WEEK 6 PTA145 Managing Hyper/Hypo lab pt2

Managing HYPER/HYPO

Groups:

(a) Managing Hypertonicity

,

(b) Managing Hypotonicity

• Resistance without overload

• Tapping

• Prolonged stretch

• Modalities

• Serial casting

• Inhibitory pressure

• Neutral warmth

• Rhythmic rotation

• Approximation

• Weight beaing (hypo)

• Quick stretch

• Weight bearing

• Prolonged icing

• Strengthening w/o overload

• Positioning (hypo)

Managing Hypertonicity

Prolonged Icing

-Reduce neurotransmission & spasticity

-Muscle spindles ​ (a)   to where there is no longer an excessive stretch reflex

-Effects can last ​ (b)  

-Most common method is LOCAL IMMERSION

-Useful w/hand ​ (c)   tone

Inhibitory Pressure

-Firm/moderate inhibitory pressure on ​ (d)  

-Manually and/or through devices such as splints or positioning (weight bearing)

Prolonged Stretching

-Inhibition of hyperactive muscle responses

-Active/passive stretching for prolonged time

​ (e)  

Neutral Warmth

Stimulates thermoreceptors and activates parasympathetic response

-10-20 minutes to produce an effect

-Wrapping body parts with towels, hot packs, tepid baths, paraffin, and SPLINTS

• flexor
• extensor
• cooled
• hot
• 1-2 hours
• 1-5 hours
• TENDONS
• BONE
• -INHIBITORY SPLINTING/CASTING

Managing Hypertonicity CONT.

Rhythmic Rotation

-​ (a)   of a limb at a point where limitation is noticed

-As muscles relax the limb is SLOWLY and GENTLY moved into the range

-As new tension is felt, rhythmic rotation is repeated

-Active or Passive

-Voluntary relaxation when possible

Modalities

-Electrical Stimulation (NMES, TENS)

-On ​ (b)   muscle for reciprocal inhibition

Weight Bearing

-Prolonged inhibitory pressure

-Proprioceptive sensory feedback to ​ (c)  

Serial Casting

​ (d)  

-At risk for contractures

-Maintained pressure

​ (e)  

-Recast every 5-7 days as ROM progresses

• Slow, repeated rotation
• antagonist
• agonist
• CNS
• -When other techniques fail
• -Low load prolonged stretch

Managing Hypertonicity Cont.

Strengthening contraction (reciprocal inhibition)

-If quads are overactive due to extensor tone, strengthening/activation of HS will inhibit quads via ​ (a)  

-AAROM until AROM possible

-Let me move you, now help if you can

-Smooth, reciprocal short arc to long arc

-Minimize stress & effort initially

-Primary functional skills emphasized

-Family & patient training for maintenance

• reciprocal inhibition
• ok

Managing Spasticity

-Spasticity untreated ---> contractures, deformities, asymmetries

PRIMARY INTERVENTION: Stretching and positioning

Handling Skills

*Lengthen vis ​ (a)   repeated rhythmic rotation

-Maintain ​ (b)   position

-Resting splints

• elongated
• SLOW
• FAST
• shortened

Decorticate vs Decerebrate Posturing

Groups:

(a) Decorticate

,

(b) Decerebrate

• MORE INDACTIVE OF SEVERE DAMAGE

• Elbows extended, legs extended and IR

• MORE FLEXION

• Elbows, wrist, and fingers flexed, legs extended and IR

• MORE EXTENSION

Loss of higher cortical activation, results in lack of Inhibition of these patterns= REEMERGENCE

• Prolonged patterns lead to MUSCULOSKELETAL IMPAIREMENTS

• Nervous system MUST be able to control both AGONISTIC & ANTAGONISTIC patterns & combinations of each for functional movement

• DON'T FEED THE PATTERN!!!!!

• MOST ARE PRE-PROGRAMMED INTO CNS

Managing Synergies Critical Elements

Movement opposite to pattern

Reciprocal inhibition

BEGIN DISTAL TO PROXIMAL for tone inhibition

• Wrist

• Finger

• Elbow

• Thumb

Managing Synergies Critical Elements

Movement opposite to pattern

Reciprocal inhibition

BEGIN ​ (a)   TO ​ (b)   for tone inhibition

(c)  

(1) - (d)  

(2) - (e)  

(3) - Elbow

Static HOLD on intermediate joints opposite to pattern

• Finger
• Thumb
• Wrist
• Elbow
• DISTAL
• PROXIMAL

Managing Hypotonicity Cont.

Strengthening/neuromuscular re-education

-use of ​ (a)   from stronger muscles

​ (b)   (gravity eliminated, against gravity, resistance)

Splints/bracing: to maintain joint alignment, ​ (c)  

• yes

• irradiation
• START in successful positions than progress
• protection
• danger