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Year 2: Neuromuscular > Test 3: Spasticity > Flashcards

Test 3: Spasticity Flashcards

(59 cards)

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1
Q

what is muscle tone

A

resistance of muscle to passive stretch/elongation

amount of tension at rest

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2
Q

normal muscle tone

A

high enough to counter gravity but low enough to allow freedom of movement

balanced/isolated for smooth/coordinated movement

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3
Q

signs of UMN lesion

A

hypertonicity
clonus
babinski
abnormal synergy

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4
Q

LMN syndrome signs

A

peripheral nerves

reduced or absent reflexes

neurogenic atrophy, not disuse

hypotonia/flaccidity

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5
Q

describe hypotonia

A

decreased/absent tone

diminished/absent stretch reflex

neurogenic muscle atrophy

finding with LMN

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6
Q

how might acute UMN lesions present

A

can initially produce hypotonia due to spinal or cerebral shock

after shock period is over, UMN show UMN signs and development of spasticity

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7
Q

characteristics of hypertonia

A

increased tone

resistance to passive movement NOT dependent on velocity

can be with or without spasticity

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8
Q

what falls into the category of hypertonia

A

spasticity
rigidity
dystonia
decorticate and decerebrate rigidity

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9
Q

what is spasticity

A

increased, involuntary, VELOCITY DEPENDENT muscle tone

resistance to passive and active movement

faster the passive movement, the stronger the resistance

can occur as primary condition (i.e. degenerative) or secondary to stroke, TBI, SCI, inflammatory conditions like MS, etc

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10
Q

spasticity originates from injury to what

A

descending motor pathways (pyramidal tracts)

brain stem (medial/lateral vestibulospinal tracts, dorsal reticulosponal tract

results in lack of inhibition of spinal reflexes causing them to be hyperexcitable

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11
Q

can spastic muscle be manual muscle tested

A

no

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12
Q

describe the synergy patterns associated with synergy

A

appears when spasticity is present

primitive movements that dominate reflexes and voluntary effory

interferes with coordinated voluntary movements and functional tasks

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13
Q

Flexor synergy pattern of UE

A

scapular retraction and elevation

shoulder abduction and ER

elbow flexion

forearm supination

wrist and finger flexion

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14
Q

LE flexor synergy pattern

A

hip flexion, abduction, and ER

knee flexion

ankle DF and inversion

toe DF

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15
Q

UE extensor synergy pattern

A

scapular protraction

shoulder adduction and IR

elbow ext

forearm pronation

wrist and finger flexion

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16
Q

LE extensor synergy pattern

A

hip extension, adduction, and IR

knee extension

ankle PF and inversion

toe PF

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17
Q

dystonia is commonly seen from

A

lesion to basal ganglia

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18
Q

characteristics of dystonia

A

involuntary and sustained muscle contractions

can be twisting, writhing, and repetitive movements

cocontraction of agonist and antagonist

increased tone

can affect only 1 body part (focal dystonia) or multiple (segmental)

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19
Q

diseases that result in dystonia

A

primary idiopathic dystonia (hereditary)

wilson’s disease

parkinson’s disease with long term L-dopa therapy

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20
Q

what is dyskinesia

A

general term used for describing abnormal involuntary writhing movements of a body part including face, UEs, and LEs

can be smooth fluid involuntary writhing movements or rapid jerky type

can present like tics

can be a side effect of meds

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21
Q

common types of dyskinesia

A

athetosis
chorea
dystonia
parkinson’s disease
tardive dyskinesia
myoclonus

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22
Q

describe athetosis

A

most common with cerebral palsy

due to damage to basal ganglia

involuntary writhing slow/continuous

more twisting observed

affects face, mouth, trunk, and limbs

less jerky than chorea

can let go of hand after grabbing

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23
Q

describe dystonia

A

involuntary and sustained muscle contractions

can be twisting/writhing/repetitive

involves cocontraction of agonist and antagonist

cant let go of hand of they grab it

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24
Q

describe chorea

Study These Flashcards
A

involuntary, rapid, abrupt twisting

writhing movements that may appear to jump form one extremity to another

25
characteristics of rigidity
stiffness resistacne to movement that is independent of velocity of movement associated with lesions of basal ganglia seen in parkinsons result of excessive supraspinal drive on alpha motor neurons; not related to spinal reflex mechanisms
26
leadpipe rigidity
constant increase in muscle tone and stiffness of affected muscles
27
cogwheel rigidity
rigidity with tremor resulting in rachet like jerkiness when the extremity is moved seen in UE at elbow and wrist
28
what is decorticate rigidity
severe injury to cortex (higher corticospinal tract lesion) UEs posture into shoulder IR/add, elbow flex, wrist flex, and fisted hands LEs extended with severe PF contractures long term impact = severe ROM contractures
29
what is decerenrate rigidity
indicates injury at brain stem with poor outcomes UEs posture in shoulder IR with full ext at elbow, flexion at wrist and fisted hand LEs posture in ext with severe PF contracture
30
what is opisthotonos
strong sustained muscle contraction of extensors of neck and trunk rigid, hyperextended posture
31
describe the re-emergence of primitive reflexes
often reemerge in neuro insult/disease primitive reflexes fire rostrally to drive development of cortex as cortex matures sufficiently it fires back to inhibit prim. reflexes insult ot brain causes cortex to fail allowing these reflexes to reemerge always want to check for them!
32
what is ANTR
asymmetric tonic neck reflex - extension of UE and LE on the side the head rotates to - flexion of UE and LE opposite of the side the head is turned to
33
assessment for ANTR
severe brain injury clients have high tone everywhere ANTR may not be obvious visually palpate for change in mm tone with head RT to identify the reflex
34
Intervention for ANTR
head position matters and is critical to reduce muscle tone that results from this reflex
35
what is SNTR
symmetric tonic neck reflex neck ext = UE ext and LE flex neck flex = UE flex and LE ext
36
assessment of STNR
move head into flexion and then to extension while palpate for change in muscle tone at elbow
37
intervention of STNR
head position to neutral which may require good posture control and positioning of trunk and pelvis
38
what is tonic labyrinthine
linked to vestibular system development and important precursor to development of posture reflexes 2 components: - FWD TLR - BWD TLR assess how use of tilt-n-space influences this reflex i.e. like babies; lay down supine and they extend, flex one part and they flex everything/curl into a ball
39
bermuda triangle of spasticity
posturing/rigidity TLR STNR
40
passive motion testing to examine muscle tone
ask pt to relax move extremity in all directions repeat specific motions with increased velocity **the first quick motion/stretch will cause highest level of spasticity so pay attention clonus = quick stretch; + spasmodic contraction of agonist; describe beats and if sustained
41
0 on MAS
no increase in tonw
42
1 on MAS
slight increase in tone with catch and release or minimal resistance at end of ROM when affected part moving in flexion/ext
43
1+ on MAS
slight increase in muscle tone, manifested as a catch followed by minimal resistance through remainder (less than half) of ROM
44
2 on MAS
marked increase in muscle tone throughout most ROM but affected parts still easily moved
45
3 on MAS
considerable increase in tone passive movement difficult
46
4 on MAS
affected parts rigid in flexion or extension
47
what to document with tone abnormalities
what segment involved what type of abnormal mm tone is present spasticity? which mm groups and MAS score asymmetric or symmetric? how is segment postured? obligatory synergy pattern present with active movement? what is the impact of abnormal tone on movement/posture/function
48
outcomes of unmanaged spasticity
contractires spinal deviation/scoliosis wounds inability to access active movement
49
possible effects of structural spinal deformity
impacts organ systems impairs breathing increases skin breakdown risk
50
wounds possible from PF/supinated feet
heel ulcers 5th Met head ulcers lateral malleolus ulcers
51
flexion of toes may result in what ulcer
PIP ulcer
52
postural deviations/scoliosis may result in ulcers where
IT ulcers GT ulcers
53
PT interventions for abnormal tone
Wbing prolonged stretch static splint synamic splint serial casting modalities positioning
54
benefits pf proper positioning
manages primitive reflexes manage deviations LE extensor tone and magic hip angle reduce destructive hip position
55
goal for dynamic splinting
low load prolonged stretch goal is to increase time in splint and tolerance for increasing resistance for gaining ROM
56
modalities for abnormal tone
goal = change motor neuron excitability cryotherapy heat* US* NMES dry needling etc
57
what might you work on for spasticity management for a complex client
manage primitive reflexes manage psoture deviations LE extensor tone and magic hip angle reduce destructive hip position 12-24 hour posture management
58
what is magic hip flexion angle
reduces extensor tone flex both hips together to find this angle needed in WC seating intervention
59

Year 2: Neuromuscular (20 decks)

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