Tone Abnormalities

Question 1

What is muscle tone?

Answer 1

Underlying tension in the muscle that serves as a background for contraction

Question 2

What are some challenges to assessing muscle tone?

Answer 2

Patient can’t relax

Changes with movement, posture, intention, and environment

Question 3

What is hypertonicity and what else is associated with it?

Answer 3

Abnormally high tone

• Rigidity (velocity independent)
• Spacticity (velocity dependent)
• Clonus (rhythmic oscillations or beats involuntary muscle contraction)

Question 4

What is Hypotonicity?

Answer 4

Abnormally low tone
(flaccidity-total absence of tone)
-examples-down syndrome, polio

Question 5

What are some types of dyskinesia?

Answer 5

Chorea - dance-like, sharp, jerky movements
Ballismus - ballistic or large throwing movements
Tremor - low-amplitude, high frequency oscillating movements
Athetoid - wormlike writhing motions
Dystonia - involuntary sustained muscle contraction

Question 6

How can you measure muscle tone Quantitatively?

Answer 6

Quantitative (objective):

• Dynamometer - compare high and low velocity (resistance to high velocity means increased tone)
• Isokinetic testing
• EMG - can be used as a biofeedback system
• Pendulum test - tests for spacticity

Question 7

How can you measure muscle tone Qualitatively?

Answer 7

Qualitative (subjective) (used most of the time)

• Clinical tone scale
• Muscle stretch reflex test
• Ashworth and Modified Ashworth scale

Question 8

What are some consideration when measuring tone?

Answer 8

Position of patient
Standardize touch
Consider muscle strength

Question 9

What happens with low muscle tone?

Answer 9

Insufficient activation of motor units

• difficulty developing enough force to maintain posture
• increased weight support through tight ligaments

Question 10

What causes low muscle tone?

Answer 10

Alpha motor neuron damage - demyleniation diseases
-treat with Estim, hydrotherapy, and quick ice (beyond normal rehab of stretch strengthen and so on)
Insufficient excitation of alpha motor neuron (prolonged immobilization, stroke, MS)

Question 11

What is high muscle tone associated with?

Answer 11

Muscle spasms
Contractures
Abnormal postures leading to skin ulcers
Difficulty with assisted dressing, transfers, hygiene
(Parkinsons)

Question 12

What causes high muscle tone?

Answer 12

Pain, cold, stress
Spinal cord injuries (initial flaccidity followed by spasticity)
Cerebral lesions (stroke, parkinsons, MS, head injuries)

Question 13

What is decorticate and decebrate posture?

Answer 13

Decorticate - Elbow flexion

Decebrate - Elbow extended (has more E’s)

Question 14

How can fluctuating muscle tone happen?

Answer 14

Basal ganglia disease (Parkinsons)
Cerebral palsy (involuntary writhing)

Question 15

When don’t you want to use the jostling technique?

Answer 15

On a person with a history of dislocations

Question 16

How long do you want to do the jostling technique?

Answer 16

10-30 seconds (no real exact time frame though)

Then reassess