Week 8 - SCI, Ataxia, Hypotonia/Hypertonia/Spasticity Flashcards
What are five sensory receptors?
- Cutaneous sense organs
- Proprioceptors
- Mechanoreceptors
- Photoreceptors
- Chemoreceptors
(first three are most important)
what are Cutaneous sense organs?
These are sensory receptors in the skin that help detect:
- touch
- pressure
- pain
- temperature
How does Cutaneous Sense Organs function?
- They send signals to the brain allowing us to respond to different sensations.
For example, if you touch something hot, these receptors alert your brain, prompting you to move your hand away.
What are Proprioceptors?
Sensory receptors located in muscles, tendons, and joints that help us sense the position and movement of our body parts without looking.
They allow coordinated movements, like touching your nose with your eyes closed, by informing the brain of limb positioning.
What are Mechanoreceptors?
- Sensory receptors that respond to mechanical pressure or distortion.
- Found in the skin, muscles, and inner ear.
- Help detect touch, pressure, vibration, and sound.
Examples:
- Skin mechanoreceptors allow us to feel textures.
- Inner ear mechanoreceptors help with hearing and balance
What can decreased movement lead to?
Decreased movement → Decreased awareness
Decreased awareness → Decreased movement
What are some examples of sensory impairment?
- Light touch
- temperature
- pain
what is an example of misinterpetation of sensory stimuli?
light touch interpreted as pain
what are some tips to manage sensory deficits?
- Provide sensory input (touching, rubbing, tracing, distraction, compression, stretch, rotation)
- Weight-bearing through extremities
- Monitor skin on affected side for red marks
- Teach to test water temperature with unaffected hand.
- Mirror Box Therapy
- Create a ‘sensory basket’ full of different textures/objects that patient can use throughout the day.
what are some possible Vision issues?
- Double vision
- blurred vision
- partial loss in one eye or both eyes
- loss of visual field (ie hemianopsia)
- visual midline shift syndrome
- post trauma vision syndrome
what is visual Inattention?
Neglect
what is Motor Imagery Therapy?
- Also known as mental practice, rehearsal, or action simulation.
- Involves imagining performing an activity without actual movement.
- Focuses on the kinesthetic sense of movement.
- A perceptual experience without external stimuli.
- Can involve multiple sensory representations: touch, sight, smell, and sound.
What is Mirror Box Therapy used for?
- Involves looking at a mirror image for visual stimulation and motor preparation.
Key components:
- Action observation: Movement of the unaffected side is reflected, stimulating motor areas.
- Sensory stimulation: The affected side receives stimulation behind the mirror (synchiria).
- Motor practice: Bilateral movements engage the target limb behind the mirror.
what are Prism Glasses used for?
- Refract light to ensure it reaches the same area on each retina.
- Can correct left/right, anterior/posterior shifts, or a combination of both.
Used to treat:
- Visual Midline Shift Syndrome
- Neglect
- Pusher Syndrome
- Double Vision
- Visual Field Deficits
What is Neglect?
- Impaired awareness of stimuli on one side of the body.
- Not caused by sensory or vision loss.
- Can reduce independence and pose safety risks.
what might a person with left-sided spatial neglect experience?
- Seldom turn their head toward the left side
- Experience difficulty finding objects on their left side
- Not realize that their left arm is dangling off of the wheelchair
- Bump into things on their left side when moving around indoors (ie when wheeling wheelchair or when walking)
- Forget to lock their wheelchair on the left side
What are some treatment strategies for left sided neglect?
- Encourage visitors to sit on their left when talking to them.
- Arrange the environment to provide stimulation, such as placing the television, a family photo, or a vase of flowers on their affected side.
What are some treatment strategies for neglect?
- Education & Cueing: Place objects on the affected side to encourage attention and use.
- Gradual Approach: Start on the unaffected side, then move to the affected side.
- Lighthouse Strategy: Turn head and body to scan.
- Constraint-Induced Therapy: Restrict unaffected limb with a sling/mitt to force affected limb use.
- Visual Cues: Place signs in key locations.
- Weight-Bearing Activities: Engage the affected side.
- Mirror Therapy
- Prism Glasses
- Eye Patches
What is pusher syndrome?
Term used to describe the behaviour of individuals using their non-parectic limb to push themselves towards their paretic side
What are some treatment methods for Pusher Syndrom?
- Hard work + being on the affected side to teach the patient where their proper alignment is located
- Will often require a PTA to assist with this treatment approach.
- Mirror can be used
What is Motor Imagery?
- mentally practicing meaningful activities without actual movement
- imagining each part individually
Who can benefit from Motor Imagery?
- Stroke survivors, especially those with limited or no movement in their limbs
- neglect on one side of their body.
How does Motor Imagery work?
- activates brain areas involved in movement
- strengthening neural connections damaged by stroke through neuroplasticity
What are some examples of Motor Imagery exercises?
- reaching for a cup
- chopping vegetables
- walking a dog.
What does research say about Motor Imagery effectiveness?
Strong evidence supports its role in improving movement and restoring daily activity participation.
When is Motor Imagery most effective?
Within the first six to eighteen months after a stroke, though benefits may still occur afterward.
Where can Motor Imagery be practiced?
Anywhere, but a quiet environment is best for concentration.
What should be expected when practicing Motor Imagery?
A minimum of 10-30 minutes per day, five times a week for 2-3 weeks, with potential improvements in movement or awareness.
What are some challenges of Motor Imagery?
- Benefits take time to appear
-some may experience frustration - boredom or fatigue from concentration.
Are there any risks associated with Motor Imagery?
No known risks, but effectiveness varies, and individuals should work with a therapist for best results.
what is Tone
- Resistance offered by muscles to continuous passive stretch
- Increased vs decreased
What are the levels of the modified ashworth scale for muscle tone?
0 - no increased muscle tone
1 - Slightly increased with the ability to resist minimal resistance at end of ROM
1+ - Slightly increased with the ability to resist less then half of ROM
2 - increased muscle tone throughout most ROM but affected parts are easily moved
3 - Considerable increased muscle tone and passive movement is difficult
4 - Rigid in Flexion and extension
What is Hypotonia?
- Low tone/flaccidity
-Variable time period post-injury
What is Hypertonia?
-Increased tone
-Is not dependent on velocity
-Can be without spasticity or in most severe situations will involve spasticity
What is Spasticity?
-Increased tone
-Velocity-dependent increase in muscle tone in response to passive movement (tonic stretch reflexes with exaggerated tendon jerks)
For example, with spasticity of the legs (spastic paraplegia) there is an increase in tone of the leg muscles so they feel tight and rigid and the knee jerk reflex is exaggerated.
What are some pathological activity for Hypertonia?
- Positive support reaction: Pattern of plantarflexion and rigid extension of LE with weight-bearing
- Flexor withdrawal response of LE: Flexion, abduction, external rotation of hip, Flexion at knee, Inversion and dorsi/plantarflexion at ankle
- Grasp reflex
- Extensor response: Limb extension with spine arching
- Associated reactions: Involuntary stereotyped abnormal movement patterns on affected side and coincide with effort at another body part
What conditions might spasticity be seen in?
- Strokes
- Cerebral palsy
- Traumatic Brain injury
- MS
- SCI
- Acquired Brain injury
What are the 4 types of spasticity that may be presented?
- focal: Affects a specific muscle or small group of muscles
- multi-focal: Involves multiple, separate, areas of the body
- regional: Affects a larger region of the body (entire limb)
- Generalized: Impacts most or all of the body
what might an abduction and internal rotation spasticity lead too?
- shoulder stiffness and painful passive ROM
- Difficulty bathing, applying deodorant, and dressing
what might an Flexed elbow spasticity lead too?
- skin maceration and breakdown
- instability to reach or grasp
- Difficulty with dressing
what might a clenched fist/Thumb in palm spasticity lead too?
- inability to wash palm
- skin maceration or breakdown
- Difficulty dressing
what might a flexed knee spasticity lead too?
- Slide forward in seat or wheelchair
what might abducted thigh spasticity lead too?
- interferes with hygiene and dressing
- scissored gait
what might Equinovarus foot spasticity lead too?
- Difficulty or pain when wearing shoes
- skin breakdown
- pain in fifth metatarsal
- lack of heel contact when ambulating
What are some common post stroke spasticity patterns?
- Clenched fist
- striatal toe
- equinus food deformity
- knee ext and PF
what percent of post strokes have spasticity and in how many weeks?
27% of pt within 6 weeks
52% of pt within 6 months in at least one joint
what are some impacts and burdens of spasticity on the patient?
- Joint contractures
- limited active function
- limited passive function
- pain
- reduced quality of life
- risk of falls
- caregiver dependency
what are some impacts and burdens of spasticity on the caregiver?
- Fatigue
- emotional distress
- work absenteeism
- reduced work productivity
- reduced quality of life
- assistance increased of daily hygiene
what are some possible treatments for Spasticity/contractures?
- Splinting
- Surgery
- Serial casting
- Botox, medications
- Taping
- Electrical muscle stimulation
what are some PT managements for Hypotonia?
- Positioning and support to avoid injury, edema
- Weight-bearing in good alignment
- Facilitation techniques
what are some PT managements for Hypertonia and provide an example?
- Firm pressure can be applied manually or by body weight.
- Slow, sustained stretches. Prolonged pressure to long tendons inhibits the hypertonicity of a muscle.
- Gentle mobilization
- Reflex inhibiting postures (RIP): Provide inhibitory pressures
Examples:
4-point kneeling and 2-point kneeling for inhibition of quadriceps
Sitting with hand open, elbow extended, and upper extremity supporting body weight for inhibition of long finger flexors
What are agonist versus antagonist muscle groups
- Assess the impact of antagonistic muscle groups when treating a spastic muscle.
- Antagonistic muscles may also be weak or spastic.
- Treating only the agonist muscle can create further issues.
- Evaluate whether spasticity aids function (e.g., transfers) to avoid reducing mobility.
what is Ataxia?
A movement disorder causing lack of muscle control, poor coordination, and inadequate postural control.
what are key signs of Ataxia?
- Decreased coordination and balance
- Unsteady gait
- Poor fine motor skills
- Speech changes
- Nystagmus (involuntary eye movements)
- Swallowing difficulties
What are common symptoms of ataxia?
- Dysmetria (under/overshooting movements)
- Tremors (intention and postural)
- Titubation (head/trunk shaking)
- Dyssynergia (sudden velocity changes)
- Dysdiadochokinesia (difficulty with rapid alternating movements)
- Hypotonia (low muscle tone)
- Dysarthria (poor speech articulation)
- Nystagmus (abnormal eye movements)
- Muscle spasms
What are the main goals of physical therapy (PT) for ataxia?
- Improve balance and posture
- Strengthen upper extremities
- Maximize independent mobility
What PT techniques help manage ataxia?
- Increasing proprioceptive input (therabands, weights)
- Trunk and proximal muscle stabilization
- Static-to-dynamic training (kneeling, balance boards, Wii Fit)
- High-intensity practice for improvements
- Gait training with visually guided stepping
- Vestibular rehabilitation exercises
- Slow, controlled, multi-joint movements
- Use of supportive aids when needed
What are synergistic patterns?
Synergistic patterns are stereotyped, primitive movement patterns associated with spasticity or increased muscle tone. They result in the loss of isolated movement control and have important functional implications.
What are the components of the flexion synergy pattern in the upper extremity?
- Scapula: Retraction/Elevation
- Shoulder: Abduction, External Rotation
- Elbow: Flexion* (most dominant component)
- Forearm: Supination
- Wrist/Fingers: Flexion
What are the components of the extension synergy pattern in the upper extremity?
- Scapula: Protraction
- Shoulder: Adduction* (most dominant), Internal - Rotation
- Elbow: Extension
- Forearm: Pronation
- Wrist/Fingers: Flexion
What are the components of the flexion synergy pattern in the lower extremity?
- Hip: Flexion (most dominant), Abduction, External Rotation
- Knee: Flexion
- Ankle: Dorsiflexion, Inversion
- Toes: Dorsiflexion
What are the components of the extension synergy pattern in the lower extremity?
- Hip: Extension, Adduction (most dominant), Internal Rotation
- Knee: Extension (most dominant)
- Ankle: Plantarflexion (most dominant), Inversion
- Toes: Plantarflexion
What is the purpose of “unwinding” a patient into a neutral supine position?
It helps to reduce abnormal muscle tone and break synergistic movement patterns, allowing for better functional movement.
What are some treatment strategies for addressing spasticity/high tone?
- Flexing a knee that is in high extensor tone to break the synergy pattern.
- Stretching the calf muscles for patients with high flexor tone.
What are some treatment strategies for addressing ataxia?
- Frenkel Exercises (coordination training).
- Weighted vest to improve stability.
- Wrist/ankle weights to help control movement.
- Theraband for resistance training and control.
