Hypertonia is a term sometimes used synonymously with flexibility and stiffness in the literature around damage to the central nervous system, ie, upper motor neuron lesions. Impaired ability of damaged motor neurons to regulate the descending pathway results in increased spinal reflexes, increased stimulation of muscle spindles, and decreased synaptic inhibition. This consequence results in an abnormal increase in muscle tone of symptomatic muscles. Some authors have suggested that the current definition of spasticity, the velocity that relies on stretch reflex activity, is insufficient because it fails to take into account patients who exhibit increased muscle tone in the absence of stretching reflex activity. They instead suggest that " reversible hypertonemia " is more precise and represents a treatable condition that is responsive to various therapeutic modalities such as medication and/or physical therapy.
Symptoms associated with central nervous system disorders are classified into both positive and negative categories. Positive symptoms include those that increase muscle activity through hyper-stimulation of the stretching reflex (ie, stiffness and elasticity) where negative symptoms include inadequate muscle activity (ie weakness) and reduced motor function. Often two classifications are considered as separate entities from interference; However, some authors propose that they may be closely related.
Video Hypertonia
Pathophysiology
Hypertonia is caused by an upper motor neurone lesion that may be caused by an injury, disease, or condition involving damage to the central nervous system. Less or decreased upper motor neuron function leads to loss of inhibition with hyperactivity resulting from lower motor neurons. Different patterns of muscle weakness or hyperactivity may occur based on the location of the lesion, causing many neurological symptoms, including flexibility, stiffness, or dystonia.
Spastic hypoidomy involves spasmodic spasms of muscle, stiffness or straightening of muscles, contractions such as shock from all or part of muscle groups, and abnormal muscle tone. This is seen in disorders such as cerebral palsy, stroke, and spinal cord injury. Rigidity is a severe hypertonia state in which muscle resistance occurs across independent independent range of motion velocities. Often associated with lesions in the basal ganglia. Individuals with stiffness present with stiffness, decreased range of motion and loss of motor control. Dystonic hypertonicity refers to muscle resistance to passive stretching (in which a therapist gently stretches an inactive muscle into a comfortable length at very low movement speed) and limb tendency to return to an unconscious (and sometimes abnormal) posture ) following the movement.
Maps Hypertonia
Management
Therapeutic intervention is the best individual for a particular patient.
The basic principles of care for hyponia are to avoid dangerous stimuli and provide frequent range of motion exercises.
Physical intervention
Physiotherapy has been shown to be effective in controlling hyperonia through the use of stretches aimed at reducing motor neuron stimulation. The purpose of a physical therapy session can be to prevent overtones as far as possible, giving the patient a normal position and movement sensation, and to facilitate normal movement patterns. While static stretching has become a classic way of increasing range of motion, PNF stretching has been used in many clinical settings to effectively reduce muscle flexibility.
Icing and other topical anesthetics can decrease reflexive activity for short periods of time to facilitate motor function. Inhibitory pressure (applying strong pressure on the muscle tendon) and increasing body heat retention and rhythmic rotation (slow repetitive rotation of affected body parts to stimulate relaxation) has also been proposed as a potential method to decrease hyponia. Aside from static stretching, splinting techniques are valuable for extending the range of lost joint motion to hypertonicity. A more unconventional method to restrict the tone is to exert passive movements quickly repeated to the joints involved in the cycle; It has also been shown to show results in people without physical disabilities. For a more permanent improvement, patient training and education are mandatory. Isocinetic, aerobic, and strength training should be done as determined by the physiotherapist, and stressful situations that may cause increased tone should be minimized or avoided.
Pharmaceutical interventions
Baclofen, diazepam and dantrolene remain the three most commonly used pharmacological agents in the treatment of spastic hypon. Baclofen is generally the drug of choice for this type of spinal cord from spasticity, whereas sodium dantrolene is the only agent that acts directly on muscle tissue. Tizanidine is also available. Phenytoin with chlorpromazine can be potentially useful if sedation does not limit its use. Ketazolam, not yet available in the United States, may be a significant addition to a range of pharmacological options. Intrathecal antispastic drug delivery allows for high drug concentrations near the site of action, which limit side effects.
Nutritional intervention
Recent studies have shown that taurine biomolecules may be effective for hyponia, possibly through benzodiazepine-like modulation of GABA inhibitory neurotransmitters or neuromuscular effects of elevated intracellular calcium levels.
See also
- Dystonia
- Hypotonia
- Spasticity
- Handheld response
References
External links
Source of the article : Wikipedia
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