Tone, Mobility, Selective Capacity and Force Generation Flashcards
List 3 positive signs of UMN lesions.
- Hyperreflexia
- Spasticity
- Pathological reflexes
List 6 negative signs of UMN lesions.
- Paresis (decreased force generation)
- Loss of fractionation
- Abnormal motor unit recruitment
- Obligatory synergies
- Decreased coordination and dexterity
- Spatial and temporal movement abnormalities
What occurs with the loss of fractionation?
Patient loses the ability to move single joints or aspects of the extremities in isolation from the others
Obligatory synergies result in decreased ______.
Selective Capacity
What is resting muscle tone?
Light tension in the muscle when it is at rest
Describe the position of the shoulder, elbow, forearm wrist, hips and ankles in decorticate rigidity.
Shoulder adduction Elbow flexion Forearm supination Wrist Flexion Hip IR Ankle PF
Describe the position of the shoulder, elbow, forearm, wrist, and ankles in decerebrate rigidity.
Shoulder adduction Elbow extension Forearm Pronation Wrist Flexion Ankle PF
List 3 interventions used to treat hypertonia. Why are they effective in treating this condition?
- Air casting
- Serial casting
- Splinting
Provide low load, long duration stretch to high tone muscles
What typically occurs immediately after a CVA?
Flaccidity/Hypotonia
What is flaccidity/hypotonia?
Complete absence of muscle tone
True or False: Flaccidity/hypotonia most commonly affects the LE.
FALSE
Most common in the UE
Length of time the period of flaccidity lasts is related to ____.
Prognosis
Longer the flaccidity lasts, the poorer the prognosis
What are 2 effects of hypotonia on the musculoskeletal system?
- Knee laxity (genu recurvatum)
2. Shoulder subluxation (weight of arm pulls humeral head down)
List 5 interventions used to treat hypotonia.
- Neurofacilitation
- E-stim to improve active movement (takes long time)
- E-stim of supraspinatus to prevent subluxation
- Scaled active movement / mirror training
- Positioning to prevent subluxation
What is scaled active movement or mirror training?
Patient begins to convert trace movements into meaningful movements
Affected limb is perceived as moving as the patient observes the non-affected limb moving in the mirror
What should be avoided when positioning the arm to prevent subluxation?
Avoid using arm sling to position the UE to prevent formation of contractures
What is spasticity?
Velocity dependent response of muscle to passive stretching
Spasticity: Resistance ____ as speed and rhythm of movement increases.
INCREASES
Spasticity: Resistance to passive movements could be ____ or ____.
unidirectional or bi-directional
What is clonus? (2)
- A series of involuntary, rhythmic, muscular contractions and relaxations.
- Self re-excitation of hyperactive stretch reflex
What are 2 causes of clonus?
- Increase in motor neuron excitability (decrease descending inhibition)
- Nerve signal delay (increased nerve conduction time and long reflex pathways)
What are 2 causes of spasticity?
- Decreased supra-spinal pre-synaptic inhibition of alpha motor efferents
- Stimulation by a hypersensitive fusimotor system
What position must the patient be in when performing the Modified Ashworth Scale? How many times is it performed?
- Supine
- Performed twice
V1: move through entire ROM slowly
V2: move through entire ROM < 1 sec
List and describe all 6 grades on the Modified Ashworth Scale.
0 – no increase in tone / normal tone
1 – slight increase in tone manifested by catch and release or by minimal resistance at End ROM
1+ - slight increase in muscle tone, manifested by catch followed by minimal resistance throughout the reminder (less than ½) of the ROM
2 – marked increase in muscle tone throughout most of the ROM but affected parts easily moved
3 – considerable increase in muscle tone, passive movement difficult
4 – rigidity in flexion or extension
What is the inter-rater/intra-rater reliability, validity and convergent validity of the Modified Ashworth Scale?
- Adequate to good intra-rater reliability
- Poor to adequate inter-rater reliability
- Poor criterion validity
- Adequate convergent validity
List 5 things than can influence spasticity.
- Tonic Labyrinthine changes in different positions
- Postural exertion / Mental exertion
- Pain or discomfort (INCREASES SPASTICITY)
- Infections, decubiti, inflammations (INCREASES SPASTICITY)
- Handling (INCREASES SPASTICITY)
List 6 complications associated with spasticity.
- Reduced strength and function (intact muscles trying to resist spastic muscles, which weakens them)
- Inactivity / Immobility
- Tissue adaptation, contracture/deformity
- Tissue breakdown, mechanical damage and necrosis
- Discomfort
- Impaired posture (respiratory distress/infections)
List 4 things that are associated with inactivity/immobility secondary to spasticity.
- Cardiovascular problems
- Social isolation
- Osteoporosis
- DVTs
List 4 effects of spasticity on the musculoskeletal system.
- Trunk asymmetries
- Ankles and feet (i.e. equino varus, very severe)
- Finger deformities (contractures develop)
- Heterotrophic ossifications: abnormal bone growth in muscle
What is a possible advantage of spasticity? Provide 2 examples.
- May assist with posture control and ADLs
Example: Spastic gastrocs stabilize knees
Example: Spastic hams stabilize trunk
List 6 inhibiting techniques used to treat spasticity.
- Slow rocking (vestibular input)
- Counter rotation
- Deep tendon pressure
- Prolonged stretching
- Reflex inhibition position (closed chain, approximation)
- Positioning
List 4 PT interventions used to treat spasticity.
- Joint mobilization
- STM
- Muscle stretching programs
- Casting
List 2 types of casting that can be used to treat spasticity.
- Inhibitive: restore normal anatomical & biomechanical relationships
- Serial: long duration, low load stretch
List 5 oral medications used to treat spasticity.
Baclofen (Lioresal) Diazepam (Valuium) Dantrolene (Dantrium) Tizanidine (Zanaflex) Clonidine (Catapres)
List 2 injectable medications/ nerve blocks used to treat spasticity.
- Phenol
2. Botulinum toxin type A or B (Botox)
List 3 surgical interventions used to treat spasticity.
- Selective Dorsal Rhizotomy (knocks out sensory information from muscle spindle)
- Intrathecal Baclofen therapy
- Tendon lengthening (Z-plasty: cut the tendon and reattach it to make it longer)
What is intrathecal Baclofen therapy? Highest level it can be placed?
- Baclofen is delivered directly to the spinal cord via indwelling pump
- Highest level = T8 so diaphragm remains unaffected allowing the patient to breathe
What is the typical presentation of the joints in an UE flexion synergy? (7)
Elevation Retraction Abduction **Elbow Flexion** Supination Radial Deviation Wrist and Finger Flexion
What is the typical presentation of the joints in an LE extension synergy? (7)
**Hip Extension** Adduction IR **Knee Extension** **Plantar Flexion** Inversion Toe Flexion
List 5 interventions used to treat synergies.
- Grade tasks to avoid synergy – (NDT)
- AAROM out of synergy
(lots of GE (gravity eliminated) work) - Strengthen out of synergy
- Facilitate opposite synergy (Brunnstrom)
- Loading with isometrics out of synergy
List 9 impairments associated with impaired force generation after stroke.
- Decrease in # of motor units
- Decrease rate of firing of motor units
- Abnormal recruitment of motor units
- Learned non-use
- Atrophy of muscle
- Loss of type II/fast twitch fibers (become smaller and do not fire as efficiently)
- Disordered patterns of agonist-antagonist muscle activity (can be caused by spasticity)
- Passive restraints due to changes in viscoelastic properties of muscle and connective tissue
- Increased fatigability (lack sufficient strength needed to sustain level of activity)
What were Bobath’s vs Guliani’s beliefs regarding the use of strength training to treat patients with synergies?
- Bobath “synergies will increase”: if muscles responsible for synergies were strengthened (don’t strengthen)
- Guliani “weakness will decrease function and increase synergies”: so argument was to strengthen the synergistic muscles
What is the current consensus regarding the use of strength training to treat patients with synergies?
Strengthen regardless of the presence of a synergy
How many stages make up Brunnstrom’s stages of recovery?
7
Define stages I, II, III of Brunstrom’s stages of recovery.
Stage I : Flaccidity
Stage II Spasticity and Synergies Emerge
Stage III: Voluntary control of synergies and spasticity increases
Define stage IV of Brunstrom’s stages of recovery. (3)
- Movement in Synergy still dominates
- Movements out of synergy emerges
- Spasticity decreases
Define stage V of Brunstrom’s stages of recovery. (3)
- Dominance of synergies decreases
- Isolated Movement Increases
- Spasticity Decreases
Define stage VI of Brunstrom’s stages of recovery. (3)
- No spasticity
- Isolated movement dominates
- Coordination emerges
Define stage VII of Brunstrom’s stages of recovery.
Normal function restored
