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

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)

Neck Signup and view all the answers

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

True Signup and view all the answers

What is the definition of normal tone?

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

What is hypotonia?

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

What problems are seen with hypotonia?

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

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

Early stages of acquired brain (TBI) or spinal cord lesions (SCI) 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?

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). Signup and view all the answers

What is rigidity?

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

How do you perform an assessment of tone?

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. Signup and view all the answers

What are the impacts of no tone?

Total flaccid paralysis. Signup and view all the answers

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

Decreased endurance Signup and view all the answers

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

Baclofen pump into spinal fluid Signup and view all the answers

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

Avoid: poor positioning & postures associated with patterns ie hip extension, adduction, internal rotation), ankle plantarflexion; sh adduction, internal rotation, elbow & wrist flexion Signup and view all the answers

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

Physical modalities Signup and view all the answers

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

Precise brain area ablations Signup and view all the answers

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

Relaxation activities and exercises Signup and view all the answers

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

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

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

Phasic response to a quick brief stretch. Signup and view all the answers

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

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

What is motor coordination?

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. Signup and view all the answers

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

Speed and timing Signup and view all the answers

What is sensory ataxia?

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

What is a neuromuscular condition?

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

What is Guillain Barré syndrome?

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

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

Respiratory muscle paralysis may require mechanical ventilation Signup and view all the answers

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

Unknown Signup and view all the answers

What is the incidence and prevalence of GBS?

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

How is GBS diagnosed? (Select all that apply)

Nerve conduction velocity tests Signup and view all the answers

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

Stable period Signup and view all the answers

What is the treatment for GBS?

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

What is Miller Fisher Syndrome?

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

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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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.