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