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Robert Delgado
Instructor
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Posted: Fri Mar 27th, 2009 06:26 am |
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I have had some limited success in breaking tone with several approaches but I cannot completely normalize it with these approaches. I have used a muscle stimulator on the antagonist muscle group (typically the hamstrings) and a manual trigger to facilitate flexion during terminal stance. while walking a patient on the PBWSTT. I also have tried facilitation with pressure, and/or tapping, of the hamstring and forcing the knee into flexion at terminal stance. The good new is through repeated practice the tone typically fatigues some as well as the patient relaxing some to facilitate a better swing an straight forward step length. With pediatric patients, i would not use the stimulator unless the child has a high pain threshold. Your hand placement is key and often need to be adjusted to get the movement you desire. I have also had short term success with patients who have undergone botox injections however this often is temporary and may not inhibit enough of the muscle depending the extend of the tone and how long the patient has had it. I still love using the litegait system because before I could never facilitate a patient and help with motor learning without the assistance and safety of the PBWS.
Robert Delgado, PT
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Mary Wardell
Instructor
| Joined: | Sun Jan 14th, 2007 |
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| Posts: | 13 |
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Offline
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Posted: Mon Mar 16th, 2009 09:46 pm |
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One techhique I've used with children with strong extensor tone who also volitionally push into extension is to not allow terminal extension. I give a manual assist at the back of the knee to initiate swing just after mid stance with the goal of getting a continuos stepping pattern. I also loosen the tibial strap on the AFO to allow for some dorsiflexion. Once they get the "feel" of the pattern I back off and try to substitute with verbal cues to step. The other approach I use is to provide 40% BWS and faster treadmill speed to prevent full blown extension patterning. I realize little legs are much easier to move than are adult legs but it's worth a try!
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dorischong
Instructor
| Joined: | Sat Jun 14th, 2008 |
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| Posts: | 33 |
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Posted: Sat Mar 14th, 2009 04:17 am |
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Regards to increased tone with no UE support, my guess is the patient is working harder and with exertion, tone increases.
I also had experience with patients with significant extensor tone and it is sooooo difficult to facilitate the swing phase. I would try doing a lot of weight bearing pregait activity and see if tone can be brought down a bit because going on treadmill.
Doris
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Lesley Smith
Instructor
| Joined: | Wed Aug 29th, 2007 |
| Location: | Humarock, MA |
| Posts: | 46 |
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Posted: Thu Mar 12th, 2009 03:49 pm |
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I had a particularly physically difficult pt at a training last week. He was s/p TBI x 2 years with B LE tone which seemd to worsen on the t-mill compared to overground. It took Max A from two therapists just to help him advance his LE and it was difficult to even try to use cues/handling to break the tone. Also, he relied heavily on uni UE support but tone wa significantly worse when taken away.
I look forward to hearing your suggestions!
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