Muscle Overactivity Flashcards
(34 cards)
What is muscle tone
Muscles resistance to being passively lengthened that is not influenced by pain or orthopedic condition
At rest!
Tone spectrum (scale)
Flaccid - hypotonic - normal - hypertonic - ridgid
Upper motor neuron excessive signs (positive)
Hyper reflexia
Clounus
Spasticity
Spasms
Co-contractions
Associated reactions
Upper motor neuron insufficient signs (negative)
Weakness
Impaired motor planning
Impaired motor control
Fatigue
What is spasticity
Increase in muscle tone due to hyper excitability of the stretch reflex
Velocity dependent!
Why is muscle overactivity a problem
Muscle shortening
Atrophy
Decreased extensibility
Increased muscle sensitivity
Decreased ability to isolate muscle contraction
Increased co-contraction
Decorticate
both UEs in flexion, LE in extension
Decerebrate
Upper and lower in extension
(E’s in the word = ext)
Assessment components
Posture at rest
PROM with varying speeds
Active movements
Standardized assessment tool (modified ashworth)
Modified Ashworth scale
0 - normal, no increase in muscle tone
1 - slight increase at the end of the ROM
1+ - Slight increase w/ less than half the ROM
2 - more marked increase throughout most of the ROM
3 - Considerable increased in tone, PROM difficult
4 - affected part rigid in flex or ext
Tardieu scale
Mostly used in research
Three velocities that are standardized
What can impact muscle over activation
Fatigue
Pain
May only occur in certain postures/positions
Underlying medical condition may produce changes
UE fixed posture implications
Decreased hygiene
Wounds from fingernails
Decreased ADL’s
Decreased balance reactions
Decreased use of assistive devices
LE fixed posture implications
Decreased positioning in WC
Abnormal pressure spots
Decreased mobility for transfers and ambulation
Decreased balance in sitting and standing
What can poor positioning lead to
Contractures
Skin breakdowns
Changes in muscle composition
Treatment considerations
Time of injury, severity, and nature of deformity
Cognitive status
Risks/benefits
Effect on functional status
Concurrent impairments
Heterotopic Ossification
Abnormal formation of new bone around joints
Commonly forms in one well-defined plane
Prevalence: 10-20%
Often occurs in areas with spastic muscles
Diagnosising HO
Physical exam
Elevated SAP
X-rays
CT scan
Treating HO
PT: increase/maintain ROM
Medications: Didronel, indocin
Manipulation
Surgical incision: ~12-18 months after injury
Radiation
Active goals
Improve:
AROM, mobility, ADL’s and QOL
Passive goals
Decrease:
Pain and spasms
Improve:
PROM, positioning and ease of care
Treatment options
Weight bearing
Heat/Ice
Stretching/splinting
Functional Estim
TEN
Strengthening and neuromuscular reeducation
Serial casting
Weight bearing
Provides long duration stretch
Places muscles in anti reflex positions making it less likely to cause spasms
Stretching/Splinting
Maintain joint ROM
Increase ROM
Joint protection in a functional position
Rate of stretch is slow to prevent activation of reflex arc
