Week 3 - Spasticity & History

Question 1

A motor disorder characterised by a velocity dependent increases in tonic stretch, reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of UMN syndrome

Answer 1

Spasticity

Question 2

The amount of resistance to passive elongation or stretching when a muscle is relaxed.
Resistance felt when passively stretching relaxed muscle

Answer 2

Tone

Question 3

What are the objectives in treating spasticity?

Answer 3

To improve quality of life
- Relive symptoms and reduce disfigurement
- Ease personal care and positioning
- Improve function and mobility of a specific limb
- Reduce burden of care
- Enable ADL

Question 4

What is spastic dystonia?

Answer 4

Stretch sensitive muscle contraction in absence of volitional command (at rest)

Involuntary muscle contractions and an inability to relax muscles

Question 5

What is spastic co-contraction?

Answer 5

Inappropriate antagonist, actively using muscle and getting an inappropriate antagonist recruitment in the absence of stretch

Question 6

Bidirectional resistance to passive stretch, relatively independent of the speed of movement; does not result from hyperactive stretch reflexes

Answer 6

Rigidity

Question 7

What is cogwheel and ledpipe rigidity?

Answer 7

Cogwheel: tension in muscle gives way in little jerks as you try to straighten limb

Ledpipe: rigid whole way through movement, have to push quite hard “might feel like it’ll break”

Question 8

Immobolisation in shortened position results in less longitudinal tension

Answer 8

Contracture

Question 9

List 3 pathophysiology to spasticity

Answer 9

1. Imbalance between excitatory and inhibitory impulses to the alpha motor neuron
2. Descending pathways also influence Renshaw cells which suppress repeated firing of alpha motor neurone
3. Descending pathways also inhibit Golgi Tendon Organ (GTO)

Question 10

List 3 management of spasticity

Answer 10

1. Muscle lengthening
2. Muscle strengthening and retraining
3. Local muscle relaxation

Question 11

How does botox BTX-A help with spasiticity

Answer 11

Blocks neuromuscular transmission by inhibiting release of Ach from presynaptic terminals, resulting in a reversible denervation atrophy

Blocks chemical signal between nerves and muscles that makes muscle contract or tighten

Question 12

What is Alexander Technique?

Answer 12

Patients learn to observe the way they move and make small changes to posture/coordination

Question 13

What is Feldenkrais method?

Answer 13

Described as somatic education
2 components: awareness through movement, functional integration