Rehabilitation: Elders can improve their mobility by actively participating in rehabilitation exercises such as muscle strengthening and balance training exercises. Passive range of motion: Passive range of motion exercise, administered either manually or through specialized equipment, which can maintain the joint range of motion and increase the extensibility of muscles. Stretching: Stretching can help sustain or improve muscle length and decrease spasticity Electrical therapy: Electrical therapy applied together with rehabilitation exercise can reduce spasticity, joint and muscle pain, and prevent loss of muscle strength.
The risk of developing pressure sores can be reduced by using pillows with good support, applying proper positioning skills in sleeping, sitting and standing postures, and changing position regularly. Heat therapy can help to reduce spasticity and muscle fatigue, and soothe. Elders can improve their mobility by actively participating in rehabilitation exercises such as muscle strengthening and balance training exercises.
AccessEmergency Medicine. Case Files Collection. Clinical Sports Medicine Collection. Davis AT Collection. Davis PT Collection. Murtagh Collection. About Search. Enable Autosuggest. You have successfully created a MyAccess Profile for alertsuccessName. Home Books Principles of Rehabilitation Medicine. Previous Chapter. Next Chapter. Spasticity and Contractures. In: Mitra R. Mitra R Ed.
Spasticity results from the loss of descending inhibition of spinal cord reflex arcs as well as loss of cortical inhibition on the postural centers contained within the vestibular nuclei and reticular formation 31 Fig.
UMN lesions that disrupt the inhibitory and excitatory pathways of the CNS may result in disinhibition of the anterior horn cells and their associated spinal reflexes. Monosynaptic muscle stretch reflex with descending control via inhibitory interneurons.
Primary Ia afferents green from muscle spindles, activated when the muscle is stretched rapidly, synapse directly on motor neurons blue going to the stretched muscle, causing it to contract and resist the movement. Pyramidal upper motor neurons aqua from the cerebral cortex suppress spinal reflexes and the lower motor neurons indirectly by activating the spinal cord inhibitory interneuron pools red.
When the pyramidal influences are removed, the reflexes are released from inhibition and become more active, leading to hyperreflexia and spasticity. Baclofen acts to restore the lost inhibition by stimulating postsynaptic gamma-aminobutyric acid GABA receptors. Tizanidine acts presynaptically to stimulate GABA release from spinal cord inhibitory interneurons.
The two mechanisms at work in the pathophysiology of spasticity are the spinal mechanism with resulting change in the function of spinal neurons and the cerebral mechanism encompassing supraspinal and suprasegmental mechanisms.
Immediately after injury to the motor portion of the CNS, there is paralysis, flaccidity, and gradual muscle shortening. Contracture formation occurs along a pathway that begins with muscle unloading when immobilized, followed by atrophy, loss of sarcomeres, and accumulation of connective tissue and fat in the muscle tissue.
As with any clinical examination, evaluation of the patient should begin as the patient enters the examination room. A scissoring gait, for example, generally indicates spasticity of the hip adductors resulting in a crossing over of the medial thighs. Limb posture, such as maintaining the elbow in a flexed position, may provide evidence of spasticity.
In hemiplegic individuals, it is common to observe a combination of internal rotation and adduction at the shoulder, flexion of the elbow, pronation of the forearm, and flexion of the wrist and fingers. A thorough skin examination is essential in individuals with spasticity. A detailed neurologic examination and musculoskeletal examination should be conducted of all four limbs, including deep tendon reflexes, abnormal reflexes e.
Many neurologic conditions are unilateral e. When examining a limb for spasticity, the proximal and distal joints should be ranged both actively and passively. The clinician should also observe and palpate for muscle spasm with joint movement, evaluate for clonus with rapid and slow stretching of the joint, and be aware that spasticity frequently is accompanied by some degree of muscle contracture, especially over time.
The scale ranges from 0 to 4, with the muscle acting across the joint rated based on what point during flexion or extension resistance or a catch is noted. These techniques are usually attempted prior to surgical intervention. Surgical goals vary based on current and expected functionality and severity of the deformity.
Children with spasticity present a unique challenge, as surgical intervention may be required to allow more normal bone, joint and muscle development.
This page was last updated on: September 21, PM Neuromuscular and Movement Disorders Program Specializing in the treatment of muscular dystrophies, neuropathies, spinal muscular atrophy and congenital myopathies. Spasticity of the lower extremity ranges from mild to very disabling.
The affected muscles may be over-active and cause joint contractures stiff joints.
0コメント