Spasticitet under bevægelse

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1 Spasticitet under bevægelse

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3 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.

4 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)

5 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 Jun;102(2):

6 Berger W, Quintern J, Dietz V
Berger W, Quintern J, Dietz V. Pathophysiology of gait in children with cerebral palsy. Electroencephalogr Clin Neurophysiol May;53(5):

7 CP The characteristic pattern of muscle activity recorded from the spastic legs mainly consisted of a co-activation 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 May;53(5):

8 Reflekser findes ikke som selvstændige fænomener – de er altid integreret med resten af nervesystemet. Problem for behandling..

9 Muskel aktivitet under gang tilpasses automatisk omgivelserne på basis af sensorisk information
af Klint, Grey, SInkjær, Nielsen J Physiol 2008 9

10 Pride and a daily marathon – the case of Ian Waterman

11 Stretch reflexes are not increased in the active spastic muscle

12 Reduced reflex modulation during bicycling in stroke
NB Schindler et al. 2007

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14 Reduceret reciprok inhibition er korreleret til forøget co-aktivering og reduceret bevægelseshastighed Boorman GI, Lee RG, Becker WJ, Windhorst UR. Electroencephalogr Clin Neurophysiol Apr;101(2):84-92. Okuma Y, Mizuno Y, Lee RG. Clin Neurophysiol Feb;113(2):292-7.

15 Pause med diskussion af den praktiske betydning