Neuro Test 2 Review - Tone Lecture
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Questions and Answers

What is tone?

Property of muscle's contractile and fascial structures.

True or false: Tone is the amount of tension in contracted muscles?

False (B)

How is tone regulated?

Spinal reflexes and multiple descending supraspinal (brainstem/cerebellum/cortex) mechanisms.

Which muscles of postural control and stability is tone necessary for? (Select all that apply)

<p>Neck (A), Trunk (core) (B), Shoulder / pelvic girdle (D)</p> Signup and view all the answers

True or false: Tone is necessary for active voluntary movement and movement control?

<p>True (A)</p> Signup and view all the answers

What is the definition of normal tone?

<p>Right amount of tension inside the muscle at rest, allows the muscle the inherently contract on command and be ready for voluntary movement.</p> Signup and view all the answers

What is hypotonia?

<p>Flaccidity in muscles, low tone (not enough tension in the muscle). It Feels slightly mushy or floppy, Limb easily moved.</p> Signup and view all the answers

What problems are seen with hypotonia?

<p>Problems of motor control/coordination, postural instability; joint laxity; weakness; decreased endurance.</p> Signup and view all the answers

What conditions are often associated with hypotonia? (Select all that apply)

<p>Early stages of acquired brain (TBI) or spinal cord lesions (SCI) (A), Cerebellar lesions (B), Neuropathies (Guillain barré) (C)</p> Signup and view all the answers

What are the 2 types of hypertonicity and associated conditions?

<ol> <li>Spasticity → MS, stroke, TBI</li> <li>Rigidity → Parkinson</li> </ol> Signup and view all the answers

What is spasticity?

<p>Velocity dependent resistance to stretch –amount of “stiffness” felt is related to speed of the passive stretch movement; specific patterns of involvement ie flexors in UE, extensors in LE. Upper motor neuron (pyramidal).</p> Signup and view all the answers

What is rigidity?

<p>Non velocity-dependent resistance – uniform increased tone whether the joint is passively moved quickly or slowly, affects both flexors and extensors (agonists &amp; antagonists) Extra-pyramidal.</p> Signup and view all the answers

How do you perform an assessment of tone?

<p>Move limb segments through passive lengthening range of motion (limb relaxed) and feel the amount of resistance during the movement → resistance is qualified or graded. Tonic response to (relatively) slow stretch.</p> Signup and view all the answers

What are the impacts of no tone?

<p>Total flaccid paralysis.</p> Signup and view all the answers

What are the impacts of low tone? (Select all that apply)

<p>Decreased endurance (A), Postural control issues. (B), Joint instability (C), Weakness (D)</p> Signup and view all the answers

What are medical managements of spasticity? (Select all that apply)

<p>Baclofen pump into spinal fluid (A), Dorsal rhizotomy (B), Botox injections (C), Surgery (D), Cannabis (E), Oral medications such as baclofen (F), Neurectomy (G)</p> Signup and view all the answers

What are was the medical team managed spasticity? (Select all that apply)

<p>Avoid: poor positioning &amp; postures associated with patterns ie hip extension, adduction, internal rotation), ankle plantarflexion; sh adduction, internal rotation, elbow &amp; wrist flexion (A), Reduction/ avoidance of noxious stimulation or discomfort (B), Decrease pain or effects from triggers such as pressure ulcer, ingrown toenail, contracture, kinked catheter, urinary tract infection, DVT, fecal impaction, sepsis, fracture, other sources (C), Positioning (D), In bed or chair: place the patient in “out of pattern&quot; positions for U &amp; LE with good trunk (E)</p> Signup and view all the answers

What are the PT management strategies for spasticity? (Select all that apply)

<p>Physical modalities (A), Stretching/exercises in PROM (B), Splinting or casting (C), E Stim (D)</p> Signup and view all the answers

What are the medical management strategies for rigidity? (Select all that apply)

<p>Precise brain area ablations (A), Deep brain stimulation (B), Oral medications (C), Surgery (D)</p> Signup and view all the answers

What are the PT Interventions for Rigidity? (Select all that apply)

<p>Relaxation activities and exercises (A), Physical modalities (B), Rhythmic exercises and trunk rotation (C), Daily movement &amp; flexibility routine and general exercise program (D), Heat or hot baths (E), Stretching/exercises (F), Cooling or ice (G)</p> Signup and view all the answers

What are the Superficial reflexes and what are they associated with?

<p>Babinski/ plantar reflex, Hoffmann reflex.</p> Signup and view all the answers

What kind of response is associate with the deep tendon reflex?

<p>Phasic response to a quick brief stretch.</p> Signup and view all the answers

What are the different DTRs and their associated spinal nerve roots?

<p>Biceps = C5/C6, Brachioradialis = C5/C6, Triceps = C7/C8, Patellar = L2-L4, Achilles = S1/S2.</p> Signup and view all the answers

What is motor coordination?

<p>The ability to execute smooth, accurate, and controlled motor responses, described as selection of the right muscle at the right time with the proper intensity to achieve desired action, characterized by appropriate speed, distance, direction, timing, and muscular tension (force). Typified by optimal interaction of muscle function.</p> Signup and view all the answers

What movement qualities are important to observe and evaluate? (Select all that apply)

<p>Speed and timing (A), Accuracy and precision (B), Range of motion (C), Fluidity and smoothness (D)</p> Signup and view all the answers

What is sensory ataxia?

<p>A form of dyscoordination caused by loss of sensory input and NOT by cerebellar dysfunction.</p> Signup and view all the answers

What is a neuromuscular condition?

<p>A condition/disease that affects the peripheral nervous system, the neuromuscular junctions, or skeletal muscles, all of which are components of the motor unit</p> Signup and view all the answers

What is Guillain Barré syndrome?

<p>Acute inflammatory demyelinating polyneuropathy (AIDPN), Body's immune system attacks part of PNS.</p> Signup and view all the answers

What are the signs and symptoms of GBS? (Select all that apply)

<p>Respiratory muscle paralysis may require mechanical ventilation (A), Mild, intermittent tingling in hands and feet paresthesia (B), Progressive weakness UE, LE, trunk, and face → distal to proximal (C), Bilateral and rapid onset (D), Bulbar involvement (E)</p> Signup and view all the answers

What is the cause of GBS? (Select all that apply)

<p>Unknown (A), 5-10% following a surgery (B), Few days to 4 weeks post viral or bacterial infection (C), Respiratory or GI (D), Flu vaccine → 1976-1977 (E), Autoimmune disease (F)</p> Signup and view all the answers

What is the incidence and prevalence of GBS?

<p>Incidence → 3500/year in usa and Canada, Prevalence 1-2/100,000.</p> Signup and view all the answers

How is GBS diagnosed? (Select all that apply)

<p>Nerve conduction velocity tests (A), Lumbar puncture (B), Clinical and medical history (C)</p> Signup and view all the answers

What are the stages of GBS? (Select all that apply)

<p>Stable period (A), Recovery (B), Acute decline (C)</p> Signup and view all the answers

What is the treatment for GBS?

<p>No cure, Plasmapheresis, High dose Immunoglobulin therapy, Corticosteroids → not recommended, Supportive treatment.</p> Signup and view all the answers

What is Miller Fisher Syndrome?

<p>Variant of GBS, Ataxia, ophthalmoplegia, areflexia, Severe weakness less common.</p> Signup and view all the answers

Flashcards

Muscle Tone

The amount of tension in relaxed muscles, essential for postural control and stability.

Muscle Tone Regulation

Controlled by spinal reflexes and descending mechanisms from the brain (brainstem, cerebellum, cortex).

Normal Tone

The right amount of tension in resting muscles, allowing for quick voluntary contractions.

Hypotonia

Low muscle tone; muscles feel floppy and easy to move.

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Hypotonia Problems

Motor control issues, postural instability, joint laxity, weakness, and decreased endurance.

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Hypotonia Conditions

Lower motor neuron disorders, neuropathies (e.g., Guillain-Barré), cerebellar problems, and early brain/spinal cord injuries.

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Hypertonia

High muscle tone; muscles feel tight and tense, making movement difficult.

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Hypertonia Conditions

Upper motor neuron, and extrapyramidal conditions. Often seen in conditions such as Cerebral Palsy

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Spasticity

A type of hypertonia; resistance to stretch is increased when the stretch happens quickly. Often related to upper motor neuron damage.

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Rigidity

A type of hypertonia; resistance to stretch is the same whether the movement is fast or slow. Related to extra pyramidal conditions.

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Tone Assessment

Assessing tone involves passively moving body parts and feeling the resistance.

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Modified Ashworth Scale

A standardized scale to objectively grade high tone.

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No Tone

Total flaccid paralysis

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Low Tone Impacts

Postural control issues, joint instability, decreased endurance, weakness, and movement problems.

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High Tone Impacts

Stiffness to difficulty moving to complete immobility; weakness, spastic paresis, and pain.

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Low Tone PT Treatments

Muscle activation exercises, stabilization, endurance exercises, core exercises, weight-bearing, and electrical stimulation.

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Spasticity Medical Managements

Pharmacological treatments (e.g., baclofen, Botox), and surgery (e.g., dorsal rhizotomy).

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Spasticity Medical Team Management

Reducing pain triggers, using proper positioning and avoiding postures associated with spastic patterns.

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Study Notes

Neuro Test 2 Review Questions - Tone Lecture

  • Tone is the amount of tension in relaxed muscles, not contracted muscles
  • Tone is regulated via spinal reflexes and descending supraspinal (brainstem/cerebellum/cortex) mechanisms
  • Tone is necessary for neck, shoulder/pelvic girdle, and trunk (core) muscles for postural control and stability.
  • Tone is necessary for active voluntary movement and movement control.
  • Normal tone is the right amount of tension inside the muscle at rest, ready for voluntary movement upon command.

Continuum of Muscle Tone

  • Hypotonia: Flaccidity, muscles feel mushy, floppy. Limb easily moved.
  • Hypertonia: Muscles tight, tense, even when relaxed. Feel of stiffness.
  • Spasticity: Velocity-dependent resistance to stretch (stiffness increases with speed). Affects flexors in upper extremities and extensors in lower extremities. Upper motor neuron (pyramidal) involvement.
  • Rigidity: Non-velocity dependent resistance to stretch; affects both flexors and extensors uniformly. Extra-pyramidal.
  • Contraction: severe hypertonia or spasticity results in muscle contraction/ no movement.
  • Flaccidity: severely low tone with no movement.

Neuro Test 2 Review Questions - Additional Information

  • Problems associated with hypotonia: include lower motor neuron conditions (like Guillain Barré), cerebellar lesions, and early stages of acquired brain (TBI) or spinal cord lesions (SCI).
  • Problems associated with hypertonia: include upper motor neuron conditions and extra-pyramidal conditions, and congenital conditions.
  • Assessment of tone involves moving limb segments through passive ranges of motion and observing resistance.
  • The Modified Ashworth Scale is used to grade tone objectivity.
  • Impact of no tone: Total flaccid paralysis.
  • Impact of low tone: Postural control issues, joint instability, decreased endurance, weakness, movement and coordination problems.
  • Impact of high tone: Mild stiffness to complete immobility, weakness, spastic paresis, mild discomfort to severe pain.
  • Medical management of spasticity: includes pharmacological agents (eg. baclofen), oral medications, Botox injections, and surgery.
  • Medical management strategies for rigidity: focus on pharmacology.
  • PT Interventions: Somatosensory techniques, facilitation techniques (tapping over muscle, quick muscle stretch, quick icing), and inhibitory techniques (positioning, prolonged gentle muscle stretch).

Other Neurological Conditions

  • Post-Polio Syndrome (PPS): New weakness, fatigue, and pain in those who recovered from past paralytic polio.
  • Guillain Barrè Syndrome (GBS): Acute inflammatory demyelinating polyradiculoneuritis.
  • Multiple Sclerosis (MS): Chronic, inflammatory and demyelinating disease of CNS. Symptoms include fatigue, sensory changes, unsteady gait, and visual changes along with others.
  • Amyotrophic Lateral Sclerosis (ALS): Progressive, fatal neurological disease affecting both upper and lower motor neurons. Symptoms include progressive weakness and muscle atrophy.
  • Spinal Cord Injury (SCI): Direct or indirect involvement of spinal cord resulting in alteration/cessation of CNS functions. Includes tetraplegia and paraplegia.

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Neuro Test 2 Review Questions PDF

Description

Prepare for your Neuro Test 2 with this comprehensive review on muscle tone. This quiz covers concepts such as hypotonia, hypertonia, spasticity, and rigidity, essential for understanding postural control and movement. Test your knowledge on the regulation of muscle tone by spinal reflexes and brain mechanisms.

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