TI For Alteration In Muscle Tone (2)

Question 1

How can you measure flaccidity/hypotonia?

Answer 1

PROM with palpation for contraction (move slowly first then quickly)

Question 2

What are the scales used to measure spasticity?

Answer 2

Modified ashworth scale (0=normal)

Tardieu scale (R1 and R2)

Question 3

What is R1 in the tardieu scale?

Answer 3

First catch in motion

Question 4

What is R2 in the tardieu scale?

Answer 4

Max range after catch occurs

Question 5

What does it mean in the tardieu scale if there is a large difference between R1 and R2?

Answer 5

More severe spasticity

Question 6

What does it mean in the tardieu scale if there is a small difference between R1 and R2?

Answer 6

More MSK tightness

Question 7

What are the affects of flaccidity/hypotonia on body structure?

Answer 7

Over stretching

Loss of muscle bulk

Loss of ROM

Question 8

What are the effects of flaccidity/hypotonia on function?

Answer 8

Can’t move correctly (development of compensations)

Question 9

What are the safety issues of flaccidity/hypotonia?

Answer 9

MSK damage

Swallowing and respiration

Pain

Balance and falls

Question 10

What is important in interventions for flaccidity/hypotonia?

Answer 10

Maintain mobility (ROM/flexibility)

Question 11

What do flaccidity/hypotonia interventions begin with?

Answer 11

Stability

Question 12

Why do you want to use compensatory strategies with flaccidity/hypotonia?

Answer 12

Minimize risk of injury or secondary impairment

Question 13

What are the interventions for applied functional activity for flaccidity/hypotonia in the UEs?

Answer 13

Estim or orthotic device that can increase functional movement of hand/wrist

Question 14

What are the interventions for applied functional activity for flaccidity/hypotonia in the LEs?

Answer 14

Estim device that substitute for weak DF in swing

Question 15

What are the positive effects of hypertonia on body structures?

Answer 15

Helps maintain muscle bulk, skin integrity, bone density, and BP

Question 16

What are the negative effects of hypertonia on body structures?

Answer 16

Decreased ROM/contracture

Muscle weakness

Pain

Greater energy expenditure

Impaired coordination and balance

Question 17

What are the positive effects of hypertonia on function?

Answer 17

May assist with sit to stand

Question 18

What are the negative effects of hypertonia on function?

Answer 18

Limits isolated movements so functional tasks often require compensations to complete

Question 19

What are safety issues in hypertonia?

Answer 19

Increased risk of fall and skin breakdown due to contracture

Question 20

What are interventions for hypertonia?

Answer 20

Sustained positioning and PROM

Handling and physical inhibition

Equipment

Question 21

How is sustained positioning achieved in hypertonia?

Answer 21

Splinting or serial casting

Question 22

What is the handling intervention used for hypertonia?

Answer 22

NDT

Question 23

What type of muscle is a spastic muscle?

Answer 23

Weak muscle

Question 24

What muscles may also grow weak due to hypertonia?

Answer 24

Muscles that oppose spastic muscles

Question 25

How do you want to strengthen muscles with hypertonia?

Answer 25

Isometric (first) Eccentric (second) Concentric (third)

Question 26

Does strengthening increase spasticity?

Answer 26

No

Question 27

What are the interventions applied to functional activities in hypertonia?

Answer 27

Aquatic therapy Quadruped Rolling Weight bearing

Question 28

Why is aquatic therapy used in hypertonia?

Answer 28

Buoyancy increases ease of movement (warm temp can be inhibitory to spasticity)

Question 29

Why is quadruped used in hypertonia?

Answer 29

Weight bearing position with fewer degrees of freedom

Question 30

Why is rolling used in hypertonia?

Answer 30

With rhythmic initiation and rhythmic rotation

Question 31

Why is weight bearing activities used in hypertonia?

Answer 31

To achieve good alignment

Question 32

What is the oral med used for muscle tone issues?

Answer 32

Baclofen

Question 33

What are side effects of baclofen?

Answer 33

Drowsiness Dizziness Weakness

Question 34

What are the pros of baclofen?

Answer 34

Non invasive and non permanent

Question 35

What are the cons of baclofen?

Answer 35

Not continuous problem solving, must take on a schedule, sedation, and danger with withdrawal

Question 36

What is chemical neurolysis?

Answer 36

Alcohol applied to nerve via injection with EMG guidance (lasts 6 months)

Question 37

What does chemical neurolysis cause?

Answer 37

Demyelination of axons

Question 38

What is a neuromuscular blockade?

Answer 38

Neurotoxin injected into muscle, binds to Presynaptic cholinergic nerve terminal and blocks release of AcH (Botox)

Question 39

What are the pros of chemical neurolysis?

Answer 39

Better effect on larger muscles and is cheap

Question 40

What are the cons of chemical neurolysis?

Answer 40

Difficult procedure Risk of sensory complications Muscle can become fibrotic with repeated injections

Question 41

What are the pros of neuromuscular blockade?

Answer 41

Less painful, easier to perform, no sensory side effects, not permanent

Question 42

What are the cons of neuromuscular blockade?

Answer 42

Another injection every 3 months, expensive, and can develop antibodies

Question 43

What is intrathecal baclofen?

Answer 43

Baclofen diffused into CSF in intrathecal space

Question 44

What does intrathecal baclofen inhibit?

Answer 44

Both mono and polysynaptic reflexes

Question 45

What are the pros of intrathecal baclofen?

Answer 45

Reversible Fewer side effects Improved function

Question 46

What are the cons of intrathecal baclofen?

Answer 46

Mechanical complications Refills every 3 months Expensive

Question 47

What are the types of orthopedic surgeries done for problems with muscle tone?

Answer 47

Lengthening Tendon transfer Releases

Question 48

What is selective dorsal rhizotomy?

Answer 48

Selective destruction of problematic nerve roots (most common in children)

Question 49

How does oral and intrathecal baclofen affect spasticity?

Answer 49

Reversible and globally

Question 50

How does neuromuscular blockade affect spasticity?

Answer 50

Reversible and focal

Question 51

How does selective dorsal rhizotomy affect spasticity?

Answer 51

Permanent and globally

Question 52

How does surgery affect spasticity?

Answer 52

Permanent and focal

Question 53

What is key in interventions when it comes to alterations in muscle tone?

Answer 53

Maintaining mobility and creating stability