2.9 Tone and Reflexes

Question 1

tone

Answer 1

• amount of tension a muscle has at rest

- resting tone works against gravity to hold our limbs in position

Question 2

resting threshold of tone

Answer 2

always signals going to muscle and up and down the spinal cord

Question 3

What does someone who has high resting tone need to get to normal “relaxed”?

Answer 3

needs a lot of inhibitory signals to get to relaxed

Question 4

What does someone with low resting tone need to get to contraction?

Answer 4

needs a lot of excitatory signals to contract the muscle

Question 5

types of tone

Answer 5

• normal
• hyper
• hypo

Question 6

two categories of hypertonicity

Answer 6

• spasticity

- rigidity

Question 7

Spasticity is dependent upon

Answer 7

velocity

Question 8

How is spasticity velocity dependent?

Answer 8

• if you move the limb slowly, can get through full ROM

- moving it quickly will increase the contraction

Question 9

types of spasticity

Answer 9

• clonus
• spasms
• dystonia
• spastic co-contraction

Question 10

What is the scale used to grade spasticity?

Answer 10

Ashworth scale

Question 11

clonus

Answer 11

• UMN problem, usually found in distal extremities
• put a stretch on the muscle, it excites it
• unless you move them out of the position that produced the clonus, it potentiates itself and continues
• typically not a detriment to therapy

Question 12

How do we refer to clonus?

Answer 12

by how many beats it has

Question 13

spasm

Answer 13

involuntary contraction

Question 14

spasm and therapy

Answer 14

typically not a detriment to therapy unless every time they do a motion, it creates a spasm

Question 15

• constant twitching in the eyelid

- can get to where they become blind

Answer 15

blepharospasms

Question 16

type of spasticity where we don’t really know why they have it

Answer 16

dystonia

Question 17

dystonia

Answer 17

• can range from full body, cervical (torticollis), other areas
• not a clear cut definition
• affects number of different age groups

Question 18

Who commonly gets spastic co-contraction?

Answer 18

CP

Question 19

How does spastic co-contraction affect gait?

Answer 19

agonists and antagonists are both firing at the same time, can’t create coordinated, smooth movement

Question 20

using spasms to advantage

Answer 20

a patient can figure out how to elicit and manipulate their spasms to facilitate a certain movement

Question 21

rigidity and the brain

Answer 21

• UMN lesions

- flow through pyramidal tracts

Question 22

rigidity and velocity

Answer 22

• not velocity dependent
• resistance to movement is present at low speed joint movement
• don’t have to hit certain velocity of movement or joint angle to get it to catch

Question 23

two types of rigidity

Answer 23

• cog wheel

- lead pipe

Question 24

cog wheel rigidity

Answer 24

“ratchet” action

puuuuuush then pop.

Question 25

lead pipe rigidity

Answer 25

- don't get it to move | - like trying to bend a lead pipe

Question 26

How is rigidity similar to spastic co-contraction?

Answer 26

typically have agonist and antagonist contractions at the same time

Question 27

movement of distal or proximal joints: spasticity and rigidity

Answer 27

spasticity: movement around rigid joint may elicit more spasticity rigidity: movement around rigid joint doesn't elicit more rigidity

Question 28

Rigidity: if you're able to get any additional ROM, what happens?

Answer 28

it will stay there

Question 29

rigidity leads to

Answer 29

- loss of ROM | - loss of function » falls

Question 30

problem with hypotonicity

Answer 30

flaccidity

Question 31

flaccidity: lesion location

Answer 31

- LMN lesions | - extrapyramidal tracts

Question 32

DTR levels: biceps

Answer 32

C5-C6

Question 33

DTR levels: brachioradialis

Answer 33

C5-C6

Question 34

DTR levels: triceps

Answer 34

C6-C8

Question 35

DTR levels: patellar

Answer 35

L2-L4

Question 36

DTR levels: plantar (achilles)

Answer 36

S1-S2

Question 37

normal for reflexes:

Answer 37

2+

Question 38

higher than normal reflexes

Answer 38

3+

Question 39

clonus

Answer 39

5+

Question 40

When should we be concerned about DTR?

Answer 40

if there's a consistent difference between sides

Question 41

reflexes other than DTR

Answer 41

- abdominal - cremasteric - bulbocavernous - anal sphincter

Question 42

abdominal reflex

Answer 42

- scratch skin of abdomen | - umbilicus moves

Question 43

cremasteric

Answer 43

- only SCI | - stroking of proximal thigh skin creates scrotal lift

Question 44

bulbocavernous

Answer 44

- only SCI - grab tip of penis, pinch, pull - will get a contraction of the penis trying to contract back in

Question 45

anal sphincter

Answer 45

- only SCI | - anal wink test

Question 46

abnormal reflexes

Answer 46

- jaw - snout - glabellar - Hoffman's

Question 47

abnormal reflexes: jaw

Answer 47

- CN V - stretches masseter, teeth clamp down - CN involvement with MS

Question 48

abnormal reflexes: snout

Answer 48

- CN VII | - upper lip creates puckering

Question 49

abnormal reflexes: glabellar

Answer 49

- CN VII - repeatedly tap the forehead between the eyebrows - usually blink a lot

Question 50

abnormal reflexes: Hoffman's

Answer 50

median nerve