UMN & LMN/ muscle tone

• UMN

  • leision of neural pathway
  • due to damage to cortical neurone of corticospinal (brain to spinal cord) and corticobulbar tract (brain to cranial nerve)

  symptoms:

  • clasp knife phenomenon (resisted passive movement)
  • exaggerated tendon jerk (over excite reflex)
  • clonus (repetitive movement when stimulated)
  • spasticity: hypertonus and muscle stiffness
• LMN

  • anterior horn cell receive command from brain to lower motor neurone to control muscle
  • acute hypotonia (sudden decrease resistance in muscle)
  • muscle weakness
  • loss of dexterity (ability to perform prrecise movement)
  • loss of coordination
  • loss of cutaneous reflex
• UMN: deficiency in generating force

  • loss of motor unit activation: brain signal to activate muscle are weaker
  • changes in recruitment ordering: order of muscle activated jumbled
  • changes in firing rate: signal from brain to muscle slow down
  • prolonged contraction time
  • slowness of muscle activation
  • change in biochemical properties of muscle: muscle stiffness, contracture(muscle tendon shorten)
  • altered motor pattern: spasticity, tone
• normal tone: consistent tension in muscle at rest, indicating that they are ready for movement, constantly adjusted by CNS

  abnormal muscle tone affects: muscle activity/ soft tissue length/ response to stimuli

  spasticity(UMN leision): resistance to move/ loss mobility/ limb feels heavy

  flaccidity(LMN leision): reduced resistance to movment/ instability/ fatigue/ limbs feel heavy/ decreased circulation/ muscle weakness
• Sarcomeres are the basic contractile units within muscle fibers that allow for muscle contraction and force generation

  • shortened muscle reduce sacromere number
  • lengthened muscle increase sacromere number

  connective tissue immobility cause

  decrease in water and GAG content: lead to impaired gliding between tissue and affect normal movement and function

  increase synthesis of collagen and collagen cross link: decreased flexibility of affected tissue
• stretching and passive movement on soft tissue extensibility

  • improve elasticity and flexibility of connective tissue
  • improve mobility and range of movement
  • optimize muscle function
  • improve sensory feedback, better body awarenss, coordination
  • promote blood flow
• massage:

  • mobilise: improve movement and reduce pain
  • increase blood flow and lymph flow: promote tissue healing and waste removal
  • soften and stretch muscle and connective tissue: improve flexibility and reduce muscle tension
• improve tone:

  decreased tone: small BOS, high COG/ supportive excitatory handling and high speed/ improve proximal stability and distal multi-joint function

  increased tone: large BOS, low COG/ supportive inhibitatory handling and low speed/ maintain soft tissue extensibility
• improve parkinson patient sitting posture and balance

  upper limb: turn head/ arm cross/ hold scapular and pelvis twist

  lower limb: bend knee/ hold scapular and knee twist
• stroke patient one side weakness low tone sit to stand:

  1. physio A hold hand hold back, hip push towards patient weak side
  2. physio B hold hand hold back, hip resist physio A
  3. physio C one hand above knee one hand under hip squeeze to excite muscle
  4. swing left right after standing up
• ataxia: disorder affecting coordination and balance and multi joint movement

  ataxia with decreased tone:

  • patient become unstable in trunk
  • patient decreased ability to perform fine task
  • soft tissue tightness: act as counter act to regain stabilityy
• soft tissue extensibility handling:

  1. hand under pillow
  2. bicep long short head
  3. sweep muscle
  4. stabilise and pick
  5. stabilise proximal move distal