Tuesday, 20 May 2014

Hypertonia & Ataxia in MS

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
Types of Ataxia

·         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