Problems w/ Body Structure/Function: Abnormal MM Tone and Motor Control: Exam 1 Flashcards
1
Q
Muscle Tone
what is it?
A
Resist. offered by mm’s when passively lengthened
*like a dimmer switch that can be turned up/down
2
Q
MM tone will be uniform _________ @ all speeds
A
resistance
3
Q
Some ex’s of Abnormal MM tone
A
- HypOtonia/flaccidity
- flaccidity==comp. absence tone
- HypERtonia
- spasticity—-velocity dep.
- rigidity—non-velocity dep.
- Dystonia
- Spasm
4
Q
Dystonia
A
Involuntary mm contractions
force body into abnorm/painful postures
5
Q
MM Spasm
A
sustained involuntary mm contraction
6
Q
HypOtonia
what is going on?
A
- LOSS of normal alpha-gamma coactivation
- slack spindle, no proprio. input
7
Q
HypOtonia
Pathologies:
A
- Down’s
- Cb damage
- UE paralyzed after CVA
- UE more common
8
Q
Hypotonia
what should you examine?
A
- Passive motion
- Relaxed posture —- whole posture
9
Q
Hypertonia
Spasticity
A
-
Velocity-dependent INC in resist. to PROM
- add speed===INC resistance
10
Q
Hypertonia
Rigidity
A
-
NON-velocity dependent INC resistance to PROM
- stiff regardless
11
Q
Spasticity vs. Spastic Paralysis
A
2 diff. things!!!
12
Q
Hypertonia
what should you Examine?
A
- passive mvmt @ varying speeds
- consider abnorm reflexes
- DTR’s
- Clonus
- Babinski
- observe posture @ rest
13
Q
Rigidity
Decorticate
the FLEXION one
A
- UE Flexion
- trunk, and LEs in EXT
***LOOK AT THE ARMS THOUGH—-THIS IS THE FLEXION ONE!!!
14
Q
Rigidity
Decerebrate
the one w/ all the e’s…..EXTENSION ONE!!!
A
- EXT of trunk and ALL extremities!!!
15
Q
Rigidity
2 types
A
- Lead pipe
- SLOW resist. t/o ROM
- Cog Wheel
- catch and release t/o ROM
16
Q
Measuring Tone
A
- Min, Mod, Severe
- describe specific mm groups
- WHERE in the ROM resistance is encountered
- Modified Ashworth
NOTE: NO SCALE FOR HYPOTONIA
17
Q
Modified Ashworth Scale
Explain
A
- Controlled, but rapid PROM @ ea jt thru ROM
- Starting point:
- limb @ rest w/ pt pos’d comfortably
- Score:
- 0-4/4
18
Q
Mod. Ashworth
Grade 0
A
NO inc in mm tone
19
Q
Mod. Ashworth Scale
Grade 1
A
SLIGHT INC. in mm tone
manifested by catch and release OR by MINIMAL RESIST. @ end range of motion when part moved
20
Q
Modified Ashworth
Grade 1+
A
SLIGHT INC mm tone
manifested by catch, followed by MIN resist. t/o remainder (<50%) of ROM
21
Q
Mod. Ashworth
Grade 2
A
MORE marked INC in mm tone thru MOST (>50%) of ROM
BUT affected part is easily moved
22
Q
Mod. Ashworth
Grade 3
A
CONSIDERABLE INC’S in mm tone, passive mvmt is difficult
23
Q
Mod. Ashworth
Grade 4
A
affected part is rigid in position
24
Q
Hypertonia causes
Neural Mech’s
A
- AMNs are more sensitive to input
- depolarized—-closer to firing threshold
- net INC excitatory inputs
- net DEC inhibitory inputs
25
Hypertonia
## Footnote
**NON-Neural Causes**
* altered **viso-elastic props** of connect. tissue from **immobilization**
* ****tendons, ligs, jt cap
* contractures
* changes in **mm fiber structure**
* ****fibrosis, atrophy
* free Ca+ in motor fibers
26
3 other ways to measure mm tone
1. functional performance
2. self-report scale
3. reflexes
\*\*H-reflex----sensitivity of AMN system
27
Flexibility is the cornerstone to.....
Mobility!!!!!
28
Treating abnormal tone
* Consider:
* neural and non-neural mech's
* systems
* **Functional relevance**
29
changing tone does NOT necessarily.....
change function!!!
if they are functioning w/ it.....no need to "treat" it
30
In relationship to function
when would you want to test mm tone?
passively vs. their motor behavior DURING functional activity
31
Treating Hypertonia
## Footnote
**pharmacologically**
* Baclofen----antispasmatic
* valium
* botox
32
Treating Hypertonia
Sx
nerve cut or block
33
Treating hypertonicity
## Footnote
**prolonged stretch**
* serial casting
* air splints
\*restores ROM and minimizes reflex
34
2 other ways to treat hypertonicity
rhythmical rotation (exactly what it sounds like)
Wt. Bearing
35
Rational for tx hypertonia
Activating the GTOs
Autogenic inhibition
DIRECT PRESS. to tendon of hypertonic mm
**effects are temporary**
**allows for functional task practice**
36
Spastic paralysis is related to...
abnormal synergy patterns
37
Abnormal synergy is the inability to what?
inability to **isolate mm's or mvmts**
38
Abnormal synergy
group of mm's working together **when they shouldn't**
39
typical patterns for UE/LE synergy patterns combines what
Flex/Ext
40
UE **Flexor** Synergy
see pics
41
UE Flex synergy
Scapula
retraction
downward rotation
elevation
42
UE Flexor synergy
Shoulder
ABD
rel. ER
EXT
43
UE Flex synergy
Elbow
FLEX w/
pro/sup
44
UE Flex synergy
Wrist
FLEX w/
radial/ulnar deviation
45
UE Flex synergy
Fingers
Flexion
46
UE **Extensor** Synergy
see pics
47
UE EXT synergy
Scapula
LESS retraction
Downward rot.
Depression
48
UE EXT synergy
Shoulder
ADD
IR
min. Flex
49
UE EXT synergy
Elbow
EXT
Pro
50
UE EXT synergy
Wrist
FLEX
min. Ulnar dev
51
UE EXT synergy
Fingers
Flexion
52
LE Flex synergy
see pics
53
LE FLEX synergy
Pelvis
elevated
retracted
POST tilt
54
LE FLEX synergy
Hip
flex
ABD
ER
55
LE FLEX synergy
Knee
Flexion
56
LE FLEX synergy
Ankle
DF
inversion
57
LE EXT synergy
see pics
\*\*\*EXT synergy more common in LE
58
LE EXT synergy
Pelvis
elevated
retracted
ANT. tilt
59
LE EXT synergy
Hip
rel. EXT
ADD
IR
60
LE EXT synergy
Knee
EXT
61
LE EXT synergy
Ankle
PF
Inversion
62
Typical Arm Posture w/ Abnorm Synergy
* Shouder ADD.
* **EXT pattern**
* Elbow FLEX
* **FLEX pattern**
* Forearm PRO
* **EXT pattern**
* Wrist FLEX
* **FLEX pattern**
63
Typical Leg posture abnorm synergy
* Hip FLEX and ADD.
* Knee EXT
* Ankle PF
64
Stages of Recovery from Spastic Paralysis
Brunnstrom and Bobath
* Brunnstrom---more detailed
* 7 stages from **flaccid thru full recovery**
* Bobath
* 3 stages
65
Brunnstroms Stages 1 and 2 correlate to...
Bobath stage 1:
Initial Flaccid Stage
66
Brunnstrom's Stages 3 and 4 correlate to...
Bobath's stage 2
Stage of Spasticity
67
Brunnstrom's stages 5 and 6 correlate to....
Bobath's stage 3
Stage of Relative Recovery
68
Stages of Recovery
Brunnstrom and Bobath correlations
see pics
69
Brunnstrom's Stage I
Flaccidity of involved limbs
NO reflex or voluntary mvmt
70
Brunnstrom's Stage II
* MIN voluntary mvmt or **associated rxns**
* ****contraction somewhere else causes contraction where we're looking
* ex. yawn and it kicks off contraction
* mvmts in **partial or whole synergy patterns**
* **Spasticity BEGINS to develop**
71
Brunnstrom's Stage III
* Voluntary control of mvmt synergies
* mvmt may NOT be thru full ROM
* **spasticity reaches peak**
* **Hypertonia @ this point**
* may be severe
NOTE: not everyone starts in stage I
72
Brunnstrom's Stage IV
* SOME mvmts out of synergy
* spasticity declining, but observable
* Ind. can now
* **place hand behind body**
* **flex arm to horiz. pos.**
* **pro/sup wrist w/ elbow @ 90deg**
73
Brunnstrom's Stage V
* DECLINING spasticity
* able to perform **more diff. mvmts OUT of spasticity**
* **indiv. can now:**
* ****arm raise to side (ABD)
* arm raise forward (flex) overhead
* PRO/SUP w/ elbow **extended**
74
Brunnstrom's Stage VI
* Individual, **isolated mvmts**
* ****indiv can: **isolating elbow===huge progress**
* hand from lap to chin
* hand from lap to opp knee
* NEARLY norm.
* NO SPASTICITY
75
Brunnstrom's Stage VII
Normal motor function
76
Brunnstrom's Method
Neurophys. tx based on the use of **reflexes** to **elicit mvmt;** stereotyped **whole-limb mvmt patterns are facilitated**
\*\*\*encouraged abnorm mvmts bc "mvmt is mvmt"
77
Brunnstrom's Method
## Footnote
**Theory**
* synergies due to absence of control **from above**
* Hemiplegia is a reversion back to earlier phylogenic pd
* return of abnorm reflexes====Normal
* seq. of recovery similar to development
* **abnorm synergies can be used early in recovery to facilitate mvmt**
78
Associated Rxns
eliciting of **involuntary mvmt** w/ **resisted voluntary mvmt of some other part of body**
79
How can we use Associated Rxns?
* Facilitate tone in hypotonic mm
* Inhibit tone in hypertonic mm
80
Using Assoc'd Rxns to facilitate/inhibit tone
**Sag. plane UE**
**SAME RELATIONSHIP**
* Resist Flex **uninvolved** ----\> get Flex **involved**
* Resist EXT **uninvolved----\>** get EXT **involved**
81
Using Assoc'd Rxns to facilitate/inhibit tone
## Footnote
**Sag Plane LE**
**Relationship is RECIPROCAL**
* Resist FLEX **uninvolved**-----\> get EXT **involved**
* Resist EXT **uninvolved----\>** get FLEX **involved**
82
Assoc'd Rxns to facilitate/inhibit tone
**Frontal Plane UE**
**Relationship is SAME**
**Ramiste's-like phenomenon**
* Resist shoulder ABD **uninvolved---\>** get shoulder ABD **involved**
* Resist ADD **uninvolved----\>** get ADD **involved**
83
Assoc'd Rxns to facilitate/inhibit tone
## Footnote
**Frontal Plane LE**
**Relationship is SAME**
**Ramiste's Phenomenon**
* Resist hip ABD **uninvoled**----\> get ABD **involved**
* resisted ABD----\> opp. side ABD
84
2 Abnormal reflexes that will Facilitate/Inhibit Tone
1. Asymmetrical Tonic Neck Reflex (the bow and arrow baby)
2. Symmetrical Tonic Neck Reflex (when baby crawls on all 4 holds neck in EXT)
85
ATNR
## Footnote
**Rotation of the Neck facilitates.....**
* EXT of "Chin Side" limbs
* FLEX of "Back of Skull Side" limbs
\*\*Eventually disappears
86
STNR
## Footnote
**EXT. of neck facilitates....**
* UE EXT & LE FLEX
87
STNR
## Footnote
**FLEX of the neck facilitates....**
* UE FLEX and LE EXT
88
NDT Theory or...
Neurodevelopment Theory
89
NDT Theory in a nutshell....
Normalize posture/tone
THEN integrate mvmt
90
W/ NDT
## Footnote
**Abnormal mvmt is the result of what?**
failure to integrate primitive reflexes
91
According to NDT theory....
Normal mvmt CANNOT be superimposed on \_\_\_\_\_\_\_\_\_\_
what must you do?
abnormal posture/tone
**\*Inhibit abnorm mvmt, THEN facilitate normal mvmt**
92
According to NDT Theory
How is Movement improved? Through what?
Thru **inhibition** or **modification of impairments** of **spasticity and abnorm reflex patterns**
93
According to NDT....
what is **motor output controlled by??**
SENSORY INPUT!!!
94
3 Pos's of developmental principles:
1. cepahlo-caudal
2. proximal-distal
3. symmetrical-asymmetrical
95
Developmental principles
## Footnote
**Wt. Shift**
1. Sagittal
2. Frontal
3. Horizontal
96
Tx Principles of NDT
## Footnote
**_Handling_**
* "key points of control"
* Reflex Inhibiting Patterns (RIPs)
* **inhibit abnorm tone/mvmt**
* **Facilitation**
* ****encourages norm. mvmt
97
Tx Principles of NDT
If hypertonia is DEC.... then what can happen?
"Weak" mm's can contract
98
NDT Tx Principles
## Footnote
**Abnorm postural rxns vs. normal postural rxns**
* **Abnorm postural rxns** should be **CHANGED**
* **Normal postural rxns** should be **FACILITATED**
99
4 Steps to NDT Tx
* 1. Prep pt to move---- have to get them out of tone
* **RIPs**
* **sensory stimulation to normalize tone**
* 2. MOVE pt---you move them passively
* 3. Pt ACTIVELY MOVES w/ PT's control
* 4. Pt moves W/OUT ASSIST or control
100
What are the 2 MAIN problems in NDT?
* 1. Abnormal **control** of **movement**
* 2. Abnormal **tone** of **postural mm's**
101
NDT Summary:
## Footnote
**Aim of Tx**
* DEC **spasticity**
* Facilitate **normal** mvmt
\*NOTE: This is only a **temporary reduction**
**NOTE:** **Permanent DEC in spasticity only achieved when pt able to perform selective mvmts.**
102
