Lecture 4 Spasticity Flashcards
What is the main difference between spasticity and rigidity
Spasticity is velocity dependent
rigidity is all time
Spasticity Incidence by diagnosis
CP- 90%
MS: 47-70%
TBI: 51%
SCI: 34%
Stroke: 20%
How do you rate a normal DTR?
0- No Response
1- Sluggish or diminished
2- Normal
3- Brisk
4- hyperreflexive or intermittent/transient clonus
The modified ashworth scale measures what?
Spasticity
Grading of ashworth scale
1- No Increase in tone
2- slight increase in tone, giving a catch when moving into flexion or extension
3- Marked increase in tone but affects parts easily flexed
4- Considerable increase in tone; passive movement difficult
5- Affected part(s) rigid in flexion or extension
What kind of scale is the modified ashworth scale
ordinal
Modified Ashworth Scale ratings
0- No increase in tone
1- Slight increase with a catch and release. Or by minimal resistance at the end of ROM when joint is moved into flexion or extension
1+ - Slight Increase in muscle tone manifested by a catch, followed by minimal resistance through remainder of the ROM (less than half)
2- More marked increase in muscle tone through most of the ROM, but affected part is easily moved
3- Considerable increase in muscle tone, passive movement is difficult
4- Affected part(s) in rigid in flexion or extension
Considerable increase in muscle tone, passive movement is difficult
What modified ashworth scale rating is this?
3
What modified ashworth scale rating is this: Slight increase with a catch and release. Or by minimal resistance at the end of ROM when joint is moved into flexion or extension
1
What does the tardieu scale measure?
Spasticity
What is V1, V2, and V3 in the Tardieu Scale
V1- moving the limb as slow as possible
V2- Speed of limb falling with gravity
V3- moving the limb as fast as possible
Out of V1, V2, and V3 in the tardieu scale, which are used for spasticity
V2 and V3
How is the tardieu scale graded?
By quality of the muscle reaction through each of the speeds:
0: no resistance through full PROM
1: slight resistance through full PROM with no clear catch
2: clear catch at a precise angle followed by release
3: Fatiguable clonus (Under 10 seconds) at precise angle
4: Unfatiguable clonus at precise angle
How would you grade this on the Tardieu scale: clear catch at a precise angle followed by release
2
How would you grade this on the tardieu scale: Unfatiguable clonus at precise angle
4
What is R1 and R2 on the Tardieu scale?
R1- PROM till catch point
R2- full PROM (till the hard endpoint whether that is their normal end feel or to their contracture)
Penn Spasm Scale
0- No Spasm
1- No Spontaneous spasm (excep with vigorous motor stimulation)
2- Occasional spontaneous spasms and easily induced spasm
3- More than 1 but less than 10 spontaneous spasms per hour
4- More than 10 spontaneous spasms per hour
What is baclofen for and what are the 2 ways it’s administered
For spasticity
Oral and Intrathecal
How does Botox work?
What kind of muscle fibers recover faster after Botox?
Blocks acetylcholine release
Slow twitch fibers recover before fast twitch
Botox injection effects seen when? Peak effects?
How is dose based
Effects seen 24-72 hours, peak effects 4-5 days, lasts 8-12 weeks
If casting is indicated, start 2-4 days after injection
Dose based upon body weight, size of muscle, client activity and levels of spasticity
What are the advantages of Botox
Selective to muscles you want to paralyze
No dysesthesia and less muscle irritation
Minimal pain
Graded degree of weakening
Frequently used during growth spurts
Disadvantages of Botox
Costs
Limit in amount that can be administered at once
Not permanent, can develop tolerance
Reinjection cannot be more frequent than once every 3 months
Muscles can be overstretched
Side effects: fever, hives, swelling
Botox contraindications
Neuromuscular transmission disease
Inflammation at projected injection site
Pregnancy
Children under 2 years old
How soon do you preform the Botox post-injection assessment
2 weeks
