muscle tone

  1. what is m tone?
    • rate of fire of electrical pulses (readiness of m to contract)
    • resistance to stretch
    • response to stimulus (deep tendon reflexes..put foot on floor, does it bear weight or collapse)
    • recruitment issues
    • distribution (areas/mm of involvement)
    • muscle characteristics can change (slow twitch, slow mvmts; fast twitch, fast mvmts)
    • involves CNS, alpha, and gamma motor neurons, muscle
  2. systemic factors that influence muscle tone
    • DNA
    • CNS
    • PNS
    • physiological factors such as nutrition, toxins, etc
  3. anatomical factors which influence m tone (things we control in therapy)
    upright increases tone, lying down decreases tone

    • body/head position: vestibular, tactile, proprioceptive
    • alignment: head on body, body on body, extremity on body (joints, etc)
    • muscle length/tension
  4. kinematic factors influcening m tone
    • mvmt: active- may increase tone; passive- may decrease tone
    • rest
  5. external factors influencing m tone
    • gravity: absolute- free from external factors, tone may not change in gravity; relative- dependent upon external factors, placing someone in a gravity dependent position
    • emotional state- if agitated, may increase tone. if calm, decrease tone
    • environmental factors- too much light may overstimulate which may increase tone
  6. considerations in treatment
    • soft tissue mobility
    • joint mobility
    • AROM and PROM
    • optimal position for mm to work (if end range is difficult to move in, place in midrange and go from there)
    • muscle tone
    • dissociation to enhance diagonal control (getting 1 arm separated from the other helps decrease tone)
  7. importance of proper alignment
    • if someone is moving in poor alignment, your not getting what you want
    • when in line, mm have better advantage to work
    • benefits of upright posture- if able to kneel or stand, do it (works head/trunk control also, not just LE strengthenging)
  8. tone increasing strategies- pts with low tone
    • alignment
    • mvmt-active weight shifts in proper alignment
    • diagonal and rotational mvmts-take out predictable patterns
    • active weightbearing in proper alignment
    • upright or higher (sitting, quadraped, standing) postures and positions require more tone to hold
    • pressure tapping-same as compression, approximation
    • alternate tapping-keep in midrange
    • sweep tapping-wakes up kids mm
    • faster mvmts
    • bouncing and swinging and some other types of vestibular motion-change direction and speed (fast-swiss ball)
    • compression
    • environmental factors- bright light, music (not relaxing)
  9. tone reducing strategies - pts with high tone
    • alignment
    • slow, gentle, rhythmical rocking (global response)
    • weightbearing in proper alignment
    • mvmt in proper alignment
    • traction-prolonged stretch
    • elongation of mm
    • postioning (lay down, prone, supine)
    • slow rotational or diagonal mvmts-dont use high tone patterns
    • dissociated mvmts or positions
    • inhibitive tapping-slow pressure
    • slow, gentle shaking of extremity joint or single distal body part to get out of pattern
    • manual vibration with hands
    • some types of vestibular motion when administered properly
    • other various manual therapy techniques
    • environmental factors - dim lighting, calm music
  10. tone management to increase tone
    • sm ranges of mvmt
    • stay close to midline
    • work toward sustaining postures
    • move quickly/faster mvmts
    • use active dissociation to increase tone and reduce compensations
    • use higher positions and more vertical postures
    • use heavier input
  11. tone management to decrease tone
    • wide range of mvmt
    • stay away from midline
    • use transitional mvmts
    • use slower, rhythmical mvmts
    • use dissociation to decrease tone and reduce holding patterns
    • use variety of positions
    • elongate m- usually shortened if tight
  12. how should you handle tone pts?
    • use hands as on ball
    • key points of control
    • prepare pt first-ensure properĀ  alignment, reduce or increase so pt can take control of mvmt
    • changing key points may increase active control by pt
    • sustaining key points may enhance active stability
  13. treatment options
    • keep moving and wait for response
    • use appropriate ROM, speed, and key points of control
    • know what components are missing and facilitate them; know desired response and modify if not achieved
    • design tx activities to include missing components, then at end of session incorporate these components into a specific goal
    • ensure proper alignment, use functional positions, and observe and problem solve throughout the treatment session
    • rotation and diagonal mvmt are shortcut to achieve goal, maintaining better tone, and decreasing compensations - use PNF if need to
  14. challenges associated with low tone
    • mashed potato - put kid there, they stay. takes kids motivation to move, more likely passive
    • runner- cant hold posture, figit, etc. compensation pattern for having low tone

    • decreased excitability
    • decreased frequency of mvmt or excessive mvmt with increased speed and decreased control
    • decreased control off midline
    • decreased control when not upright
    • decreased postural control- may have decreased postural control when stationary, probably has decreased control when moving; either prop in upright or use distal parts for stability
    • more fast twitch fibers- waves goodbye faster
  15. challenges associated with high tone (like stable positions)
    • increased excitability
    • slow, labored mvmts
    • decreased frequency of mvmt- mvmts more resisted
    • decreased control of mvmt
    • decreased postural control-tend to hang on with few mm or distal parts-avoid weightshifts
    • decreased postural stability
    • more slow twitch fibers
  16. considerations in handling
    • use facilitation and inhibition together to achieve more normal mvmt
    • key points of control
    • hands should be soft, guiding, not rigid
    • hands give set of instructions for desired mvmts
    • most appropriate speed- wait for response
    • assess response ans adjust accordingly
    • facilitate muscle-avoid bony prominence
    • provide point of stability from which mvmt can occur
    • allow pt to do as much actively as they can
    • cue missing components
    • may need to change key points often to maintain acitivity, or sustain key points to increase stability
    • use mvmt rather than static positioning
    • may use transitional mvmts or partial transitions to facilitate missing components and desired mvmts
Card Set
muscle tone
muscle tone high/low