Transcript Hvad er spasticitet?

Spasticitet under bevægelse
http://www.youtube.com/watch?v=UDgxjRy
Pe2w&list=QL&playnext=16
• Målet med Bobath-konceptet er at skabe normal
spændingstilstand i musklerne ved at fremme normale
bevægelser og hæmme unormale bevægelser. Det sker ved at
regulere spændingen i musklerne, fremme evnen til at opfatte
påvirkninger, få begge kropshalvdele til at arbejde sammen og
derved skabe symmetrisk eller ret kropsholdning, forhindre
sygdomsfremkaldte bevægelser og stillinger samt muliggøre
selvstændige bevægelser.
• Anvendelse ved spasticitet: Når metoden bruges ved
spasticitet, er målet at løsne nøglepunkterne i skulderbæltet,
kropsstammen, tommelfingeren og hoften samt evnen til
fysisk at kunne løfte ting, approksimation, lejring i
antispastiske mønstre, og at man bevæger sig på en naturlig
og antispastisk måde.
Textbooks
• Spasticity may limit a patient´s ability to move
quickly because of activation of the stretch
reflex (Shumway-Cook and Woollacott)
• ”antagonist restraint” (Bobath 1978; Davis
1985)
Apopleksi
• calf muscles were prematurely activated in the
stance phase, probably due to enhanced
stretch reflexes
• EMG activity was abolished or extremely low
in 2 or more of the muscles examined
• pathological coactivation of several or all of
the muscles during part of the gait-cycle, thus
disrupting the normal sequential shift of
activity in antagonistic muscles
Knutsson E, Richards C. Different types of disturbed motor control
in gait of hemiparetic patients. Brain. 1979 Jun;102(2):405-30.
Berger W, Quintern J, Dietz V. Pathophysiology of gait in children with cerebral
palsy. Electroencephalogr Clin Neurophysiol. 1982 May;53(5):538-48.
CP
• The characteristic pattern of muscle activity recorded
from the spastic legs mainly consisted of a coactivation of antagonistic leg muscles during the
stance phase of a gait cycle and a general reduction
in amplitude of EMG activity.
• it is proposed that muscle co-activation recorded in
spastic children is due to an impaired maturation of
the locomotor pattern with an early neuronal
adaptation to altered muscle fibre mechanical
characteristics.
Berger W, Quintern J, Dietz V. Pathophysiology of gait in children with cerebral
palsy. Electroencephalogr Clin Neurophysiol. 1982 May;53(5):538-48.
Reflekser findes ikke som selvstændige fænomener – de er
altid integreret med resten af nervesystemet. Problem for
behandling..
[email protected]
Muskel aktivitet under gang tilpasses automatisk
omgivelserne på basis af sensorisk information
af Klint, Grey, SInkjær, Nielsen J Physiol 2008
Pride and a daily marathon – the case of Ian Waterman
Stretch reflexes are not increased in the active spastic
muscle
Reduced reflex modulation during bicycling in stroke
NB
Schindler et al. 2007
The stretch reflex during spastic walking
PATIENT
CONTROL
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Reduceret reciprok inhibition er korreleret til forøget coaktivering og reduceret bevægelseshastighed
Boorman GI, Lee RG, Becker WJ, Windhorst UR. Electroencephalogr Clin Neurophysiol. 1996 Apr;101(2):84-92.
Okuma Y, Mizuno Y, Lee RG. Clin Neurophysiol. 2002 Feb;113(2):292-7.
Pause med diskussion af den praktiske betydning