Management of residual physical deficits
Mark J. Ashley, David A. Hovda in Traumatic Brain Injury, 2017
Hypertonia, a term used interchangeably with spasticity, is one component of an upper motor neuron injury and may be a residual deficit from TBI. Spasticity, as defined by J. W. Lance,38 is an increase in muscle tone due to hyperexcitability of the stretch reflex. Consideration must be given to the differentiation between spasticity and rigidity in an effort to determine the best treatment approach. Although spasticity is characterized by a velocity-dependent increase in tonic stretch reflexes, the increased tonic stretch reflexes in rigidity are not velocity-dependent. Spasticity typically involves a muscle on one side of a joint, but rigidity affects the muscles on both sides of a joint. Both hypertonia and hypotonia become problematic when the patient is unable to regulate the amount of muscle tone needed when activating various muscle groups. The residual problem is often very one-sided, either hyper-reflexive or hyporeflexive, resulting in mobility deficits at specific joints that interfere with functional activities.
Musculoskeletal and Soft-Tissue Emergencies
Anthony FT Brown, Michael D Cadogan in Emergency Medicine, 2020
Tetanus itself is rare, but worldwide it is an important cause of death in parts of Asia, Africa and South America. The incubation time from injury to first symptoms ranges from 3 to 21 days (usually about 10 days).The most common symptoms are jaw stiffness (trismus), dysphagia, neck stiffness and abdominal and back pain. Hypertonia is found on examination.Localized or generalized painful spasms follow within 24–72 h, becoming more severe and prolonged from minimal stimuli.Death may occur from laryngospasm, respiratory failure or autonomic dysfunction.There is no rapid diagnostic test to prove the diagnosis, therefore admit a suspected case immediately to the intensive care unit (ICU).
Examination of a Child with Cerebral Palsy
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
Tone is resistance felt to a passive stretch in a relaxed state of muscle activity and is best demonstrated by passive movement about a joint. The child is assessed in a relaxed state and can be examined in the parent’s lap. It may be increased in the form of spasticity, dystonia, or rigidity. The criteria described by Sanger et al.6 to assess hypertonia can be followed: Palpate the muscle to be examined to assess whether there is muscle contracture at rest.Define the available passive range of motion by moving the limb gently.Now move the limb at different speeds through the available range to look for catch, i.e., sudden resistance offered to the passive range and further possible slow stretch.Now the patient is asked to move the same joint on the other side and look for an alteration in resistance to movement or involuntary movement on the side being examined, which may indicate the presence of dystonia.
An expansion of phenotype: novel homozygous variant in the MED17 identified in patients with progressive microcephaly and global developmental delay
Published in Journal of Neurogenetics, 2022
Rafiullah Rafiullah, Alia M. Albalawi, Sultan R. Alaradi, Majed Alluqmani, Muhammad Mushtaq, Abdul Wali, Sulman Basit
Perinatal history of both affected individuals was unremarkable. Head circumference in both affected individuals was more than 2 SD below the mean. Patient IV:3 was diagnosed at the age of 4 months with severe ID and progressive microcephaly. The onset of seizures was noted at the age of 2 years. The EEG showed multifactorial spikes and poly spikes during sleep. Magnetic resonance imaging (MRI) findings at the age of 6months revealed mild atrophy of vermis, cerebellar, and cerebral as well as mild delay in myelination, small thalami, and thin brainstem (Figure 1(B)). Both patients never acquire speech and were unable to walk at the age of 3 and 5 years. Moreover, both patients experience severe eye tracking problems. Muscle tone was found high (hypertonia). Patients failed to move their upper or lower limbs and were completely bedridden.
Classification of Congenital Zika Syndrome: Muscle Tone, Motor Type, Body Segments Affected, and Gross Motor Function
Published in Developmental Neurorehabilitation, 2021
Janiele de Sales Tavares, Gabriela Lopes Gama, Marcia Cristina Dias Borges, Agda Cristina de Sousa Santos, Jousilene de Sales Tavares, Melania Maria Ramos Amorim, Adriana Melo
Although a wide spectrum of motor impairment has already been described in children with CZS, the typical phenotype of this syndrome remains to be established. Studies have described severe motor impairment,8 associated with hypertonia.15,28,29 However, the fact that the methods used to evaluate muscle tone in those studies were insufficiently described renders comparison impossible. Furthermore, the children evaluated were younger than those in the present sample, also hampering comparison,13 since, during motor development, other disorders such as the occurrence of convulsive seizures, sensory impairment and delayed motor development may affect muscle tone.30 Moreover, this is a disease that has only recently been described and the resulting brain abnormalities are severe, with little information available on how peripheral innervation is affected; therefore, characterizing muscle tone remains challenging.
The Impact of Intrathecal Baclofen Therapy on Health-related Quality of Life for Children with Marked Hypertonia
Published in Developmental Neurorehabilitation, 2020
Kirsty Stewart, Lisa Copeland, Jennifer Lewis
The effective management of spasticity and dystonia in pediatric neurological conditions such as cerebral palsy (CP), genetic conditions and acquired brain injury (ABI), is challenging. The presence of severe spasticity and dystonia commonly results in associated pain, difficulties with daily cares, poor sleep hygiene, difficulties with feeding and positioning and reduced quality of life.1,2 In the treatment of severe hypertonia, a multimodal treatment approach is frequently taken including physical therapies, prescription of complex equipment, positioning, oral medications, orthopedic surgery, and Botulinum toxin injections.3,4 For children whose hypertonia cannot be adequately managed, intrathecal baclofen therapy (ITB) may be considered as a treatment option.