862: management of hypertonicity and coordination

Conditions that cause hypertonicity

Spinal cord, motor cortex, or basal ganglia

Spasticity vs rigidity

Increased resistance to speed and usually in one direction vs passive resistance in general

Interventions for spasticity

• Limb positioning to maintain muscle length (splints or orthoses)

• Passive stretching through entire ROM

  • caution on which muscles you are stretching; some musculature is better slightly shortened

• WB to prolong muscle stretch

• Vibration/ whole body vibration

Electrical stimulation for spasticity

• to agonist muscles to increase recurrent inhibition and fatigue the muscles to reduce spasticity

• To antagonist muscles to enhance reciprocal inhibition to agonist muscle

• To a dermatome in the same spinal segment as the spastic muscle to activate a low threshold afferent signal in the skin sending inhibitory effects to the muscle

Use of NMES or FES as an intervention for spasticity

Strengthening the antagonist

Works to decrease tone with reciprocal inhibition

Does NOT increase spasticity

Use of strengthening exercises for the agonist

Medications commonly used for spasticity

• chemodenervation via NM or perineural blocks - Botox injections

• Baclofen

• Diazepam

• Dantrolene

• Tizanidine

Selective dorsal rhizotomy

Surgical procedure that reduces spasticity in the lower limbs by cutting nerve root lets in the spinal canal

Diagnosis for spasticity and rigidity

Fractionated movement deficit

Impairments to the cerebellum resulting in

• ataxia: lack of coordination, appearing clumsy, intoxicated, and awkward

• Dysmetria: undershooting and overshooting

General principles of coordination interventions

• constant repetition of a few motor activities

• Use of sensory cues to enhance motor performance

• Increase of speed of the activity over time

• Activities are broken down into components that are simple enough to be performed correctly

• Assistance is provided whenever necessary

• High repetition of precise performance must be performed for accurate neuroplasticity to be solidified

Traditional intervention for ataxia

Involved weighting the limbs or trunk with slow and reciprocal movements, however evidence doesn’t support this to help with recovery

Functional task specific training interventions for ataxia

• including virtual reality, biofeedback, and BW support treadmill training

• Level of the challenge is more important than the duration of the activity