Maintain mobility (ROM/flexibility)
What do flaccidity/hypotonia interventions begin with?
Stability
Why do you want to use compensatory strategies with flaccidity/hypotonia?
Minimize risk of injury or secondary impairment
What are the interventions for applied functional activity for flaccidity/hypotonia in the UEs?
Estim or orthotic device that can increase functional movement of hand/wrist
What are the interventions for applied functional activity for flaccidity/hypotonia in the LEs?
Estim device that substitute for weak DF in swing
What are the positive effects of hypertonia on body structures?
Helps maintain muscle bulk, skin integrity, bone density, and BP
What are the negative effects of hypertonia on body structures?
Decreased ROM/contracture
Muscle weakness
Pain
Greater energy expenditure
Impaired coordination and balance
What are the positive effects of hypertonia on function?
May assist with sit to stand
What are the negative effects of hypertonia on function?
Limits isolated movements so functional tasks often require compensations to complete
What are safety issues in hypertonia?
Increased risk of fall and skin breakdown due to contracture
What are interventions for hypertonia?
Sustained positioning and PROM
Handling and physical inhibition
Equipment
How is sustained positioning achieved in hypertonia?
Splinting or serial casting
What is the handling intervention used for hypertonia?
NDT
What type of muscle is a spastic muscle?
Weak muscle
What muscles may also grow weak due to hypertonia?
Muscles that oppose spastic muscles
How do you want to strengthen muscles with hypertonia?
Isometric (first)
Eccentric (second)
Concentric (third)
Does strengthening increase spasticity?
No
What are the interventions applied to functional activities in hypertonia?
Aquatic therapy
Quadruped
Rolling
Weight bearing
Why is aquatic therapy used in hypertonia?
Buoyancy increases ease of movement (warm temp can be inhibitory to spasticity)
Why is quadruped used in hypertonia?
Weight bearing position with fewer degrees of freedom
Why is rolling used in hypertonia?
With rhythmic initiation and rhythmic rotation
Why is weight bearing activities used in hypertonia?
To achieve good alignment
What is the oral med used for muscle tone issues?
Baclofen
What are side effects of baclofen?
Drowsiness
Dizziness
Weakness
What are the pros of baclofen?
Non invasive and non permanent
What are the cons of baclofen?
Not continuous problem solving, must take on a schedule, sedation, and danger with withdrawal
What is chemical neurolysis?
Alcohol applied to nerve via injection with EMG guidance (lasts 6 months)
What does chemical neurolysis cause?
Demyelination of axons
What is a neuromuscular blockade?
Neurotoxin injected into muscle, binds to Presynaptic cholinergic nerve terminal and blocks release of AcH (Botox)
What are the pros of chemical neurolysis?
Better effect on larger muscles and is cheap
What are the cons of chemical neurolysis?
Difficult procedure
Risk of sensory complications
Muscle can become fibrotic with repeated injections
What are the pros of neuromuscular blockade?
Less painful, easier to perform, no sensory side effects, not permanent
What are the cons of neuromuscular blockade?
Another injection every 3 months, expensive, and can develop antibodies
What is intrathecal baclofen?
Baclofen diffused into CSF in intrathecal space
What does intrathecal baclofen inhibit?
Both mono and polysynaptic reflexes
What are the pros of intrathecal baclofen?
Reversible
Fewer side effects
Improved function
What are the cons of intrathecal baclofen?
Mechanical complications
Refills every 3 months
Expensive
What are the types of orthopedic surgeries done for problems with muscle tone?
Lengthening
Tendon transfer
Releases
What is selective dorsal rhizotomy?
Selective destruction of problematic nerve roots (most common in children)
How does oral and intrathecal baclofen affect spasticity?
Reversible and globally
How does neuromuscular blockade affect spasticity?
Reversible and focal
How does selective dorsal rhizotomy affect spasticity?
Permanent and globally
How does surgery affect spasticity?
Permanent and focal
What is key in interventions when it comes to alterations in muscle tone?
Maintaining mobility and creating stability
