Spasticity, Contractures, Artherosclerosis

Question 1

Repetition of reflex arc

Answer 1

Receptor signals to sensory neuron which conducts to inetrneuron in spinal cord which further conduct through motor neuron out to muscle

Question 2

Explain reciprocral inhibition

Answer 2

Definition: inhibition of antagonised causing it to relax during motion
* Ex. during elbow flexion reciprocral inhibition of antagonist so tricep brachii

Question 3

What is the Golgi tendon apparatus and explain Golgi tendon inhibition

Answer 3

• Golgi tendon apparatus is located in transition between muscle and tendon
• Inhibition is golgi tendon adapting to stretch and letting go instead of contract when stretching

Question 4

What is spasticity?

Answer 4

A velocity dependent increase of muscle tone due to disturbance of sensory-motor control caused by injury of the upper motor neuron

Question 5

How is spasticity presented?

Answer 5

• Irregular or continous involuntary activation of muscles
• Recorprical inhibition is impaired causing co-contraction resulting in no movement
• Can affect any part of the body but most common:
  1. Plantar flexors - tricep surae
  2. Flewors of hip - ilipsoas
  3. Adductors of shoulders - pectoralis major

Question 6

Which condition is usually associated with spasticity?

Answer 6

• CP
• MS
• Brain injuries
• Spinal cord injuries
• Tumor of CNS

Question 7

Name 5 typical symptoms of spasticity

Answer 7

• Increased muscle tone
• Increased tendon reflexes
• Increased sensitivity of musclecutaneus reflexes: activation from tight clothes for example
• Clonus = continous spreading of reflexes by passive activation
• Clasp-knife phenomenon

Question 8

How can we diagnose spasticity?

Answer 8

• Ashworth scale for rigidity
• Assess joint mobility
• Clonus scale
• Reflexes of extremities

Question 9

What can worsening of symptoms in spasticity depend on?

Answer 9

• Ongoing infection
• Contractures
• Peripherial vascular disease

Question 10

How is spasticity treated?

Answer 10

• No cure for spasticity but we treat the symptoms and consequences
• Physiotherapy to maintain ROM, prevent contractures, and increase muscle strength
• Orthotic devices enhencing stretch to prevent contractures, and standing exercising devices
• Surgery for correction of deformed limb

Question 11

What is contracture?

Answer 11

Loss of joint mobility due to structural changes

Question 12

How do contractures occur?

Answer 12

Shortening and hardening of soft tissie around the joint, due to a greatly restricted mobility of the joint

Question 13

What are the risk factors of contractures?

Answer 13

• Musclotendon injury/trauma
• Aging due to loss of muscle fibers and mobility
• Burn injuries
• CP, stroke, spasticity, SCI
  Common “end stage” of conditions causing immobility

Question 14

Which consequences can contractures lead to?

Answer 14

• Difficulties with daily activities
• Pressure ulcers
• Degenerative joint disease
• Abnormal posture and gait for people with hip contractures (which can lead to further contractures below)

Question 15

Which symptoms does contracture give and how can it be diagnosed?

Answer 15

Symptoms are:

• Pain and loss of movement in affected joint

To diagnose these symptoms are evaluated together with:

• Neuromuscular examination like passive and active ROM, and joint stability
• Imaging tests like X-rays, MRI, ultrasound

Question 16

How do we treat and prevent contractures?

Answer 16

Contractures are easier to prevent than treat hence risk of contractures should be preventative treated:

• Mobilization as soon as possible after injury
• Bed-mobility if bed rest is inavoidable
• Flexibility exercises

Treatment options are:
* Physiotherapy to regain ROM (possible if treated early)
* Splinting for severe contractures
* Casting in streched position to increase ROM
* Surgical for ex. reposition joint en lengthen tendons

Question 17

What is Artherosclerosis?

Answer 17

It is a Peripheral Artery Disease (PAD) that causes problems with circulation

Question 18

What is the pathophysiology behind Artherosclerosis?

Answer 18

Build up of cholesterole (LDL) and other fatty molecules of the inside walls of the arteries, causing:
* Decreased diameter of lumen causing increased resistance and therefore more strain onto the heart
* Turbulance in blood flow

Question 19

Name some risk factors for artherosclerosis

Answer 19

• Diabetes
• High cholesterole
• Smoking
• Fatty diet
• Physical inactivity

Question 20

What are the symptoms/consequences of artherosclerosis?

Answer 20

• Disturbance of bloodflow leading to:
  1. Tissue damage due to ischemia or hypoxia
  2. Necrosis leading to gangreen infection and black toes
• Heart attack
• Oedema = fluid filled tissue due to thickening of lumen making it hard for fluid to get back into vessels
• Pain (ex. due to necrosis)