Management of MS Hypertonia
· Spasticity
· Reduction of tone must have a clear objective with an achievable functional benefit
· High tone is often useful for standing and transferring
· Some hypertonia can be changeable in distribution, for example lower limb extensors in standing but flexors in lying
· Where there is a hypertonic muscle, the antagonists are often hypotonic.
· Imbalances may need to be corrected to avoid contractures and deformity
· Most common muscle groups are:
· Trunk rotators
· Trunk lateral flexors
· Hip flexors and adductors
· Knee flexors
· Plantarflexors
· Inverters
· Sensory ataxia
· High stepping gait pattern
· More reliance on visual or auditory senses
· Information about leg or foot position
· Vestibular ataxia
· Disturbed equilibrium in standing and walking
· Loss of equilibrium reactions
· Wide-based, staggering gait pattern
· Cerebellar ataxia
· Disturbance in the rate, regularity and force of mvt
· Loss of mvt co-ordination
· Dysmetria (overshooting of target)
· Dyssynergia (decomposition of mvt)
· Dysdiadochokinesia
· Inco-ordination of agonist and antagonists
· Loss of continuity of muscle contraction (tremor)
Management of MS Ataxia
· Commonly seen with spasticity
· Alters the direction and extent of a voluntary mvt
· Impairs the sustained voluntary and reflex muscle contraction necessary for maintaining posture and equilibrium
· Inability to make mvts which require groups of muscles to act together at varying degrees of co-contraction, as required during gait as the single stance phase requires co-contraction in order to support body weight whilst shifting body weight forward
· Walking aids allow the pt to flex at the hips removing the need for co-ordinated change between hip flexion to extension whilst weight bearing on the stance leg
· Can lead to postural abnormality
· Exaggerated lumbar lordosis
· Anterior pelvic tilt
· Hip flexion
· Hyperextensive knees
· Weight shift towards heels
· Clawed toes
Assessment & Treatment Approached for MS Ataxia
· Maintaining equilibrium
· Weight bearing and transference
· Increase postural stability
· Control of CoG
· Differing base of support
· Co-ordination of dynamic mvt
· Patterns of mvt
· Enhance smoothness of control
· Progress from simple, fast mvts to complex, slow mvts
· Located in body axis and trunk
· Gross body mvts ie transfers
· Independent head mvt
· Increase control of mvt around the midline
· Mvt of limb girdles in relation to midline (especially rotation)
· Located in limbs
· Voluntary body mvts
· Enhance proximal limb stabilisation
· Co-ordinate activity of agonist and antagonists
· Progress from large to small range mvts
· Reduce requirement of visual guidance