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Spasticitet under bevægelse http://www.youtube.com/watch?v=UDgxjRy Pe2w&list=QL&playnext=16 • Målet med Bobath-konceptet er at skabe normal spændingstilstand i musklerne ved at fremme normale bevægelser og hæmme unormale bevægelser. Det sker ved at regulere spændingen i musklerne, fremme evnen til at opfatte påvirkninger, få begge kropshalvdele til at arbejde sammen og derved skabe symmetrisk eller ret kropsholdning, forhindre sygdomsfremkaldte bevægelser og stillinger samt muliggøre selvstændige bevægelser. • Anvendelse ved spasticitet: Når metoden bruges ved spasticitet, er målet at løsne nøglepunkterne i skulderbæltet, kropsstammen, tommelfingeren og hoften samt evnen til fysisk at kunne løfte ting, approksimation, lejring i antispastiske mønstre, og at man bevæger sig på en naturlig og antispastisk måde. Textbooks • Spasticity may limit a patient´s ability to move quickly because of activation of the stretch reflex (Shumway-Cook and Woollacott) • ”antagonist restraint” (Bobath 1978; Davis 1985) Apopleksi • calf muscles were prematurely activated in the stance phase, probably due to enhanced stretch reflexes • EMG activity was abolished or extremely low in 2 or more of the muscles examined • pathological coactivation of several or all of the muscles during part of the gait-cycle, thus disrupting the normal sequential shift of activity in antagonistic muscles Knutsson E, Richards C. Different types of disturbed motor control in gait of hemiparetic patients. Brain. 1979 Jun;102(2):405-30. Berger W, Quintern J, Dietz V. Pathophysiology of gait in children with cerebral palsy. Electroencephalogr Clin Neurophysiol. 1982 May;53(5):538-48. CP • The characteristic pattern of muscle activity recorded from the spastic legs mainly consisted of a coactivation of antagonistic leg muscles during the stance phase of a gait cycle and a general reduction in amplitude of EMG activity. • it is proposed that muscle co-activation recorded in spastic children is due to an impaired maturation of the locomotor pattern with an early neuronal adaptation to altered muscle fibre mechanical characteristics. Berger W, Quintern J, Dietz V. Pathophysiology of gait in children with cerebral palsy. Electroencephalogr Clin Neurophysiol. 1982 May;53(5):538-48. Reflekser findes ikke som selvstændige fænomener – de er altid integreret med resten af nervesystemet. Problem for behandling.. [email protected] Muskel aktivitet under gang tilpasses automatisk omgivelserne på basis af sensorisk information af Klint, Grey, SInkjær, Nielsen J Physiol 2008 Pride and a daily marathon – the case of Ian Waterman Stretch reflexes are not increased in the active spastic muscle Reduced reflex modulation during bicycling in stroke NB Schindler et al. 2007 The stretch reflex during spastic walking PATIENT CONTROL Stretch reflex amplitude [µV] 200 150 150 100 100 50 50 0 0 EMG [µV] 100 80 80 SOL TA 60 40 40 20 20 0 500 EMG [µV] 100 60 0 Stretch reflex amplitude [µV] 200 1000 1500 Time [ms] 2000 0 TA SOL 0 500 1000 1500 Time [ms] 2000 Reduceret reciprok inhibition er korreleret til forøget coaktivering og reduceret bevægelseshastighed Boorman GI, Lee RG, Becker WJ, Windhorst UR. Electroencephalogr Clin Neurophysiol. 1996 Apr;101(2):84-92. Okuma Y, Mizuno Y, Lee RG. Clin Neurophysiol. 2002 Feb;113(2):292-7. Pause med diskussion af den praktiske betydning