BTM III - Muscle Tone Assessment

BTM III - PFYZ 0104C

• Course date: October 7, 2024
• Topic: Changes in muscle tone, diagnostic and therapeutic procedures

Muscle Tone

• Muscle tone is variable tension in the muscle, depending on the state of the central nervous system (CNS).
• Tone is assessed by palpating the muscle's consistency and the surrounding tissues' turgor.
• Muscle tone is closely related to the muscle's consistency or elasticity, a constant property.
• Rheological properties of fibrous tissue also influence muscle tone/tension.

Control of Muscle Tone

• Knowledge of physiology and anatomy is emphasized (one-year).
• The regulation of muscle tone—and its various levels of control—are covered.
• Diagrams of intrafusal and extrafusal muscle fibers, gamma motor neurons, and alpha motor neurons were included.

Muscle Tone - Quantitative Assessment

• Atonia: Complete loss of muscle tone.
• Hypotonia: Decreased muscle tone.
• Eutonia: Normal muscle tone.
• Hypertonia: Increased muscle tone.

Assessment of Muscle Tone

• Inspection: Basic orientation (muscle relief, joint position, body posture).
• Palpation: Basic and crucial procedure.
• Passive movements.
• Instrumental methods, including algometers.

Changes in Muscle Tone

• Local tone changes are primarily caused by damage in peripheral signal areas (nervous system).
• Overall (resting) tone changes originate in subcortical regulatory areas, including the brainstem, basal ganglia, and cerebellum.

Muscle Hyper-Tone

• Muscle hypertonia can result from morphological or functional changes.
• Morphological changes, such as spasticity and rigidity, are detailed.
• Functional changes (according to Janda) include limbic system dysfunction causing segmental, whole or part muscle dysfunction, nociceptive irritation, and muscle shortening.

TH - Muscle Hyper-tone

• Treatments for muscle hypertonia can include pharmacological, surgical, and physiotherapy approaches.

Therapy of Functional Tone Changes - Hyper-tone

• Addressing dysfunction of the limbic system, a holistic approach is vital.
• Techniques like global relaxation, autogenic training, yoga, and Feldenkrais are mentioned for therapy.

Therapy of Functional Tone Changes - Hyper-tone (Impaired Function at Segmental Level)

• Techniques focus on impaired function at the segmental level (whole muscle, part of a muscle), and use the principle of post-facilitation inhibition (PIR).

Trigger Points

• Trigger points (TrPs) are areas of increased tissue irritation in muscles that result in increased sensitivity to touch.
• Different classifications of Trigger Points (TrPs): active, latent, and primary.

Therapy of Functional Tonus Changes - Hypertonus

• Nociceptive irritation is a treatment target
• Post-facilitation inhibition (PIR) techniques are addressed for treatment.

Therapy of Functional Tone Changes - Hypertone (Muscle Shortening)

• Muscle shortening is a target for treatment.
• Post-facilitation inhibition (PIR) maximum resistance + stretch, and stretching techniques are covered.

Postfacilitation Inhibition (PIR)

• Lewit's approach to PIR method- Relaxation after isometric contractions
• Janda's technique blends PIR with stretches.
• Zbojan's anti-gravity relaxation (AGR) approach is described.

PIR – Principle

• Autogenic inhibition and the Golgi tendon organ system are explored.

Similar techniques (like PIR)

• Mitchell's and MET (Muscle Energy Technique) techniques, and their distinctions from PIR, are described.

AGR – Antigravity Relaxation Method

• AGR uses isometric muscle contractions combined with relaxation, leveraging gravitational force.
• The procedure parallels PIR, though position-control procedures are essential.

PIR followed by Stretching

• Janda's post-facilitation stretch involves isometric muscle contraction followed by relaxation, then manual stretching.
• Instructions address position, contraction duration (approximately 10 seconds), and the importance of release followed by stretching.

Reciprocal Inhibition

• Antagonist activation is crucial.
• Brügger's AEC method is discussed; it uses eccentric contractions of antagonist muscle groups. The concept of diagnostic and therapy of functional disorders of the locomotor system, with reciprocal inhibition (activation of the antagonist leads to relaxation of the agonist), is presented.

AEC - Technique

• AEC, an agistic eccentric contraction procedure, has two phases: a concentric contraction phase without resistance, and an eccentric contraction phase with resistance.

Other Procedures

• Active and passive movements (pendulum, swing, thrust, positioning);
• Manual techniques (massage, pressure, etc.);
• Physical therapy modalities (heat, cold, etc.).

Stretching - Notes

• Various stretching types are introduced, including static stretching.
• Key principles include positioning, duration (15-45 seconds), and proper breathing techniques.

Decreased Muscle Strength

• Introduction to therapeutic procedures related to decreased muscle strength is covered.

Repetition 1st Year

• Examination procedures for evaluating strength, methods of manual tests, instrumental and special tests are covered.

Strength Training

• Types of strength training, including static, dynamic (concentric, eccentric), and isokinetic are introduced.

Static Strength Training

• Early initiation of therapy, atrophy prophylaxis, selective muscle group selection, dosing option, and coordination aspects are explored.

Static Strength Training (Method)

• Isometric contractions and Hettinger methods are covered for static strength training.
• Dosage recommendations on Intensity (50-70% of maximum strength) and Duration of isometric contraction (5 to 10 seconds) are noted.

Dynamic Strength Training

• Physiological and complex movements, variable load parameters, and frequent device use with possible incorrect instructions are essential considerations.

Dynamic Strength Training (Recommendation/dosing)

• Number of repetitions and resistance (load) are vital for determining the appropriate dose.

Isokinetic Training

• This method includes testing options, precise dosage, training recording/analysis, versatility, eccentric/concentric training option, workforce requirements, and cost-effectiveness aspects.

Strengthening Hypotonic, Hypoactive, and Weakened Muscles

• Strengthening involves three stages: minimal resistance training on hypertonic muscles, strengthening simple muscle interactions, and strengthening/training daily movements.

In Practical Lectures

• Evaluation of fascia and periosteal points are discussed.

Knowledge

• Muscle tone definition, muscle tone changes, and therapeutic procedures for influencing increased/decreased muscle tone are addressed.
• Therapeutic procedure characteristics, including PIR, PIR + stretch, AGR, AEC, and general procedures, are explored.

Skills

• Muscle tone change evaluations, fascia and periosteal point evaluations, and the application of muscle group procedures, are noted; including advanced physical therapy methods.

This quiz covers the changes in muscle tone, including diagnostic and therapeutic procedures. It emphasizes the importance of understanding the central nervous system's role in muscle tension, as well as the regulation and assessment of muscle tone. Key concepts such as atonia, hypotonia, eutonia, and hypertonia will be explored.