Management For Muscle Tone

Management For Muscle Tone

The management is done by different techniques and approach based on the type of lesion it can be UMN (upper motor neuron) or LMN (lower motor neuron) eg: spasticity, dystonia

Muscle tone .

(a) Medical management

 BOTOX

 Baclofen

 Clonidine

(b) Surgical management

 Tendon release and transfer

 Osteotomy

 Deep brain stimulation

(c) Physiotherapy management

Muscle tone was managed by rood’s approach. It is an extroceptive technique which was proposed by Margret Roods in 1970.

It was based on two techniques

1. Facilitatory techniques: Due to LMN lesion the muscle will go for flaccid, so this facilitatory technique is used to increase the muscle tone

(a) Light moving touch:-

Stimuli: light touch

Procedures: It is done with a fingertip, camel hairbrush or cotton swab and apply 2 times per sec for 10 times for 3-5 strokes and allow 30 seconds of rest between strokes to prevent over stimulation

(b) Fast brushing:-

Stimuli: brush

Procedures: Apply it over the dermatomes to stimulate the muscle which supplies the myotome for 3 to 5 sec and repeat after 30 seconds. Facial brushing is inhibited in high cervical brain stem or spinal cord lesion to prevent autonomic dysreflexia.

(c) Icing:-

Stimuli: quick icing

Procedures: Ice is applied the skin in 3 quick swipes and it is given from insertion to origin of muscle bulk.

(d) Proprioceptive Facilitatory techniques:

Heavy joint compression: I can be given with weighted cuff or sand bags. It helps to facilitate co-contraction activity of muscles

Stretch: Activates the proprioceptors in selected muscles and imply the principle of reciprocal innervations.

Tapping: This stimulus acts on the afferent of the muscle spindles and increases the tone of the underlying muscles.It can be given on the muscle bulk with the fingertips or percussed 3-5 times

Vestibular stimulation: The vestibular system is found to activate the antigravity muscles and their antagonist muscle before the stretch reflex of the muscle spindles. It can be used to obtain extensor pattern in neck, trunk and extremities

2.Inhibitory techniques: Due to UMN lesion the muscle will go for spasticity and to reduce it inhibitory technique can be used

(a) Neural warmth: Affect the temperature receptors in hypothalamus. It stimulate the parasympathetic nervous system and relieve hypertonia, spasticity, rigidity

(b) Gentle rocking / shaking: Shifting the weight forward and backward, progressing to side to side then diagonal patterns, helps to reduce the hypertonia

(c) Tendinous pressure: Manual pressure applied to the tendon insertion of a muscle; can be used in spastic or tight muscle

(d) Maintain /prolonged stretching: Positioning in the elongated position to cause lengthening of the muscle. Spindle to reset the afferents of the mm spindle to a longer position so they become less sensitive to stretch

(e) Prolong icing: Helps to reduce the spasticity of muscle to maintain normal tone

(f) Slow stroking: Patent should be on prone lying while the therapist provides a rhythmical, moving deep pressure over the dorsal distribution of the posterior rami of the spine; done from occiput to coccyx and alternated and should not exceed 3 minutes because it causes a rebound phenomenon