Spasticity pt 1

Spasticity

What is it characterized when there is resistance moving through normal range? ( continuous through range & not cogwheel)

MS (multiple sclerosis)

What condition do we see the highest level of spasticity?

Anterior region of Frontal Lobe

Decision making occurs in which area of the brain?

Cerebellum and Basal Ganglia

Control circuits is controlled by which parts of the brain?

Upper Motor Neuron Tract (UMN)

The cerebellum and basal ganglia regulate the activity of…

Muscle length

Resistance to stretch is dependent on what?

Passive Range of Motion

How do we assess muscle tone?

Titin not unfolding and weak actin-myosin bonds

The resistance to stretch in a relaxed muscle (passive ROM) is caused by….

Stretch Reflex

What is it called when you quickly activate the golgi tendon and muscle spindle fibers?

Muscle Contractions

In terms of the stretch reflex and PNF, what does it elicit?

Muscles contractions are intense, reflexes are exaggerated and there is no inhibition

In terms of the stretch reflex what do we see with patients with spasticity?

Loss of sarcomeres → stiffness

What do we see as an effect of being immobilized in a shortened position for an extended period of time? and it leads to…

Lengthened Position

What is the most beneficial way to immobilize muscles?

Decrease hypertonicity and possible elongation of shortened muscles

With prolonged static stretch to spastic muscles, we see what?

Serial Casting

What is it treatment/procedure called when a sequence of casts applied in progressively greater range over several weeks? Muscle must be positioned in maximal stretch → muscle fatigue & elongation

1 to 2 weeks and an orthotic brace is implemented

With serial casting how often is the cast changed and what is implemented afterward?

Serial Casting

An established contracture with or without concurrent spasticity are general indications for what ?

Skin breaking down & follow up wounds

What are the big concerns with serial casting?

Position and maintain the joint/associated muscles to gain ROM and decrease tone

What is the goal of orthotic devices to control hypertonicity?

Orthotics, Seating & Positioning, Passive stander

What are the 3 classifications of equipment used to manage hypertonicity?

Drowsiness, weakness, sedation and some have cognitive effects

What are the common side effects of commonly prescribed medications for spastic hypertonia?

Implement strengthening techniques

Medications for reducing hypertonicity cause a reduction in muscular force so as therapists our focus should be to …

limit/reduce UMN activity (work on CNS)

Medications to treat spasticity work to…

Paralysis, does not directly affect the CNS. It stops the message as it travels to the specific muscle w/ the functioning nerve problem.

Botox unlike most spasticity medications works how?

Reciprocal Inhibition and Autogenic Inhibition

PNF treatment of CR (contract relax) and HR (hold relax) work through which 2 principles?

Inhibition of the agonist alpha motor neurons b/c of the stimulation of the GTO

What is Autogenic Inhibition?

Decreased activity of the antagonist when its agonist is active, allows for more active ROM (of agonist)

What is Reciprocal Inhibition?