Neural System 3: Spasticity

Question 1

What is spasticity?

Answer 1

caused by a lesion on the spine or brain which leads to reduced neural innervation and increased tone

Question 2

Spasticity is synonymous with _________

Answer 2

hypertonicity

Question 3

What is muscle tone?

Answer 3

continuous tension in muscle

• normal tone enables motor function
• low tone = flaccid
• high tone = excessive muscle tension

Question 4

spasticity is ___________ resistance to ________ stretch

Answer 4

velocity-dependent

passive

Question 5

What scale measures spasticity?

Answer 5

Ashworth Scale (0-4)

Question 6

Hypertonicity can lead to impairment with:

Answer 6

1. ROM
2. coordination
3. skin hygiene
4. pain
5. functional mobility
6. ADLs

Question 7

What are muscle spasms?

Answer 7

increased muscle tension following musculoskeletal injury and inflammation

no damage to brain or spinal cord

Question 8

What overall drug class is used to treat spasticity and muscle spasms?

Answer 8

Muscle Relaxants

and

Antispasticity meds

Question 9

Drug list for treating muscle spasms and spasticity

Answer 9

1. Tizanadine
2. Cyclobenzaprine (Flexaril)
3. Diazepam (Valium)
4. Botox (botulinum toxin)
5. Baclofen (Lioresal)
6. ITB pump (intrathecal baclofen)

Question 10

What type of drug is tizandine?

Answer 10

alpha-2 agonist

Question 11

MOA of tizanadine

Answer 11

bind to alpha-2 receptors to decrease excitatory NTs which decrease excitability to post synaptic neurons

Question 12

tizanadine instructions for use

Answer 12

2-3x/day

PO at night

must tritate to find correct dosage

Question 13

tizanadine AEs

Answer 13

1. drowsiness
2. dizziness
3. asthenia
4. sedation (within 30 min, peaks 1.5 hrs after dose)
5. hypotension (within 1 hr, peaks 2-3 hrs after dose)

Question 14

what type of drug is cyclobenzaprine (Flexaril ) and diazepam (Valium)?

Answer 14

Centrally acting antispasmodic

Question 15

MOA of centrally acting antispasmodics

Answer 15

Unknown

might inhibit polysnaptic reflex in spinal cord

possible GABA and serotonin effects

Question 16

instructions for use of cyclobenzaprine (Flexaril)

Answer 16

onset: 1 hr
peak: 3-8 hrs
duration: 12-24 hr

Question 17

AEs of cyclobenzaprine (Flexaril)

Answer 17

1. sedation
2. dizziness
3. **on the Beers list

Question 18

Note on Benzodiazepines (aka Valium)

Answer 18

Schedule IV drug

Sedation and respiratory depression when used with opiods

Question 19

how does botox work?

Answer 19

works at the neuromuscular junction to block the release of ACh

Question 20

T/F: botox has decreased efficacy with longterm use

Answer 20

TRUE

Question 21

instructions for Botox use

Answer 21

onset: 1-3 days

duration 3-6 months

Question 22

Botox (botulinum toxin) AEs

Answer 22

Boxed warnings!

may spread to distal tissues causing issues = distant paralysis

Question 23

what type of drug is Baclofen (Lioresal)?

Answer 23

Ethyl Alcohol and Phenol Direct Acting Agent

Question 24

Baclofen MOA

Answer 24

inhibits excitatory neurons = decreased NT release and K+ influx to increase inhibition

Question 25

Use of Baclofen (Lioresal)

Answer 25

PO intrathecal pump (ITB)

Question 26

baclofen (Lioresal) AEs

Answer 26

1. CNS depression 2. muscle weakness 3. memory and cognitive impairments in adults with TBI

Question 27

why would someone use an ITB?

Answer 27

better results with less AEs generally need smaller doses

Question 28

PT notes for post-implantation of ITB?

Answer 28

1. assess changes in motor skills due to muscle tone changes 2. equipment modifications 3. no modalities near pump site 4. refill is needed every 3 months 5. battery must be replaced every 4-5 years

Question 29

Complications of an ITB pump

Answer 29

1. infection 2. dislodgement 3. kinking and blocking 4. failure 5. observe for signs of withdrawl or overdose

Question 30

Boxed warnings for ITB

Answer 30

abruptly stopping meds can cause: 1. fever 2. altered mental status (AMS) 3. exaggerated rebound spasticity/rigidity 4. in extreme cases 1. rhabdomyolysis 2. organ failure

Question 31

Therapeutic concerns for pts on muscle relaxants and antispastic meds

Answer 31

1. sedation and weakness are biggest AEs 1. can result in limited participation in PT 2. requires intensive PT to develop new motor patterns and functional abilities 3. must assess equipment 4. be aware of ITB pump malfunctions