Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro Rehab 2 > Tone Management > Flashcards

Tone Management Flashcards

1
Q

what is ms tone and why is it adaptive

A

resting tension in ms
resistance to elongation/stretch when relaxed

state of partial ms contraction at rest that supports posture and provides baseline tension for volitional contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are anatomical structures that contribute to the complex control of a ms fiber (5)

A

cortex
brainstem
cerebellum
spinal stretch reflexes
ms spindles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

clinical reasoning: do you always want to dec ms tone if person has hypertonicity?

A

not necessarily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

clinical reasoning: do you always want to inc ms tone if person has hypotonicity?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are 4 pathologies can result in hypotonicity and how

A

LMNL:
- impacts ant horn of SC, ventral nerve root, spinal nerves, or peripheral nerves

UMNL:
- damage to corticospinal tract -> have hypotonicity in acute/shock phases & even long term s/p stroke

chromosomal abnormalities (ie downs)
cerebellar lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is hypotonicity and how does it present

A

dec resistance to passive elongation
limbs/trunk feel heavy/floppy
- ms are soft/squishy to palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is hypotonicity associated with (2)

A

dec stretch reflex
dec DTRs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

why do you commonly see secondary weakness in hypotonicity

A

those w normal strength w low tone require more energy for more tension to be generated in extrafusal ms fibers to make up for that low baseline tension
- takes more energy to move and endurance may be a problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are secondary complications that result from hypotonicity (2)

A

atrophy, weakness
joint misalignment, subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a common manifestation that you can observe in people who have low tone

A

poor postural alignment
- forward flexed trunk
- forward head
- post pelvic tilt
- W-sitting in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the goal when treating hypotonicity

A

improve motor response and mvmt patterns for inc safety and independence w functional activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are 5 strategies to inc ms response w sensory input

A

approximation
ms tapping, quick swipe
light, graded resistance
wt bearing positions
moveable/pliable surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how does approximation inc ms response

A

inc proprioceptive input from joint receptors
-> help facilitate co-contraction in wt bearing position -> help w extensor response primarily (some flexor, but mostly extensor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how does ms tapping inc ms response

A

activate ms spindle
-> if activate briskly can inc motor response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how does light, graded resistance inc ms response

A

tracking resistance -> facilitatory to encourage smoother mvmt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does wt bearing inc ms response

A

stability, postures, co-contraction, proprioceptive input
- get approximation -> facilitate co-contraction and inc extensor response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does moveable/pliable surfaces inc ms response

A

if hypotonicity -> activates reticular system and facilitates a ms response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the focus of treating someone w hypotonicity

A

focus on strengthening ms and proper postural alignment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a consideration of when to implement strategies to inc ms response in hypotonic pts

A

preparatory techniques that are not a treatment in and of itself
-> prepping to optimize motor system and prepare for work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

if preparatory techniques don’t work, what is the next approach to use and examples of that

A

compensatory approach
- ex: external support via bracing, orthotics, splints for stability, improved function and joint protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is hypertonicity

A

inc resistance to passive stretch
-> difficult to move limb and elongate ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are 2 conditions that you see hypertonicity in

A

UMNLs
basal ganglia disorders
- ie Parkinsons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is hypertonicity associated with

A

inc stretch reflex and hyper-reflexia DTRs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how does hypertonicity impact ms

A

preserves ms bulk (dont see much atrophy)
-> still can have underlying weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are examples of hypertonicity (3)

A

rigidity
spasticity
clonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when do you want to minimize hypertonicity

A

if it interferes w function, causes pain, positioning problems, hygiene issues (maladaptive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when do you NOT want to minimize hypertonicity

A

if supports posture and improves balance, mobility (adaptive)
-> may rely on passive tension to help w posture and transfers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is spasticity

A

velocity dependent inc resistance of ms or ms groups to passive stretch d/t loss of suppression of spinal stretch reflex

29
Q

what is the cause of spasticity

A

overactive spinal stretch reflex

30
Q

what are 2 functional classifications of spasticity

A

weak and spastic
strong and spastic

31
Q

how is spasticity measured (3)

A

clinical exam
MAS
tardieu

32
Q

what is a common sx to be associated w hypertonicity and why

A

pain
- esp w adaptive shortening of ms

33
Q

what are 3 activities to assess as part of a comprehensive clinical exam

A

balance
functional mobility
ADLs

34
Q

what are 5 modalities that can treat hypertonicity and what does the literature say ab their use

A

US
cryotherapy
vibration
estim (TENS, FES)
neutral warmth

literature doesn’t strongly support any of them
- some anecdotal success through trial and error

35
Q

how could estim be helpful in treating hypertonicity

A

could apply to spastic ms to fatigue and tire out

could apply to antagonists to get a stronger contraction and overcome the tone in spastic ms to allow for mobility/motion

36
Q

what are 3 manual techniques to temporarily modify hypertonicity and what as sheri baby found to be the most successful

A

deep pressure **
prolonged stretch (slow speed)
RRo

37
Q

how does deep pressure temporarily modify hypertonicity

A

deep (but not painful) pressure on ms spindle or tendon (GTO) to induce reflexive relaxation
- after few seconds ms relaxes, can then start to open limb up slowly

38
Q

why is it important that deep pressure to temp modify hypertonicity not be painful? what is a strategy to avoid this?

A

if painful stim will trigger guarding and inc ms contraction

use widely distributed pressure

39
Q

what are examples of using a prolonged stretch to temporarily modify hypertonicity

A

splints & air sleeves for longer term management
serial casting

40
Q

how does RRo help to modify hypertonicity

A

rotating along long axis of limb
- can do for trunk in hooklying or SL
- rotation can be inhibitor to nervous system and relax ms

41
Q

what are 2 examples of noninvasive neuromodulation (NINM) for spasticity management, what are outcomes, & when/where is this seen

A

repetitive transcranial magnetic stim (rTMS)
transcranial direct current stim (tDCS)

more effective when combined w other interventions, safe and low risk

more on a research level, not seen in practice yet
- not FDA approved, not widely clinically available

42
Q

what does the evidence say about serial casting

A

no/little evidence on permanently altering ms tone or improving function
- evidence to improve PROM

43
Q

who is most appropriate for serial casting

A

if complex spasticity and want to aggressively manage tone and prevent contractures

44
Q

what is the process of serial casting

A

prolonged stretch over 3-5 days
-> then remove and apply new cast in further elongated position and continue until desired effect achieved

45
Q

what are 3 types of medical management options for hypertonicity

A

meds
- oral
- intrathecal (baclofen)
injections
surgical interventions

*rTMS and tDCS still in trials

46
Q

what is PT’s role in the team’s selection of a medical management option

A

we have insight on how tone is affecting pt function and how the intervention is or isn’t working
- we can advise on what may be the best option for the pt

47
Q

what are 5 types of oral meds for managing hypertonicity

A

tizanidine (zanaflex)
dantrolene
gabapentin
diazepam
baclofen

48
Q

what are advantages and disadvantages of oral meds

A

advantages:
- easy to admin & make changes quickly
- non-invasive
- acts globally to target multiple ms groups

disadvantages:
- large doses may be needed
- systemic side effects
- compliance
- acts globally (if focal spasticity, may cause relaxation of ms throughout body and can lead to weakness and fatigue)

49
Q

tizanidine (zanaflex): purpose, MOA, dosage, adverse effects

A

reduce spasms

acts on alpha-2 adrenergic system at spinal and supraspinal levels to dec spinal stretch reflex

starting dose 1-4mg at bedtime
- avoid side effects
max dosage = 36mg

common adverse effects:
- fatigue, dizziness, drowsiness
- weakness, anxiety, nausea, HAs

50
Q

dantrolene: purpose, MOA, adverse effects

A

spasticity, dec ms contraction

affects release of calcium from sarcoplasmic reticulum of skeletal ms
- acts peripherally at level of ms fiber

adverse effects:
- drowsiness, dizziness, fatigue
- ms weakness, **abdominal pain

51
Q

gabapentin (neurontin): MOA, adverse effects

A

binds to calcium channel receptors on neurons interfering w transmission
- works at nerve level
- interferes w nerve signal transmission

usually well tolerated**
side effects of fatigue, reduced concentration

52
Q

diazepam (valium): MOA, adverse effects

A

inc affinity of neurotransmitter GABA to its receptor in brainstem and SC (works centrally)
- results in inc in presynaptic inhibition and dec of monosynaptic and polysynaptic reflexes

side effects:
- drowsiness, dizziness, fatigue
- weakness, nausea
- memory impairment, constipation

53
Q

oral baclofen: purpose, MOA, adverse effects, dosage, and important pt ed and why

A

treat spasticity

interacts w GABA neurotransmitter and works w/i CNS pre and post-synaptically to inhibit spinal reflexes
- enters CSF and crosses BBB causing side effects

Side Effects:
- fatigue, weakness
- hypotonia, somnolence, n/v
- HA, dizziness, paresthesias, withdrawal

starting dose 5-10mg 2-3x/day
-> inc slowly to 80mg/day

education of importance of compliance and dosing schedule
- can cause serious side effects if quickly withdraw

54
Q

what pts are appropriate for a intrathecal baclofen pump trial (6)

A

person w global spasticity, spasms, and/or clonus
progressive/chronic dz
primarily LE involvement
varying functional needs
potentially failed focal management
on high dose of oral baclofen
- ie need >80mg of baclofen

55
Q

what is intrathecal baclofen

A

surgically implanted pump to deliver baclofen into spinal thecal subarachnoid space

56
Q

advantages and disadvantages of an intrathecal baclofen pump

A

advantages
- lower med doses bc delivered directly into CSF -> dec SE
- ability to tailor delivery times to needs
- systemic effect
- ability to do trial before implantation

disadvantages
- surgical implant (invasive)
- compliance is important (regular f/u, interrogate it, make sure working properly)
- doesn’t effect UE as well as trunk and LE

57
Q

what happens on trial day for a ITB pump

A

battery of tests
admin med which peaks 3-4hrs post
- we will retest at 1.5hr increments after injection

58
Q

what are some tests and assessments we may perform during a trial of ITB pump (7)

A

ROM
spasticity - MAS
strength
functional assessment
- mobility & transfers
- postural control & alignment
PSFS
pain
caregiver burden

59
Q

what are indications of a successful ITB pump trial (5)

A

reduction of spasticity per MAS, PSFS
no adverse reactions
inc ROM, function, positioning
dec in pain, spasms
dec caregiver burden & inc (I)

60
Q

botox injection: indication, MOA, duration of effectiveness and why, SE, and outcomes

A

focal spasticity

inhibits acetylcholine release at NMJ
-> causes weakness of ms injected & temporary paralysis

wears off in 3mo secondary to nerve sprouting and re-innervation
- can’t do multiple injections in same spot bc of this effect

no systemic side effects

dec spasticity by 1-2pts on MAS
- improves ROM
- improves mobility

61
Q

phenol injection: indication, MOA, duration, and effects

A

focal lesions

injected directly into nerves -> damages both motor and sensory nerves via chemical neurolysis

lasts 9-12mo

effects: ms paralysis, immediate response to injection

62
Q

phenol vs botox

A

phenol works directly at nerve
- causes more paralysis
- prevents any contraction at all
- no delay

botox works at NMJ
- may still have some underlying contraction
- may have slight delay

63
Q

what are surgical interventions

A

selective dorsal rhizotomy
msk surgeries
- tenotomy
- myotomy
- tendon lengthening or transfer

64
Q

what is a selective dorsal rhizotomy and what does this do? SE?

A

surgical procedure to cut a portion of dorsal nerve roots in lumbosacral spinal cord
-> dec sensory input or afferent arc of stretch reflex at segmental spinal level and dec excitability

SE: sensory loss, weakness

65
Q

what population is there good evidence for dec in spasticity after a selective dorsal rhizotomy

A

children w CP
- spastic diplegia

66
Q

what is the purpose of a tenotomy or myotomy as a surgical intervention

A

prevent contraction to dec hypertonicity

67
Q

what populations do you tend to see MSK surgeries in

A

more adults than peds

68
Q

why would they do a tendon or ms transfer after a tenotomy or myotomy

A

try to preserve function that may be lost in surgery

69
Q

when do we intervene for hypotonicity

A

almost always
- almost always marked as mal-adaptive

Neuro Rehab 2 (48 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions