PNE Questions

[gcoe]

Hi physioroman

Re: tone questions: I don't know what the Canadian authorities are seeking as an answer. However all the questions are from my view redundant questions. They really make no sense. Rather I think you have to ask yourself 1) why are you assessing tone? 2) what aspect of tone are you wanting to assess? and once you know that 3) how will you measure it using a valid and reliable measure?

Why are you assessing tone?
Tone is simply the magnitude of resistance to passive stretching of a musculotendinous unit or group of units. In terms of impairments that patients with stroke present with increased tone has been overrated as an important problem. Commonly weakness and loss of dexterity are considered way more important (although increased tone may be a more important impairment in the chronic stroke patient or in other neurological problems)

I would only assess for increased tone if I suspected this was affecting the patients function. Otherwise I wouldn’t bother.

Example:

Let’s say the patient is unable to reach for an object. He can’t flex at the shoulder and extend at the elbow appropriately. I would be thinking that this may be most likely due to weakness of the scapular upward rotators, shoulder flexors and triceps. Possibly there could be a dexterity problem so I would be looking for smoothness of movement and interjoint coordination as well. I wouldn’t be that concerned about increased tone in the acute setting although the patient may be developing contracture and the shoulder extensors/scapular retractors or elbow flexors, particularly if not undergoing preventive positioning. Anyhow if I wanted to test for tone I would therefore logically test the resistance to movement of the scapular downward rotators, shoulder extensors and internal rotators and elbow flexors. The order of testing is not important as long as I have tested the key muscles that are antagonistic to the functional movement I am assessing. In another functional task the testing I would do would be related to that task so different muscles.

What aspect of tone are you wanting to assess?

On the whole increased tone is either due to:

1. Contracture: shortening of the non contractile elements. Contracture can be defined by
a) increased resistance through range
b) Loss of end of range
c) Deformity at rest.
2. Spasticity. Spasticity is defined as velocity dependent increased resistance to lengthening the muscle.

So if I want to differentiate contracture from spasticity I need to do passive stretch at slow and fast speeds

How will you measure it using a valid and reliable measure?
There are two clinical tools commonly available: the Ashworth Scale (or Modified Ashworth Scale). The Tardieu scale

Of the two scales the Tardieu Scale has superior validity as well as good reliability. It successfully differentiates and quantifies spasticity from contracture.

Here are two articles on the Tardieu Scale. Both articles have the scale instructions in the back.

I am sorry if my answer is long-winded and doesn’t answer what you wanted. However you have to know what you are intending to do in order answer questions appropriately and know whether a question is valid. These questions seem a nonsense to me

I’ll leave it to an orthopaedic physio to answer the arthroplasty question