Neuro Summary 5-10 Exam 2 PDF

5.1 Manual Interventions For Flaccidity and Hypotonia Hypotonia and Flaccidity- genetic, mitochondrial, cns etiologies NOT postural tone. Postural tone is amount of tension needed to maintain upright position against gravity Hypotonicity refers to those who have SOME DEGREE of tone, but is less than...

5.1 Manual Interventions For Flaccidity and Hypotonia Hypotonia and Flaccidity- genetic, mitochondrial, cns etiologies NOT postural tone. Postural tone is amount of tension needed to maintain upright position against gravity Hypotonicity refers to those who have SOME DEGREE of tone, but is less than normal. Flaccidity refers to those who lack muscle tone Keep joints safe, mobilization would make the condition worse. REVIEW: Muscle tone is influenced by neuromuscular and musculoskeletal componenets Neuro intrafusal muscle fibers of the muscle spindle detect changes of muscle link sending impulses to the spinal cord then the brain to monitor muscle stretch Brainstem, cerebrum, cerebellum, basal ganglia, descending nerve pathways, ant horn cells, peripheral nerves, and the neuromuscular junction ALL PLAY A ROLE Example: Patient with foot drop. We want to put electrical stimulation. Is Injury Central or Peripheral ? IF CENTRAL- then electrical stim for peripheral nerve is appropriate IF PERIPHERAL- then muscle is denervated, then peripheral nerve can’t depolarize to cause a contraction of muscle. Electrical stim is still feasible but with different parameters Examination Standpoint most outcome measures in infants Modified Ashworth is for HYPERtonia or INCREASED tone. SO NO Passive Range of Motion Observation Palpation Skills ascertain the number of finger widths for subluxation General Interventions Facilitatory stimulation Scooping Joint approximation gives joint feedback to the brain for awareness of limb Weightbearing technique by using hands to press joints into the floor All interventions need to be within realistic expectations and within a certain function 5.2 Alternative Interventions- Flaccidity and Hypotonia Equipment- Slings, Splints/Positioning Devices, Tabletop/support (For patients with subluxation and general joint laxity) Slings- Understand that the sling puts shoulder in IR, and ADD with Elbows also in FLXN. This can cause tightness for the patient and would shorten muscles leading to contractures. Does not approximate the joints to reduce subluxation. GiveMohr Sling is a much better alternative. Figure 8 design that provides approximation support Should be used for upright ambulation, standing, and transfers can’t be used sitting Splints and Positioning devices are provided by OTs Tabletop support wheelchair lap trays used in combination with tape Cushions will approximate the glenohumeral joint in a seated position Tape UE- decease incidence of subluxation McConnell/Endura/Leuko Tape. NOT KINESIO TAPE Kinesio tape has give and is stretchy. can be used in combination with electrical stimulation for added benefits Taping Method revolves around using bony prominences as anchors. Electrical Stimulation - Alphamotor neuron stimulated to help with contractions FES with flaccidity in UE patients have shown active control and improvements in tone with task training , NMES- used to decrease subluxation BIONESS- UE device to activate wrist and finger flexors and extensors for fine motor tasks WALKAIDE- shoe insert to be triggered from heel lift to stimulate ant tibialis Vibration sinusoidal oscillations throughout the whole body to stimulate mechanical receptors AND vestibular system Cerebral activation in the sensory cortex and thalamus Vibrations alter neurotransmitter concentrations: dopamine and serotonin Adults with MS, spinal cord injury, and CVA have shown strength improvements and torque production. Motor function too Mirror Therapy Mirror used in sagittal plane placed between limbs. Non paretic limb movements make the paretic limb appear as if they are functioning normally. Theory: observation of movements and performance share similar cortical areas in the brain In watching an activity being done by the more involved limb. This would help stimulate the same areas. Moderate effectiveness for UE 5.3 interventions for hypertonia review of terms hypertonicity: any increase in muscle tone spasticity: velocity dependent resistance to stretch agonist muscle: resistance to passive high speed resistance dystonia: involuntary or sustained posturing due to damage to cortex rigidity; resistance to stretch independent of velocity lead pipe: resistance to one fluid motion cogwheel: catch and release of resistance pathophysiology spastic hypertonicity: damage to UMNs prim and sec motor cortex corona radiata corticospinal tracts of bs ventral thalamus spasticity: damage to post limb of internal capsule (descending pathways of UMNs w/in lat corticospinal tract) spasticity thought to occur due to hypersensitivity of reflex arc due to changes in CNS related to loss of descending inhibition from cortex rigid hypertonicity: damage to BG (substantia nigra)push downward on dorsal aspect of MCP to distract support needed at wrist and forearm during activity bc hand will curl back up extend thumb, PIP/DIPs: while MCP jnts in flexion allows greater ease to achieve extension always want to maintain arches of hand extend MPs & provide WB -foam roller or towel can be used -inhibitory feedback: a. deep pressure to stimulate GTO activation, jnt traction & rhythmic rotation mvmnts rehab interventions taping: kinesiotape- control jnt positions & improve jnt proprioception a. applied perpendicular to muscle fibers biofeedback: so pt actively contracts antagonist muscle to reduce agonist hypertonicity whole body vibration: normalize muscle tone a. used for both hypo/hypertonia estem: applied to antagonist muscle to cause them to contract & override agonist stimulus FES cycling: stimulate agonist & antagonist aquatic exercise: improve strength, motor control & balance a. decrease effects of rigidity trager therapy: gentle rocking provided to body to decrease rigidity a. improved effects when pt in supine other interventions: acupuncture summary hypertonicity - spasticity = velocity dependent - rigidity = velocity independent - dystonia = variable presentation - direct Interventions o pharmacology - rehabilitative Interventions o weightbearing o inhibition o cycling o electrical Stimulation o vibration o taping