Treatment of Abnormal Muscle Tone

Question 1

‘Muscle Tone’?

Answer 1

Amount of tension in a muscle when at rest

• A continuous state of mild muscle contraction
• Allows for movement and stability at the same time

Question 2

‘Muscle tone’ impact on functional performance?

Answer 2

No muscle tone = no joint stability
(Impairs movement, balance, & posture)

CNS & PNS must be intact to have good muscle tone

Question 3

‘Hypo-tonicity’?

Answer 3

Decrease in tone (flaccid)

• No resistance to passive movement
• Muscles feel soft
• Limb feels heavy
• No/limited function of limb
• Can result in joint subluxation

Question 4

Facilitation techniques? (To treat low tone)

Answer 4

GOAL = Normalize Muscle Tone (via Facilitation Techniques)

We work proximal to distal, gross to fine motor

TACTILE:

• Light touch
• Fast brushing

THERMAL:
- Icing

PROPRIOCEPTION:

• Quick stretch or tapping over muscle or tendon
• Vibration – high frequency
• Light Joint Compression
• Heavy Joint Compression
• Functional Electrical Stimulation (FES)
• ROM exercises
• PROM, AAROM

SPECIAL SENSES:

• Auditory
• Visual
• Vestibular (specialized training required)

Question 5

‘Subluxed Shoulder’ causes?

Answer 5

CAUSES:

• Poor postural control
• Weak rotator cuff muscles
• Decreased scapular mobility
• Poor care (taken past 90 degrees)

RESULTS IN:
Dislocation

Question 6

‘Subluxed Shoulder’ treatment?

Answer 6

• Education
• Positioning
• Slings
• Splints
• PROM

Modified ADLs (flaccid arm goes in first when dressing etc..)

Question 7

‘Hypertonia’?

Answer 7

Increased tone in anti-gravity muscles

• Increased resistance to passive stretch (Spasticity & Rigidity)

Question 8

‘Hypertonicity’ Impact on UE?

Answer 8

Worsens with effort, emotional stress, fear, pain

• Discomfort
• No or limited functional use of limb
• Contractures

Too much velocity dependent tone = faster you move the more response you get from it

Question 9

Associated Reactions?

Answer 9

The involved extremities move in a synergistic, mass pattern

Occurs when an activity requires extensive effort of the unaffected limbs

Question 10

Treating Hypertonia?

Answer 10

GOAL = Decrease abnormal muscle tone, using ‘Inhibitory Techniques’

Question 11

Inhibitory Techniques? (To reduce high tone)

Answer 11

TACTILE:
- Deep, slow, rhythmical muscle stroking

THERMAL:

• Neutral warmth
• Prolonged Cooling

PROPRIOCEPTION:

• Prolonged stretch
• Light joint compression
• Deep/Tendon pressure
• Intense Contraction (hold-relax procedure)
• PROM
• Weight bearing
• Sustained circumferential pressure
• Positioning (bed, wheelchair)

SPECIAL SENSES:

• Auditory
• Visual
• Vestibular (slow rhythmical rocking (eg. rocking chair))

Question 12

Treatment Goals for Abnormal Tone?

Answer 12

GOALS:

• Normalize tone
• Facilitate symmetrical posture
• Improve balance
• Restore coordinated and purposeful movement
• Return to independent functioning

Question 13

Relaxes or Excites muscle (list)?

Answer 13

RELAXES:
Vibration 
Warmth
Rocking 
Swaddling 
Darkened room

EXCITES:
Rubbing 
Deep pressure
Traction 
Light touch, stroking 
Tapping
Staccato music

BOTH:
Icing
Postural changes