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NI1 > Tone > Flashcards

Tone Flashcards

1
Q

What is tone?

A

The resistance of a normal, relaxed limb to passive stretch

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2
Q

What is tone determined by?

A
  • Passive mechanical properties of soft tissues

- Inertia of the limb

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3
Q

What is hypertonus & what is it caused by?

A

Increased resistance (tone impairment), caused by

  • Contracture
  • Spasticity
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4
Q

What is contracture?

A

Increased stiffness due to changes in passive mechanical properties of the soft tissue

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5
Q

What is spasticity?

A
  • Abnormal reflex muscle contraction
  • Velocity dependent increase in tonic stretch reflexes
  • Due to hyper-excitability of the stretch reflex
  • One component of upper motor neuron syndrome
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6
Q

What is the role of the stretch reflex in normal movement?

A
  • Small part in movement
  • Don’t initiate or control movement
  • Dynamic modulation of muscle reflexes occurs during motor tasks
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7
Q

What does recent evidence show regarding spasticity after stroke?

A
  • Spasticity after stroke is often mild & does not always occur
  • Spasticity doesn’t appear to be related to activity limitations
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8
Q

What evidence is there for spasticity in plantar flexors after stroke?

A
  • Investigated spasticity in ankle PF’s & impact on walking after stroke
  • Stroke patients exhibited action tonic stretch reflexes that were of similar magnitude to control subjects
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9
Q

What evidence is there for spasticity of the upper limb after stroke?

A
  • Looked at stroke survivors to determine impact of spasticity on UL activity performance
  • Spasticity was seen early but did not hinder recovery of activities
  • Contracture was more likely to develop in patients with poor outcomes
  • Not clear if contracture caused poor outcomes or if loss of range caused contracture
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10
Q

What is the evidence regarding modulation of stretch reflexes in adults with CP?

A
  • Trained adults with CP to modulate their stretch reflex using EMG biofeedback
  • Subjects could learn to regulate stretch reflex
  • No impact on dexterity or activity performance
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11
Q

What is are the primary impairments of stroke?

A
  • Loss of strength
  • Loss of dexterity
  • Increased stretch reflex/loss of inhibition causing spasticity
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12
Q

What is a common cause of contracture in patients after stroke?

A

They are often immobilised as a result of primary impairments (secondary impairment)

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13
Q

What does immobilisation cause?

A
  • Atrophy
  • Loss of sarcomeres
  • Accumulation of connective tissue
  • Increased fat content
  • Degenerative changes at the MTJ
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14
Q

What evidence is there for the relationship between spasticity & contracture after stroke?

A
  • Investigated development of weakness, spasticity, contracture & disability over 1 year period in stroke patients
  • Patients with early spasticity were likely to develop contracture in the first 4-6 months
  • Patients with weakness are likely to develop contracture after 6 months
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15
Q

What are the common measurement tools for tone?

A
  • Ashworth Scale

- Tardieu Scale

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16
Q

What evidence is there for the Tardieu & Ashworth scales?

A
  • Examined effectiveness of the Ashworth & Tardieu scales for differentiating between spasticity and contracture
  • Tardieu scale predicted spasticity 100% of the time
  • Ashworth scale predicted spasticity 63% of the time
  • Tardieu scale predicted contracture 94% of the time (Ashworth couldn’t distinguish between the two)
17
Q

Why is the Tardieu scale able to distinguish between spasticity & contracture (unlike Ashworth)?

A
  • Gives muscle response at slow & fast speeds

- Highlights velocity-dependent changes in movement

18
Q

What are some of the differences between spasticity & contracture?

A
  • Spasticity is velocity-dependent, contracture is not
  • Spasticity is a primary impairment, contracture is secondary
  • Spasticity is due to increased excitability of stretch reflex
  • Contracture is due to changes in the soft tissue
19
Q

What are the key strategies for managing mild-moderate spasticity?

A
  • Maintain muscle length & joint ROM
  • Train muscle activity for specific actions
  • Eliminate inappropriate muscle force during attempts at motor tasks
20
Q

What are the key strategies for managing moderate-severe spasticity (e.g. MS)?

A
  • Pharmacology

- Serial casting (casting in end of range)

21
Q

What is the evidence for upper limb stretching in stroke patients?

A
  • Stroke patients with UL paralysis
  • No stretch vs ER stretch at end of comfortable range
  • Stretch for 30min, 5 days per week for 4 weeks
  • Statistically & clinically significant difference (12 degrees) between groups
22
Q

What is the evidence for serial casting combined with stretching in TBI patients?

A
  • TBI patients & ankle PF contracture
  • 1/52 casting + stretching vs 1/52 usual physio
  • Significant increase in ankle DF with casting & stretching compared usual physio
23
Q

What is the evidence for stretching?

A
  • Cochrane review of stretching for neurological conditions
  • Little or no effect of stretch on pain, spasticity, activity limitation, participation restriction or QOL
  • Mod-high quality evidence stretching doesn’t elicit clinically important effects
24
Q

What are the clinical implications of the Cochrane review?

A
  • Need to monitor patients closely when treating contracture (not all patients respond the same)
  • If active training is not possible, stretching should still be used to prevent/reverse contracture
  • Need to continue reading current literature
25
Q

What are the primary strategies to maintain muscle length in muscles at risk of shortening?

A
  • Active movement through ROM
  • Activity practice
  • Active assisted movement through ROM
  • Electrical stimulation
26
Q

What are the secondary strategies to maintain muscle length in muscles at risk of shortening?

A

More passive:

  • Positioning throughout the day in optimal position
  • Low load prolonged stretch
  • Resting splints
  • Serial casting
27
Q

What evidence is there for the effects of immobilisation of muscles?

A
  • Immobilisation of muscles in a shortened position causes degeneration at the MTJ
  • Caused inability for muscle to contract
28
Q

What evidence is there for prolonged calf & hamstring stretching in spinal cord injury patients?

A
  • Prolonged calf & hamstring stretching for 30 mins/day for 4 weeks (2 separate studies)
  • Spinal cord injury patients
  • No difference between legs after 4 weeks
29
Q

What evidence is there for splinting to prevent contracture in stroke survivors?

A
  • Hand splinted to prevent contracture of wrist/finger flexors for 8 hours/day
  • No difference compared to no splinting
30
Q

What evidence is there for stretching in preventing wrist contracture in stroke survivors?

A
  • Compared UL retraining +/- stretching
  • Upper limb retraining & stretching for prevention of wrist contracture was not clinically significant but effect was maintained at 5 week follow-up
31
Q

What is the evidence for serial casting combined with saline injections in TBI patients?

A
  • TBI patients, 88% with spasticity
  • Ankle serial casting + saline injections compared to usual physio for 12 weeks
  • Serial casting alone is enough to increase DF ROM
  • Botox might not be necessary

NI1 (10 decks)

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