Dominic Stone
Abnormal muscle tone refers to a disruption in the normal resistance to passive stretching of a joint. This can manifest as either hypertonia (increased tension in the muscles) or hypotonia (decreased tension in the muscles). These abnormalities are often associated with neurological diseases and can occur alongside other issues such as weakness, dystonia, parkinsonism, and neuromuscular diseases. Physiotherapy can help manage the effects of abnormal muscle tone, including improving functional independence and reducing pain.
| Characteristics | Values |
|---|---|
| Definition | Resistance to passive stretch |
| Disorders | Hypertonia, Hypotonia, Dystonia, Paratonia, Spasticity, Rigidity |
| Causes | Dysfunction in neural circuits in the brain, spinal cord, and muscle spindle |
| Treatment | Physiotherapy, Botulinum toxin injection, Oral antispastic drugs, Pharmacological interventions |
| Symptoms | Contractures, Loss of independence, Increased muscle tension, Reduced muscle strength, Clumsiness, Coordination problems, Falling over, Reduced balance, Slow or rigid movement, Spasms, Weakness, Fatigue, Pain |
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What You'll Learn
Dystonia and paratonia
Dystonia is characterised by twisting movements and postures. It is often caused by genetic disease or known aetiologies. Treatment options include botulinum toxin injections to weaken the muscles in focal cases, while more generalised dystonia may require drug treatment or deep-brain stimulation.
Paratonia, first described in 1828 by Friedlander and later by Dupre in 1910, is the inability to relax muscles during muscle tone assessment. It is frequently associated with dementia and other cognitive impairments, particularly those related to frontal lobe dysfunction. There are two types of paratonia: oppositional and facilitatory. Oppositional paratonia occurs when individuals involuntarily resist passive movements, while facilitatory paratonia occurs when they involuntarily assist with such movements. Paratonia can be relieved with botulinum toxin injections.
The distinction between dystonia and paratonia can be made through electromyography, which records muscle activity during repetitive elbow movements. Oppositional paratonia increases with movement velocity, while spasticity decreases if elicited repeatedly. Advanced glycation end products (AGEs) are also found to be significantly increased in patients with paratonia and are linked to the severity of the condition.
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Hypertonia
Spastic hypertonia, also known as spasticity, is characterised by exaggerated reflexes and muscle spasms that increase with movement. It is often associated with disorders such as cerebral palsy, stroke, and spinal cord injuries. On the other hand, dystonic hypertonia, or rigidity, is marked by muscle stiffness that remains constant regardless of movement. This type of hypertonia is commonly seen in diseases affecting the basal ganglia, such as Parkinson's disease.
The diagnosis of hypertonia involves moving the patient's arm or leg at different speeds and directions to assess muscle resistance and identify the specific type of hypertonia present. Therapeutic interventions are individualised, but the basic principles include avoiding noxious stimuli and promoting frequent range-of-motion exercises. Physical therapy, including stretching to reduce muscle spasticity, is often recommended. Additionally, muscle-relaxing drugs, such as baclofen, diazepam, and dantrolene, are commonly prescribed to alleviate spasticity.
In severe cases of hypertonia, contracture may occur, causing joints to freeze in place and resulting in permanent muscle, tendon, tissue, and skin tightening. This condition further impedes movement and can have serious health implications, including increased bone fragility, infection, bed sores, and pneumonia. Therefore, early diagnosis and intervention are crucial to managing hypertonia and preventing potential complications.
While hypertonia can affect people of all ages, it is important to note that it is less common in babies than hypotonia (weak muscle tone). However, when it does occur in infants, it can cause similar difficulties with movement and balance, making it challenging for them to walk and control their limbs.
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Hypotonia
The symptoms of hypotonia include a "'floppy" or "rag doll" appearance, with drooping arms and legs. Infants with hypotonia may struggle with acquiring motor-related developmental milestones, such as holding their head up without support, rolling over, sitting up, or walking. They may also experience problems with feeding due to an inability to suck or chew for prolonged periods. Speech difficulties are also common, as hypotonia can affect the muscles in the mouth and jaw, inhibiting proper pronunciation and making it difficult to form words and sentences. Other symptoms include hypermobile or hyperflexible joints, drooling, poor reflexes, decreased strength, decreased activity tolerance, and rounded shoulder posture.
The treatment for hypotonia depends on the underlying cause and the patient's age, overall health, and medical history. Physical therapy and occupational therapy are often used to remediate the condition, and early intervention is key to helping manage the condition. While hypotonia can impact a person's ability to perform daily tasks, it does not affect their intellectual abilities.
Benign congenital hypotonia is a type of hypotonia that is not progressive and is of unknown origin. It does not usually cause developmental delays, but children with this type of hypotonia may acquire gross motor skills more slowly than their peers.
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Spasticity
There are several treatment options for spasticity, including physical therapy, medication, and botulinum toxin injections. Local injections of botulinum toxin (Botox) or phenol into spastic muscles can be very effective for treating spasticity. These injections can selectively reduce tone in muscles causing the most tightness or spasms. During botulinum toxin injections, the toxin is injected into carefully selected sites in the muscle, causing spastic muscles to relax. This may improve comfort, positioning, and function. The effects usually take seven to ten days to become noticeable and typically last around three months.
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Rigidity
Muscle tone is the resistance to passive stretch. Abnormal muscle tone can manifest as hypertonia or hypotonia. Hypertonia can result in spasticity or rigidity. Rigidity is a common muscle tone disorder characterised by resistance to passive movement, irrespective of posture and velocity. It is a hypertonic state, usually present in extrapyramidal disorders, and is one of the cardinal features of Parkinson's Disease.
In rigidity, muscle tone is increased even at rest and is usually present during passive range of motion in all directions across individual joints. The resistance to passive movement can be tested by an examiner who holds the patient's hand above the wrist with one hand and keeps it fixed. With the other hand, they slowly rotate the patient's hand along its long axis. If there is rigidity, the examiner will experience resistance during the movement. This is known as the cogwheel phenomenon, which is positive when the examiner experiences an interruption or repeated catch during the movement.
Cogwheel rigidity is a type of hypertonic state with superimposed ratchet-like jerkiness commonly seen in upper extremity movements, such as wrist or elbow flexion and extension. It is a combination of lead-pipe rigidity with tremor. Lead-pipe rigidity refers to a hypertonic state throughout the range of motion, reflected in the immediate resistance to a reversal of the direction of movement about a joint.
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Frequently asked questions
Abnormal muscle tone refers to either an increase (hypertonia) or decrease (hypotonia, atonia) in resistance to passive stretching of a joint.
Hypertonia is increased tension in the muscles, which makes it difficult for them to relax and can lead to contractures and loss of independence with everyday tasks.
Hypotonia is a reduced amount of tension in the muscles, accompanied by decreased muscle strength. This can significantly impact functional tasks such as rolling in bed, standing, and walking.
