Definitions and Pathophysiology
Positive signs of upper motor neuron syndrome (5)
What are:
•Spasticity
•Hyperexcitable stretch reflex with spread
•Positive primitive reflexes
•Clonus
•Spasm
•Rigidity
•Athetosis
These two agents require periodic liver function testing — at baseline, 1, 3, and 6 months.
What are dantrolene and tizanidine?
On the Ashworth Scale, "considerable increase in muscle tone; passive movement is difficult" corresponds to this grade
What is grade 3?
Complications of spasticity (6)
What are:
Pain
Impaired function
Cosmesis
Pressure sores
HO
Poor hygiene
Contractures
Fractures
Joint subluxation and/or dislocation
Acquired peripheral neuropathy
Sleep disturbance
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Who are the Saskatchewan Roughriders?
Negative sings of upper motor neuron syndrome (3)
What are:
•Weakness
•Loss of dexterity
•Fatiguability
•Loss of selective muscle and limb control
Tizanidine and clonidine share this receptor mechanism, which explains their overlapping side effects of hypotension and sedation.
What is α-2 adrenergic agonism?
This MAS grade is defined as a catch followed by minimal resistance through the remainder — less than half — of the range.
What is grade 1+?
In a chronic SCI patient with previously stable tone, these three common noxious triggers should be sought before escalating medication.
What are:
UTI/stones
Constipation/impaction
Pressure wounds/ skin breakdown/ ingrown toenails
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Who is Chappell Roan?
Definition of spasticity
What is: a motor disorder characterized by a velocity dependent increase in the tonic stretch reflex with exaggerated tendon jerks (phasic stretch reflex), resulting from hyperexcitability of the stretch reflex as one component of the UMN syndrome.
Phenol and alcohol work by this mechanism, distinct from BoNT's presynaptic blockade.
What is chemical denervation via protein denaturation/Wallerian degeneration of the nerve (nonselective axonal destruction)?
This MTS parameter is the full passive range measured during slow movement, essentially reflecting contracture/passive tissue length
What is R2?
Potential benefits of spasticity (4)
What are:
Maintain muscle bulk
Decreased risk of DVT
Decreased risk of osteoporosis
Detects exposure to noxious stimuli
Mobility - ambulation, standing, transferring
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What is The Princess Bride?
After SCI, spasticity emerges over this interval and generally stabilizes by this point — following this initial areflexic state.
What are 4 weeks, 12 months, and spinal shock?
Typical adult baclofen start and labeled daily maximum
What are 5 mg TID and 80 mg/day (20 mg QID)?
Beyond resistance intensity and catch angle, the Tardieu also records the presence and character of this phenomenon.
What is clonus (fatigable vs. nonfatigable)?
Conservative management (5)
What are:
•Goal setting, education
•Avoid noxious stimuli
•Stretching/ROM
•Proper positioning
•Splinting, serial casting, bracing
•Modalities: Deep heat via US, Cold, Direct tendon pressure, FES, TENS, Biofeedback
The best musical(s) ever.
What is/are:
Mamma Mia (not Mamma Mia 2)
Les Mis
Rent
The motor neuron that makes the muscle contract and produce force and the motor neuron that adjusts how sensitive the spindle is, respectively
what are the alpha motor neuron and the gamma motor neuron?
Tizanidine adult start and maximum daily dose
What are 2 mg qhs and 36 mg/day (in 3-4 divided doses)?
A patient has MAS 2 at the elbow, but R1 ≈ R2 on Tardieu. Name the dominant contributor and the implied treatment pivot.
What is fixed contracture/passive tissue shortening (minimal dynamic component) — favoring stretching, casting, or orthopedic referral over botulinum toxin?
Contraindications to intrathecal baclofen (3)
What are:
•Unreliable patient or caregiver
•UL>LL
•Contracture > spasticity
•Comorbidities/complexity
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What are honey mustard / aioli and ketchup?