Tone,Mobility,Force Generation

Question 1

What are positive signs of UMN lesion?

Answer 1

• Hyperreflexia
• Spasticity
• Pathological Reflexes

Question 2

Negative signs of UMN lesion?

Answer 2

• Paresis( v force generated)
• Loss of fractionation
• abnormal motor recruitment
• Obligatory synergy
• Decreased coordination
• abnormal spatial/temporal movements.

Question 3

A light tone in muscle AT REST

Answer 3

tone.

Question 4

Decerebrate vs decorticate rigidity?

Answer 4

decerebrate=extension.

Question 5

What are the interventions for hypertonia?

Answer 5

air casting
serial casting
splinting.

Question 6

Complete absence of muscle tone?

when does it happen?

where is it most common?

Answer 6

Flaccidity/hypotonia

Immediately after CVA(Stage 1)

most common in UE

Question 7

what does the length of flaccidity relate to?

Answer 7

Prognosis.

Question 8

What are some effects of hypotonia?

Answer 8

shoulder sublet

genu recurvatum

Question 9

What are interventions for hypotonia?

Answer 9

Estim
mirror training
Neurofacilitation.
positioning to prevent sublet

Question 10

Velocity dependent response of muscle to Passive stretching

Answer 10

spasticity.

Question 11

Spasticity resistance increases as ____

in what direction?

Answer 11

speed and rhythm of movement increase.

uni/bidirectional

Question 12

a series of involuntary, rhythmic,muscular contractions and relaxations.

Answer 12

clonus.

Question 13

What are possible reasons for clonus?

Answer 13

hyperactive stretch reflex
increased mn excitability/decreased inhinition
nerve signal delay
cletus?

Question 14

What are hypotheses for spasticity?

Answer 14

decreased inhibition of alpha motor neuron**

or stimulation of hypersensitive fusimotor system.

Question 15

What is modified ash worth tested in and what are 2 speeds?

Answer 15

supine

entire ROM slow then fast.

Question 16

Grades for modified ash worth

Answer 16

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.

Question 17

What is reliability of ash worth scale?

Answer 17

good intrarater

bad inter-rater

Question 18

What are influences of spasticity?

Answer 18

Tonic labyrinthine change in positions
postural exertion/mental
pain/discomfort
infection/inflammation
handling

Question 19

What are complications of Spasticity?

Answer 19

• dec strength/fx
• inactivity
• contracture/deformity
• tissue breakdown
• discomfort
• impaired posture

Question 20

What are the effects of Spasticity on MS

Answer 20

• trunk asymetry
• inversion spasticity
• finger deformity
• heterotopic ossifications

Question 21

What are the advantages of spasticity?

Answer 21

assist with posture control/ADLs

gastroc stabilize knee and ham stabilize trunk

Question 22

What are inhibiting techniques of spasticity?

Answer 22

slow rocking

• counter rotation
• Deep tendon pressure
• Prolonged stretch
• positioning.
• reflex inhibition position
• jt mobs and ST
• Casting

Question 23

2 types of casting?

Answer 23

inhibitive: restore normal.
Serail: long duration low load stretch.

Question 24

What are pharmacological interventions?

Answer 24

ORal meds

injectable meds/nerve block

Question 25

What are the oral meds given?

Answer 25

Baclofen
Diazepam
Dantrolene
Tizanidine
Clonidine

Question 26

what are injectable meds/nerve

Answer 26

Phenol

Botulinum toxin

Question 27

What are surgical interventions for Spasticity?

Answer 27

Selective Dorsal Rhizotomy
Intrathecal Baclofen Therapy
tendon lengthening

Question 28

What is selective dorsal Rhizotomy?

Answer 28

knocking out sensory info in spindle. Helps to grade amount of input

Question 29

What is intrathecal Baclofen?

Answer 29

Medication given directed to spinal cord. given at lower dose.

Question 30

abnormal coactivation of muscle groups

Answer 30

synergies.

happen together when proximal muscle group loaded

Question 31

UE flexion lesion?

Answer 31

elevation
retraction
abd
elbow flexion
sup
radial deviation

Question 32

LE extension?

Answer 32

hip ext
add
ir
knee ext
pf
inversion

Question 33

Interventions for synergy?

Answer 33

NDT
arrom/strengthen out of synergy
facilitate opposition synergy
load isometrics out of synergy.

Question 34

Why is there impaired force generation after stroke?

Answer 34

• 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.

Question 35

Brunnstrom stages of recovery

Answer 35

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

Question 36

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?

Answer 36

limited elbow ext. 2ndary to flexion synergy

Question 37

What is the rationale for administering the Modified Ashworth Scale with the patient in supine for all muscle groups?

Answer 37

to standardize influence of vestibular inputs on spasticity

Question 38

What PT technique would you use to decrease the influence of this structure on spasticity?

Answer 38

Tendon pressure

Question 39

What surgical technique would you use to decrease the influence of this structure on spasticity?

Answer 39

dorsal rhisotomy