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NM 2 > lecture 5: managment of spasticity > Flashcards

lecture 5: managment of spasticity Flashcards

1
Q

what is mm tone

A

resistance to stretch in resting

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2
Q

MM tone exists on a continuum so what does these mean

  • flaccidicty
    -hypotonia
    -hypertonia
    -spasticity
    -rigidity
A
  • flaccidicty: complete lack of resistance

-hypotonia : abnormally low resistance

-hypertonia: abnormally high resistance to passive stretch

-spasticity : velocity dependent

-rigidity: velocity independent

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3
Q

what is spasticity

A

velocity dependent resistance to passive stertch

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4
Q

does spasticity affect people with UMN or LMN lesions

A

UMN

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5
Q

which condition is spasticity incidence the highest

A

CP

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6
Q

what is a chronic loss of PROM of a joint because of structural changes in non bony tissues

A

contractures

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7
Q

____ and ___ significantly contribute to contractures, but are not
the sole cause.

A

Spasticity and paralysis

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8
Q

what are 4 ways that spasticity may be helpful

A
  • assist patients w postural control and mobility
  • maintaining mm mass and bone mineralization
  • reduce dependent edema
  • prevent DVT
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9
Q

what are teh 5 clinical assessment measure of spasticity

A
  • Placing (NDT - see lab notes)
  • Modified Ashworth Scale
  • Tardieu Scale
  • Penn Spasm Scale
  • Patient Reported Impact of Spasticity Measure (PRISM
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10
Q

if a patient has a Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder
(less than half) of the ROM what grade is it on the modified asworht scale

A

1+

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11
Q

if a patient has a Considerable increase in muscle tone, passive movement is difficult what grade would that be on the modified ashworth scale

A

3

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12
Q

if the patient has no increase in tone what is the grade on the modified ashworth scale

A

0

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13
Q

what is the velocity of stretch for the tardieu scale to measure spasticity and what is V1-V3 used for

A

v1: as slow as possible (passive)
v2: speed of limb fallling w gravity
v3: as fast as possible

V1 used for PROM
V2 & 3 for spasticity

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14
Q

what is the angle of mm reaction for the tardieu scale

A

measured from 0° position

R1= PROM will catch point
R2: full PROM

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15
Q

for the QUality of mm reaction of the tardieu scale what would a patient be graded if there was a clear catch at precise angle , followed by a release ?

A

grade 2

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16
Q

for the QUality of mm reaction of the tardieu scale what would a patient be graded if there was a fatigable clonus at precise angle

A

3

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17
Q

what is the patient reported impact of spasticity measured ?

A

self report measure of impact of spasticity on numerous things

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18
Q

what are the 7 medical management of spasticity

A
  • botulinum toxin A
  • baclofen (oral or intrathecal pump)
  • nerve or motor point block
  • spinal or cerebral electrical stimulation
  • peripheral neurotomy
  • rhizotomy
    -tendon release w/without transfer
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19
Q

what is the only strain of Neuroparalytic toxin produced by clostridium botulinum bacteria avaiable for clinical use

A

type A

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20
Q

what are the brand names of botulinum toxin A

A

botox, dysport , xeomin

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21
Q

how does botox work for spasticity

A

blocks acetylcholine relseae at the NM junction , autonomic ganglia and posthganglionic parasympathetic and sympathetic nerve endings

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22
Q

for botox does slow twitch fibers recover then fast twitch ? or slower ?

A

faster

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23
Q

how do you use BOTOX and how do u dose it

A

inject directly into the MM BELLY

dose based up body weight , size of the mm , client activity levels , and levels of spasticity

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24
Q

• Can be injected for selective muscle
paralysis
• No dysesthesia
• Less muscle irritation
• Minimal pain (done in MD office)
• Graded degree of weakening
• Frequently used during growth
spurts

these are advantages for what

A

botox

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25
• Costs • Limits in amount of drug that can be administered at one time • Not permanent, and can develop decreased response, because of antibody production • Re-injected no more frequently than once per 3 months • Muscle can be overstretched • Side effects: can produce fever, swelling, hives. what is this disadvantages to
botox
26
what are **contraindications** of BOTOX
- NM trasnmission disease -inflammation at projected injection site - preganancy - children under 2 years of age
27
what oral medication can be used for systemic effect for **generalized spasticity**
baclofen , tizanidine, dantrolene, clonidine, diazepam
28
**topical anesthesia** is applied to entire extremity **except** what surfaces
extensor surfaces over lower leg and forearm
29
what can be given oral bs intrathecal and is effective in **reducing spasticity**
baclofen
30
what is the mechanism of action of baclofen
not fully understood inhibits reflexes at the spinal cord level possibly inhibits excitatory NT relsease (looks like inhibitory NT GABA)
31
- Does not reach the systemic circulation or brain in appreciable amounts • Fewer systemic side effects as stays in area of the cord rather than circulating in the bloodstream • Provides a mechanism for patients who otherwise would not tolerate oral baclofen • Can be used for the management of spinal (SCI, MS) and supraspinal (CP, CVA, TBI) spasticity • Can positively affect pain in these populations • Improvements in voluntary muscle control what does this relate to
INTRATHECAl BACLOFEN PUMP ( I T B )
32
what are **contraindications** for intrathecal baclofen pump
-* Allergy or hypersensitivity to baclofen * Active infection
33
what are teh adverse effects of intrathecal baclofen pump
-risk of pump malfunction or tip displacement - overdose if pump malfunctions causes sedation , respiratory depression , decreased cardiac function - rapid cessation causing withdrawal syndrome -risk of disinhibition
34
what is the implantation of the intrathecal baclofen pump
• Catheter is inserted into subarachnoid space at L3-4 with catheter tip extending to T12-L1. • Pump is implanted in abdomen
35
what are the **short** and **long** term effects of **nerve or motor point blocks**
short term is similar to local anesthetic , directly proportional to thickness of fibers long term casues protein denaturation
36
what is a advantage difference between botox and nerves or motor point blocks for spasticity
botox does not cause dysesthesias when nerve block does botox casues less mm irritation as compared to nerves block nerve block last longer then botox
37
spinal cord stimulation=
dorsal column stimulation
38
what is the **advantage** of **spinal stimulation**
better tone management of UEs then baclofen pump
39
what is the cerebral electrical stimulation
- sensory stimulation of sensory nuclei of thalamus for pain control - cerebellar stimulation for movement disorders
40
what is a rhizotomy
certain % of sensory nerve root lets are cut
41
where is a rhizotomy usually performed and what does it require
performed in lower thoracic or lumbar regions and requires laminectomy or laminotomy
42
are there more advantages or disadvantages for a rhizotomy
disadvantages
43
what **tendons** are most commonly released for a **tendon release**
hamstrings and heel cord (achilles)
44
does a tendon release a change the mechanism for how mm adn tendon lost original length
NOOOO
45
what is SPLATT
split anterior tibialis tendon transfer lateral aspect attached to cuboid , frequently after heel cord lengthening
46
for the tendon release with transfer the ___ ___ tendon transfer from ___ surface of ___ cuneiform to dorsum of ____
Peroneus longus tendon transfer from plantar surface of medial cuneiform to dorsum of navicular
47
• Passive stretch • Electrical stimulation • EMG biofeedback • Temperature • Casting and splinting • Medications what kind of treatments are these for reduction of spasticity
non invasive
48
what is the physcial therapy management of spasticity
-objective assessment -stretching and range of motion exercises -strength training
49
from stretching and range of motion exercises for PT management of **spasticity** how long wold u have to **stretch**
long time 20-30 years
50
what is functional/ neuromuscular electrical stimulation
- antagonist stimulation to increase reciprocal inhibition of spastic mm and increase strength of antagonist
51
what are contraindications to TES ( 4 )
• Primary muscle disorder • Degenerative disease • Behavioral disorders • Medical complications (strict) Arrhythmia Pacemaker Pregnancy • Growth complications Obesity Fixed contractures
52
what do u use **therapeutic electrical stimulation** for
general spasticity that interferes with function
53
when do u use Therapeutic electrical stimulation (TES)
• Used at night during peak secretion of growth hormone to prevent disuse atrophy
54
what **electrical stimulation** is used to treat **pain** associated with spasticity to break spasticity pain cycle
TENS
55
what do u use **EMG biofeedback** to promote
* To promote **voluntary relaxation**, keeping readings below threshold * To promote **voluntary active efforts**, in combination with FES/NMES when threshold reached
56
what **nonremoveable** cast is more successful wehn **contracture** present < 6 months adn when patient is **able** to use extremity
serial cast
57
are cast and AFOs static or dynamic
static
58
what **splint** is very good with **painful/hypersensetive** patients , holds limb in **inhibited posture** ,and applies deep pressure stimulation acts on proprioceptors
air filled pressure splint
59
what is used for general relaxation , hot or cold ?
hot
60
what is used to numb skin receptors (hot or cold)
collie

NM 2 (17 decks)

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