tone

Question 1

what is tone?

Answer 1

the resistance offered by muscles to continuous passive stretch

(resistance encountered when a joint of a relaxed person is moved passively)

Question 2

what are examples of non-neural factors contributing to tone?

Answer 2

-passive stiffness of a joint & surrounding tissue
-compliance of muscles, ligs and joints
-age
-exercise state
-limb temperature

Question 3

what are examples of neural factors that can affect tone?

Answer 3

-can vary with age, emotional state
-output of alpha motor neuron
-active tension set up by stretch reflex

Question 4

what are examples of peripheral and central systems that contribute to tone?

Answer 4

-muscle spindles (part of stretch reflex)
-golgi tendon organ
-somatosensory receptors
-sensory systems - visual, auditory, vestibular
-limbic system
-motor systems

Question 5

what is the stretch reflex?

Answer 5

the body’s involuntary response to an external stimulus that stretches the muscles

Question 6

what is the function of muscle spindles?

Answer 6

provide info regarding muscle length and rate of change of length

Question 7

what is a stretch reflex a direct result of?

Answer 7

stimulation of the muscle spindle (stretch receptor)

Question 8

what is the sequence of events in a stretch reflex once a muscle spindle is activated?

Answer 8

Question 9

what are the steps of stretch reflex in simple terms

Answer 9

-stretching of muscle stimulates muscle spindles
-activation of sensory neuron
-info processing of motor neuron
-activation of motor neuron
-contraction of muscle

Question 10

where are the gamma motor neurons located in the muscle spindle?

Answer 10

the intra-fugal fibres

Question 11

what is the basic function of the muscle spindle?

Answer 11

helps to maintain muscle tone

Question 12

what can abnormal PROM of joint be due to?

Answer 12

-joint stiffness
-reduced muscle/ tendon length
-tone
-patient activity

Question 13

what is high tone and low tone called?

Answer 13

-hyperTonia , spasticity, rigidity
-hypotonia, flaccidity

Question 14

what is spasticity?

Answer 14

-velocity dependent increase in resistance to passive stretch of a muscle with exaggerated tendon reflexes

Question 15

why does spasticity happen?

Answer 15

-abnormal enhancement of spinal stretch reflex - due to increased muscle spindle sensitivity, loss of inhibition of stretch reflex
-central - loss of cortical inhibition, imbalance in descending pathways
-peripheral - altered biomechanics properties of muscles

Question 16

what causes a spasticity?

Answer 16

-upper motor neuron lesion (from motor cortex to spinal motor neuron)
-stroke
-spinal cord compression
-brain damage
-MS

Question 17

describe the clinical features of spasticity

Answer 17

-increased responsiveness of muscles to stretch- hyper-reflexia
-clasp knife(catch) followed by melting away of resistance
-clonus (rhythmic contractions) usually of ankle or foot
-associated reactions - unwanted movement which is brought on by increased tone eg yawning and arm goes up

Question 18

recap - what are the common patterns of spasticity in the upper limbs?

Answer 18

-adducted / internally rotated shoulder
-flexed wrist
-pronated forearm
-flexed elbow
-thumb in palm deformity

Question 19

what are common patterns of spasticity in the lower limbs?

Answer 19

-striatal toe
-stiff knee
-flexed knee
-adducted thighs
equinovarus

Question 20

what are factors that influence spasticity?

Answer 20

-positioning
-stress
-fatigue
-full bladder
-pain
-infection
-fear
-pressure sore
-constipation

Question 21

how do you assess abnormal tone?

Answer 21

-ash worth scale or tardieu
-movement grading - severe, moderate, mild
-tendon jerks - +/ ++
-others such as EMG

Question 22

how do we manage spasticity?

Answer 22

-relieve symptoms
-handling / positioning
-standing frames
-avoid noxious stimuli
-splinting
-slow passive movements
-medication

Question 23

list some examples of medication used to treat spasticity

Answer 23

-baclofen (lioresal) - GABA deriative
-diazepam (valium). - GABA
-botulium toxin (dysport) injected into muscle - blocks ACH release
-tizanidine (zanaflex) - short acting muscle relaxer

Question 24

how does spasticity affect the patient?

Answer 24

-weakness
-decreased movement
-abnormal movement
-poor posture
-pain
-contractures
-loss of function and adaptive

Question 25

in terms of spasticity, what are the aims of physiotherapy?

Answer 25

-normalise the tone -maintain normal muscle length -improve ROM -decrease pain -improve function -reduce complications

Question 26

describe the physio management of spasticity ?

Answer 26

-positioning of limb - to reduce abnormal reflex activity - NB sitting out -passive movement SLOW of affected limb -ice -weight bearing -splinting -pain management

Question 27

what is rigidity?

Answer 27

-increased resistance to los passive movement which is CONSTANT through out full ROM

Question 28

what's the difference between lead pipe rigidity and cogwheel rigidity?

Answer 28

lead pipe - resistance felt throughout movement -cogwheel - presence of additional tremor

Question 29

what is the pathophysiological mech of rigidity?

Answer 29

normal stretch reflex is composed of short latency (spinal) and long latency (brain) - the longer the latency the greater the rigidity

Question 30

what are causes of rigidity?

Answer 30

-extrapyramidial lesions -parkinsons

Question 31

what are the clinical features of rigidity?

Answer 31

-increased resistance to relatively slow imposed passive moments -lead pipe resistance (throughout ROM) -tendon reflexes are normal -can have superimposed tremor - leading to cogwheel rigidity

Question 32

how is rigidity assessed?

Answer 32

usually scales tend to be disease or condition specific eg parkinsons - foehn and yahr scale

Question 33

what does the physio management of rigidity involve?

Answer 33

-assessment and regular re assessment -normalise tone -manage of stiffness and pain( heat, stretch etc ) -gait, mobilioty transfers - re-education -re educate about posture

Question 34

what is hypotonia?

Answer 34

low state of tone

Question 35

what are the characteristics of hypotonia?

Answer 35

-decreased resistance to passive movement -decreased reflexes

Question 36

what are the causes of hypotonia?

Answer 36

-central cerebral shock - after UMNL -spinal shock after spinal cord injury -peripheral nerve lesion -cerebellar

Question 37

what is the pathophysiological mech of hypotonia

Answer 37

-not clear -can be due to neural shock -prolonged hypotonia 0 reduced level of arousal

Question 38

what effect does hypotonia have on patients?

Answer 38

-loss of function -inability to move against gravity -inability to sustain upright posture -muscle is prone to atrophy -inability to weight bear and transfer

Question 39

what is the aim of physio for hypotonia?

Answer 39

-protect limb and joint eg splints -sensory input - sitting balance, tapping, ice brushing, tapping, stroking - sensory re education -positioning- optimal level of support -promote tone -education and awareness to patient and carers

Question 40

what is serial casting used for ?

Answer 40

it helps to decrease muscle tightness and allow for better function and mvt of a joint