tone and facilitation of movement- adult process

what is constraint induced movement therapy

constraining the movement of intact limb to perform ADLs or IADLs to force use of the unaffected side

what is proprioceptive neuromuscular approach?

a motor learning approach where diagonal motor patterns crossing sides of the body/brain allow the sides of the brain to work together, which is good for pts with unilateral brain trauma

why do we assess tone?

in cases of spastic CVA’s tone may is abnormally high, and in cases of flaccid CVA’s tone is abnormally low

what is the modified Ashworth scale?

rating scale used to measure abnormality in tone or the resistance to passive movements (like if you try to get pt into elbow extension and feel resistance against that, this indicates high tone)

what can be caused due to long term spasticity/hypertonia?

contractures

what are facilitation techniques?

allows the muscles and nerves to wake up in a pt with low tone

what are some examples of facilitation techniques?

• heavy joint compression/WB for 10-20 seconds

• quick stretch at the end of PROM

• tapping muscle tendon on LE or UE 3-5 times before and during muscle contraction. could also be done on vertebrae if person has poor trunk control.

• vestibular stim by having fast or irregular movements with increasing or decreasing speed

• icing, vibrating, brushing, electrical stim

what are some good ways to WB for someone with low tone?

in quadraped, leaning on elbow on a mat or bed, sitting up in bed leaning/putting pressure on UE for support. Must be functional (like scrubbing or cleaning)

what are inhibition techniques?

ways to relax and chill out the nerves/muscles in pts with high tone

what are examples of inhibition techniques?

• deep tendon pressure (like in the typical flexor tone in unilateral UE elbow is so flexed you put pressure on inside of elbow to aid in extension)

• neural warmth by applying moist heat from heavy blanket over the muscles for 5-10 minutes

• slow gentle rocking

• maintaining stretch only when joint is able to open up

• slow vestibular stim like rocking an a ball with sustained rhythm or horse

• relaxation techniques and serial casting (aggressive measure)

what is dynasplint?

30 minutes a day of progressive static splinting which helps the muscle open a bit at a time and in the long term stretches muscle out

what are some precautions for working with pts with tone?

• shoulder subluxation (if 2 fingers fit in shoulder joint, this is subluxed and is common in low tone)

• scapular winging

• contractures

what does NDT suggest as facilitation techniques?

weight bearing, trunk rotation, and scap retraction

what does PNF and Rood suggest for facilitation techniques

heavy joint compression, quick stretch, brushing, vibration, light touch.