Tone,Mobility,Force Generation Flashcards
What are positive signs of UMN lesion?
- Hyperreflexia
- Spasticity
- Pathological Reflexes
Negative signs of UMN lesion?
- Paresis( v force generated)
- Loss of fractionation
- abnormal motor recruitment
- Obligatory synergy
- Decreased coordination
- abnormal spatial/temporal movements.
A light tone in muscle AT REST
tone.
Decerebrate vs decorticate rigidity?
decerebrate=extension.
What are the interventions for hypertonia?
air casting
serial casting
splinting.
Complete absence of muscle tone?
when does it happen?
where is it most common?
Flaccidity/hypotonia
Immediately after CVA(Stage 1)
most common in UE
what does the length of flaccidity relate to?
Prognosis.
What are some effects of hypotonia?
shoulder sublet
genu recurvatum
What are interventions for hypotonia?
Estim
mirror training
Neurofacilitation.
positioning to prevent sublet
Velocity dependent response of muscle to Passive stretching
spasticity.
Spasticity resistance increases as ____
in what direction?
speed and rhythm of movement increase.
uni/bidirectional
a series of involuntary, rhythmic,muscular contractions and relaxations.
clonus.
What are possible reasons for clonus?
hyperactive stretch reflex
increased mn excitability/decreased inhinition
nerve signal delay
cletus?
What are hypotheses for spasticity?
decreased inhibition of alpha motor neuron**
or stimulation of hypersensitive fusimotor system.
What is modified ash worth tested in and what are 2 speeds?
supine
entire ROM slow then fast.
Grades for modified ash worth
0= normal tone 1=catch and release 1+ catch and resistance through half rom 2=increase in tone and resistance through most rom 3= passive movement difficult 4=rigid.
What is reliability of ash worth scale?
good intrarater
bad inter-rater
What are influences of spasticity?
Tonic labyrinthine change in positions postural exertion/mental pain/discomfort infection/inflammation handling
What are complications of Spasticity?
- dec strength/fx
- inactivity
- contracture/deformity
- tissue breakdown
- discomfort
- impaired posture
What are the effects of Spasticity on MS
- trunk asymetry
- inversion spasticity
- finger deformity
- heterotopic ossifications
What are the advantages of spasticity?
assist with posture control/ADLs
gastroc stabilize knee and ham stabilize trunk
What are inhibiting techniques of spasticity?
slow rocking
- counter rotation
- Deep tendon pressure
- Prolonged stretch
- positioning.
- reflex inhibition position
- jt mobs and ST
- Casting
2 types of casting?
inhibitive: restore normal.
Serail: long duration low load stretch.
What are pharmacological interventions?
ORal meds
injectable meds/nerve block
What are the oral meds given?
Baclofen Diazepam Dantrolene Tizanidine Clonidine
what are injectable meds/nerve
Phenol
Botulinum toxin
What are surgical interventions for Spasticity?
Selective Dorsal Rhizotomy
Intrathecal Baclofen Therapy
tendon lengthening
What is selective dorsal Rhizotomy?
knocking out sensory info in spindle. Helps to grade amount of input
What is intrathecal Baclofen?
Medication given directed to spinal cord. given at lower dose.
abnormal coactivation of muscle groups
synergies.
happen together when proximal muscle group loaded
UE flexion lesion?
elevation retraction abd elbow flexion sup radial deviation
LE extension?
hip ext add ir knee ext pf inversion
Interventions for synergy?
NDT
arrom/strengthen out of synergy
facilitate opposition synergy
load isometrics out of synergy.
Why is there impaired force generation after stroke?
- decreased motor units/rate of firing/recruitment
- learned nonuse
- atrophy/ type 2 fibers fire like type 1
- Disordered pattern of activity
- Passive restraints
- increaased fatigue.
Brunnstrom stages of recovery
1: flaccid
2: spasiticty/synergy emerge
3: spasticity is highest/moev in pattern
4: Most movement in synergy
5: more isolated movement
6: No spasticity/ coordination emerges
7: normal
A patient with hemiplegia with full passive elbow ROM is unable to lift a book and place it on a table with his hemiplegic UE that is within arm’s reach. Patient is able to place the empty hemiplegic hand on the shelf easily. What is the MOST likely cause?
limited elbow ext. 2ndary to flexion synergy
What is the rationale for administering the Modified Ashworth Scale with the patient in supine for all muscle groups?
to standardize influence of vestibular inputs on spasticity
What PT technique would you use to decrease the influence of this structure on spasticity?
Tendon pressure
What surgical technique would you use to decrease the influence of this structure on spasticity?
dorsal rhisotomy
