Tone
- Weight bearing
- weight shifting
- Joint approximation
- tapping on muscle
- brisk stroking
- quick stretch
- application of ace wrap to ankle/foot
- kinesiotaping
Interventions -- Low tone
What is the first step of inhibiting and facilitating tone?
Seating the pelvis
Which RLA level:
- Patient appears to be in a deep sleep and is completely unresponsive to any stimuli
Which RLA level:
Patient shows goal directed behavior but is dependent on external input or direction. Follows simple directions consistently and shows carryover for relearned tasks such as self care. Responses may be incorrect but are appropriate to the situation. Past memories show more depth than recent memory.
RLA VI - confused, appropriate
Which RLA level:
- Patient reacts specifically but inconsistently to stimuli. Responses are directly related to the type of stimulus presented. May follow simple commands such as closing eyes or squeezing hand in an inconsistent delayed manner.
RLA III - Localized response
Where should you contact the patients hand when attempting to decrease tone of the UE?
Thenar eminence
To inhibit tone, what are the techniques for unwrapping the UE and LEs?
Approximation
Which RLA level:
- Patient is in a heightened state of activity. Behavior is bizarre and non purposeful relative to immediate environment. Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts. Vernalizations frequently are incoherent and/or appropriate to the environment; confabulation may be present. Gross attention to environment is very brief; selective attention is often nonexistent. Patient lacks short term and long term recall.
RLA IV - confused, agitated
Which RLA level:
Patient shifts back and forth between tasks and completes for 2 hours, uses memory device to assist when requested. Aware of limitations but needs standby assist to anticipate and correct problems before they occur. Able to think about consequences of decisions with assist, can adjust to task demands with standby assist, may have depression, may be easily irritates or have low frustration tolerance; able to self monitor social appropriateness with standby assistance.
RLA IX - purposeful, appropriate
Which RLA level:
Patient is unable to respond to simple commands fairly consistently. With increased complexity of commands or lack of any external structure, responses are nonpurposeful, random or fragmented. Demonstrates gross attention on a specific task. With structure, may be able to converse on a social automatic level for short periods of time. Verbalization is often inappropriate and confabulatory. Memory is severely impaired; often shows inappropriate use of objects; may perform previously learned tasks with structure but is unable to learn new information
RLA V - confused, inappropriate
- Weight bearing
- Weight shifting
- joint approximation
- Deep pressure to muscle or tendon
- unwrapping
- reciprocal inhibition
- low-load long duration stretch (brace, cast)
- application of ace wrap to ankle/foot
Interventions -- high tone
For facilitating tone, what are the techniques used for UE and LEs?
1. Approximation
2. Tapping
3. Progressive hold
Which RLA level:
Patient is able to recall and integrate past and recent events and is aware of and responsive to environment. Shows carryover for new learning and needs no supervision once activities are learned. May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgement in emergencies or unusual circumstances
RLA VIII - purposeful, appropriate
Which RLA level:
- Patient reacts inconsistently and non-purposefully to stimuli in a nonspecific manner. Responses are limited, often the same regardless of stimulus presented. Responses may be physiological changes, gross body movements, and/or vocalizations.
RLA II - generalized response
Which RLA level:
Patient appears appropriate and oriented within the hospital and home settings goes through daily routine automatically, but frequently robot like. Patient shows minimal to no confusion and has shallow recall of activities. Shows carryover for new learning but at a decreased rate. With structure is able to initiate social or recreational activities; judgement remains impaired.
RLA VII - automatic, appropriate
- Moving into a synergistic pattern involuntarily when performing a strong/forceful movement, during heightened emotion, during intense focus
Associated reactions
When trying to inhibit tone of the LE, what is the first step?
Getting great toe extension
Which RLA level:
Able to handle multiple tasks in all environments but might need breaks; able to develop and maintain memory assistive devices; initiates and carries out all personal, leisure, household, community, and work tasks but may need more time; anticipates impact of disability and consequences of actions but may need more time to process decisions or use compensatory techniques; accurately estimates abilities; able to recognize needs of others, may have periodic depression, and irritability or low frustration level noted with fatigued, sick, or under stress.
RLA X - purposeful, appropriate
- Type of associated reaction where resistance applied to one extremity facilitates muscle response on the opposite extremity
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