Tbi - Spasticity

Front 1

Common tract disrupted in TBI pt's that leads to loss of fractionated movement?

Back 1

Lateral corticospinal tract

Front 2

Which descending system is responsible for Flexor Reflex Afferents (FRA)?

Back 2

Corticospinal tract

Front 3

5 causes of abnormal reflexes?

Back 3

1) Alpha-MN hyper excitability
2) Gamma-MN hyper-excitatbility
3) Loss of 1a afferent inhibition
4) Cutaneous reflexes
5) Changes in muscle

Front 4

Co-contraction typically occurs from altered descending input. What two places does the altered input occur?

Back 4

1) Alpha-MN
2) Interneuron

Front 5

Describe Autogenic Inhibition

Back 5

GTO -> 1b afferent -> 1b interneuron -> inhibition of agonist muscle.
** Inhibits it's own contraction **
**Helps grade muscle force**

Front 6

Describe function or Renshaw cell

Back 6

Activates own alpha-MN, inhibits own alpha-MN and disinhibits 1a inhibitory interneurons (not the only input though).
**activated by own anterior horn cell**
**grades muscle force**
Acts via a loop?

Front 7

Neurons responsible for normal muscle synergies?

Back 7

Propriospinal neurons

Front 8

Bottom line of muscle overactivity?

Back 8

Altered descending system

Front 9

Secondary muscle spindle endings?

Back 9

1) Nuclear bag fibers
2) Static chain fibers

Front 10

What influences secondary endings?

Back 10

Tonic stretch reflex

Front 11

muscle spindle fibers do 1a endings wrap around?

Back 11

All

Front 12

1a endings are influenced by?

Back 12

Phasic stretch reflex (AKA velocity dependent)

Front 13

Ashworth scale:
Catch attributed to?
Resistance through ROM attributed to?

Back 13

1) Phasic stretch reflex
2) Tonic stretch reflex

Front 14

Action of Baclofen? Generic?

Back 14

1) Gama agonist (sits on gaba receptor site)
2) Lioresal

Front 15

Criteria for a Baclofen pump?

Back 15

1) Must be level 3 or 4 on Ashworth
2) Multi-joint spasticity
3) Can't take oral medications
4) Shunt could be an issue

Front 16

Explain the trial for a Baclofen pump

Back 16

Bolus is injected, Typically takes effect in 4 hrs. PT will perform Modified Ashworth every 2 hours to see if pt is getting desired affect (typically want to reduce score by 2 points). If response isn’t found on 1st day -> higher dose on second day -> highest dose on 3rd day

Front 17

Treatment for a pt who has just been approved for a Baclofen pump

Back 17

The pt is now on bedrest for several days so attempt the following: Maintain ROM, educate family, re-assess DME, educate on transfers

Front 18

What should PTs avoid for Baclofen pump pts?

Back 18

1) Forceful trunk exercise
2) Limited heat modalities

Front 19

Appropriate substitute for Baclofen that has less S&S?

Back 19

Xanaflex

Front 20

List medications to manage spasticity(5)

Back 20

1) Baclofen
2) Dantrium
3) Valium
4) Neurontin
5) Xanaflex

Front 21

3 neurlytics

Back 21

1) Botox
2) Procane
3) Phenol

Front 22

shortest lasting neurolytic

Back 22

Diagnostic block (procane) ~ 8hrs.

Front 23

Contra-indications for a spasticity managment medication?

Back 23

1) Uses spasticity for functional compensations (i.e., walking)
2) Anti-coagulation therapy pts
3) Pt or family is unable/willing to cooperate
4) Any joint deformities or contractures