Bedienungsanleitung Chattanooga Wireless Professional (Seite 265 von 283) (Englisch)

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14. HOW TO USE THE WIRELESS PROFESSIONAL ON SPECIFIC

INDICATIONS

 EN

WIRELESS PROFESSIONAL

.. Spasticity

Reminder

Spasticity or spastic hypertonia is a term which describes the condition of paretic or paralysed muscles

showing dierent symptoms to varying degrees, including in particular, an increase in muscle tonus mainly

in the antigravity muscles, hyperreﬂexia, and clonus.

During passive stretching of a spastic muscle, there is resistance at the beginning of the movement, which

then diminishes in the course of extension.

The more rapid the passive stretching movement, the stronger this resistance.

If passive stretching is very rapid and is maintained, clonus may occur, i.e. a contractile oscillation of  to 

Hz, which persists for  to  cycles for as long as the stretching is maintained.

Spasticity is caused by a lesion in the central nervous system which aects the tractus pyramidalis

(cerebral-spinal tract).

This interruption in central control releases the activity of the myotatic stretch reﬂex, which becomes

hyperactive. As this stretch reﬂex is responsible for muscular tonus, hypertonia develops aecting mainly

the antigravity muscles (extensions of the lower limbs and ﬂexors of the upper limbs), since these contain

more neuromuscular spindles than their antagonist muscles.

In time, spasticity leads to the shortening of muscle-tendon structures and a reduction in the range of

articular movement, which can lead to stiening and misalignment of the joints.

Use of neuromuscular electrical stimulation (NMES)

Starting in the neuromuscular bundles are aerent proprioceptive nerve ﬁbres, which are directly

associated with the α motor neurons of the same muscle and which are indirectly associated (via

interneurons) with the α motor neurons of the antagonist muscle.

Stretching a muscle therefore stimulates the aerent proprioceptive nerve ﬁbres of the neuromuscular

bundles and they monosynaptically activate the α motor neurons of the muscle being stretched (myotatic

stretch reﬂex) and inhibit, via an interneuron, the α motor neurons of the antagonist muscle (reciprocal

inhibition reﬂex).

NMES of a muscle excites not only the α motor neurons of that muscle but also, and even more readily,

the aerent proprioceptive nerve ﬁbres which are contained in the neuromuscular bundle of the muscle

and which have a lower stimulation threshold.

Stimulating these activates the α motor neurons of this muscle and also inhibits the α motor neurons of

the antagonist muscle (reciprocal inhibition reﬂex). It is this last action that NMES uses in the treatment of

spasticity: NMES of a muscle antagonist to a spastic muscle makes it possible to reduce the spasticity by

inhibiting the α motor neurons of the spastic muscle via the reciprocal inhibition reﬂex.

This phenomenon of inhibiting α motor neurons through NMES of the antagonist muscle is clearly

demonstrated by electromyography.

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