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Neurology I > tone > Flashcards

tone Flashcards

1
Q

what is tone?

A

the resistance offered by muscles to continuous passive stretch

(resistance encountered when a joint of a relaxed person is moved passively)

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2
Q

what are examples of non-neural factors contributing to tone?

A

-passive stiffness of a joint & surrounding tissue
-compliance of muscles, ligs and joints
-age
-exercise state
-limb temperature

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3
Q

what are examples of neural factors that can affect tone?

A

-can vary with age, emotional state
-output of alpha motor neuron
-active tension set up by stretch reflex

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4
Q

what are examples of peripheral and central systems that contribute to tone?

A

-muscle spindles (part of stretch reflex)
-golgi tendon organ
-somatosensory receptors
-sensory systems - visual, auditory, vestibular
-limbic system
-motor systems

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5
Q

what is the stretch reflex?

A

the body’s involuntary response to an external stimulus that stretches the muscles

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6
Q

what is the function of muscle spindles?

A

provide info regarding muscle length and rate of change of length

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7
Q

what is a stretch reflex a direct result of?

A

stimulation of the muscle spindle (stretch receptor)

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8
Q

what is the sequence of events in a stretch reflex once a muscle spindle is activated?

A
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9
Q

what are the steps of stretch reflex in simple terms

A

-stretching of muscle stimulates muscle spindles
-activation of sensory neuron
-info processing of motor neuron
-activation of motor neuron
-contraction of muscle

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10
Q

where are the gamma motor neurons located in the muscle spindle?

A

the intra-fugal fibres

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11
Q

what is the basic function of the muscle spindle?

A

helps to maintain muscle tone

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12
Q

what can abnormal PROM of joint be due to?

A

-joint stiffness
-reduced muscle/ tendon length
-tone
-patient activity

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13
Q

what is high tone and low tone called?

A

-hyperTonia , spasticity, rigidity
-hypotonia, flaccidity

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14
Q

what is spasticity?

A

-velocity dependent increase in resistance to passive stretch of a muscle with exaggerated tendon reflexes

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15
Q

why does spasticity happen?

A

-abnormal enhancement of spinal stretch reflex - due to increased muscle spindle sensitivity, loss of inhibition of stretch reflex
-central - loss of cortical inhibition, imbalance in descending pathways
-peripheral - altered biomechanics properties of muscles

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16
Q

what causes a spasticity?

A

-upper motor neuron lesion (from motor cortex to spinal motor neuron)
-stroke
-spinal cord compression
-brain damage
-MS

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17
Q

describe the clinical features of spasticity

A

-increased responsiveness of muscles to stretch- hyper-reflexia
-clasp knife(catch) followed by melting away of resistance
-clonus (rhythmic contractions) usually of ankle or foot
-associated reactions - unwanted movement which is brought on by increased tone eg yawning and arm goes up

18
Q

recap - what are the common patterns of spasticity in the upper limbs?

A

-adducted / internally rotated shoulder
-flexed wrist
-pronated forearm
-flexed elbow
-thumb in palm deformity

19
Q

what are common patterns of spasticity in the lower limbs?

A

-striatal toe
-stiff knee
-flexed knee
-adducted thighs
equinovarus

20
Q

what are factors that influence spasticity?

A

-positioning
-stress
-fatigue
-full bladder
-pain
-infection
-fear
-pressure sore
-constipation

21
Q

how do you assess abnormal tone?

A

-ash worth scale or tardieu
-movement grading - severe, moderate, mild
-tendon jerks - +/ ++
-others such as EMG

22
Q

how do we manage spasticity?

A

-relieve symptoms
-handling / positioning
-standing frames
-avoid noxious stimuli
-splinting
-slow passive movements
-medication

23
Q

list some examples of medication used to treat spasticity

A

-baclofen (lioresal) - GABA deriative
-diazepam (valium). - GABA
-botulium toxin (dysport) injected into muscle - blocks ACH release
-tizanidine (zanaflex) - short acting muscle relaxer

24
Q

how does spasticity affect the patient?

A

-weakness
-decreased movement
-abnormal movement
-poor posture
-pain
-contractures
-loss of function and adaptive

25
Q

in terms of spasticity, what are the aims of physiotherapy?

A

-normalise the tone
-maintain normal muscle length
-improve ROM
-decrease pain
-improve function
-reduce complications

26
Q

describe the physio management of spasticity ?

A

-positioning of limb - to reduce abnormal reflex activity - NB sitting out
-passive movement SLOW of affected limb
-ice
-weight bearing
-splinting
-pain management

27
Q

what is rigidity?

A

-increased resistance to los passive movement which is CONSTANT through out full ROM

28
Q

what’s the difference between lead pipe rigidity and cogwheel rigidity?

A

lead pipe - resistance felt throughout movement
-cogwheel - presence of additional tremor

29
Q

what is the pathophysiological mech of rigidity?

A

normal stretch reflex is composed of short latency (spinal) and long latency (brain) - the longer the latency the greater the rigidity

30
Q

what are causes of rigidity?

A

-extrapyramidial lesions
-parkinsons

31
Q

what are the clinical features of rigidity?

A

-increased resistance to relatively slow imposed passive moments
-lead pipe resistance (throughout ROM)
-tendon reflexes are normal
-can have superimposed tremor - leading to cogwheel rigidity

32
Q

how is rigidity assessed?

A

usually scales tend to be disease or condition specific eg parkinsons - foehn and yahr scale

33
Q

what does the physio management of rigidity involve?

A

-assessment and regular re assessment
-normalise tone
-manage of stiffness and pain( heat, stretch etc )
-gait, mobilioty transfers - re-education
-re educate about posture

34
Q

what is hypotonia?

A

low state of tone

35
Q

what are the characteristics of hypotonia?

A

-decreased resistance to passive movement
-decreased reflexes

36
Q

what are the causes of hypotonia?

A

-central cerebral shock - after UMNL
-spinal shock after spinal cord injury
-peripheral nerve lesion
-cerebellar

37
Q

what is the pathophysiological mech of hypotonia

A

-not clear
-can be due to neural shock
-prolonged hypotonia 0 reduced level of arousal

38
Q

what effect does hypotonia have on patients?

A

-loss of function
-inability to move against gravity
-inability to sustain upright posture
-muscle is prone to atrophy
-inability to weight bear and transfer

39
Q

what is the aim of physio for hypotonia?

A

-protect limb and joint eg splints
-sensory input - sitting balance, tapping, ice brushing, tapping, stroking - sensory re education
-positioning- optimal level of support
-promote tone
-education and awareness to patient and carers

40
Q

what is serial casting used for ?

A

it helps to decrease muscle tightness and allow for better function and mvt of a joint

Neurology I (13 decks)

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