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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
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systemic factors that influence muscle tone
- DNA
- CNS
- PNS
- physiological factors such as nutrition, toxins, etc
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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
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kinematic factors influcening m tone
- mvmt: active- may increase tone; passive- may decrease tone
- rest
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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
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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)
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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)
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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)
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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
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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
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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
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how should you handle tone pts?
- use hands as on ball
- key points of control
- prepare pt first-ensure proper 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
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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
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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
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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
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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
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