Deck 18: Intervention for Flaccidity and Hypotonia

Question 1

You are working with a 78 year-old patient who was admitted to the inpatient acute rehabilitation unit this afternoon;4 days post right (R) middle cerebral artery (MCA) cerebral vascular accident (CVA).The patient presents with a flaccid upper extremity and hypotonic trunk and lower extremity.Which of the following would NOT be one of your initial safety considerations?

A)Contractures due to immobility
B)Risk for falls
C)Poor postural control
D)Careful handling to prevent damage to joint.

Answer 1

A

Question 2

Natural aging may further compromise function in individuals with hypotonia.Which of the following would NOT influence recovery in the older adult?

A)Decreased muscle recruitment
B)Muscle fiber changes
C)Increase in percentage body fat ratios
D)Shorter healing time

Answer 2

D

Question 3

Which of the following characteristics distinguishes flaccidity from hypotonia?

A)Flabby or soft with palpation
B)Likely decreased sensation
C)Absent resistance to passive movement
D)Decreased muscle force production

Answer 3

C

Question 4

You are working with an 85 year-old patient who was admitted to the inpatient acute rehabilitation unit this afternoon;3 days post right MCA CVA.The patient presents with a flaccid upper extremity and hypotonic lower extremity.The patient's spouse is very involved in the patient's care and wants to help out as much as possible.Which of the following would be MOST important to address with the spouse immediately?

A)Management of the flaccid/hypotonic limbs during transitions
B)Stretching techniques for the upper extremity
C)Emergency call system at home such as Lifeline medical alert
D)Proper donning/doffing of ankle foot orthosis

Question 5

You are working with a 53 year-old schoolteacher who is referred to outpatient therapy following a right anterior cerebral artery CVA.The biggest barrier to her function presently is her hypotonic foot and ankle.She can initiate ankle dorsiflexion for about 1/3 the range and her muscles easily fatigue.Which of the following interventions hold the MOST promise for functional motor dorsiflexion return for gait?

A)Tapping or vibration to the anterior tibialis
B)Manual resistance against gravity
C)Functional electrical stimulation
D)Range of motion and positioning

Question 6

You are working with a 6 year-old girl who recently had a brain tumor removed.As a result of the tumor removal she now presents with a left flaccid upper and lower extremity.Which of the following would you consider appropriate supine positioning in bed?

A)Upper extremity draped across tummy
B)Support for extremities in non-abnormal synergistic patterns
C)Foot board placed at the foot of the bed
D)Abduction,external rotation of the hip and ankle plantarflexion

Question 7

Weight-bearing in functional positions is often integrated into positioning and handling treatment techniques with flaccid and hypotonic upper and lower extremities.Which of the following would most likely NOT be a component of your rationale for use of weight-bearing techniques?

A)Increase range of motion
B)Facilitate muscle activation
C)Promote normal postural alignment
D)Decrease excessive joint range of motion

Question 8

Which of the following medical conditions would produce hypotonia of central origin?

A)Myasthenia gravis
B)Acute inflammatory demyelinating polyneuropathy
C)Post polio syndrome
D)CVA

Question 9

A 57 year-old male recently suffered a hemorrhagic stroke and is referred to you for outpatient therapy.Upon exam you find the patient presents with a flaccid upper extremity.He has absent deep tendon reflexes,absent muscle tone and no resistance to passive movement.You can elicit no voluntary movement and you observe no associated reactions (e.g.,involuntary movements occurring with higher stress activities).You also note a three-finger shoulder subluxation.He has not been given any shoulder support and is complaining of mild shoulder pain.Given the known long-term benefits and risks of various shoulder supports,which of the following would you NOT recommend for this patient?

A)Humeral cuff sling
B)Giv-Mohr sling
C)Traditional single strap hemi-sling
D)Neuromuscular electrical stimulation (NMES)

Question 10

You are working with a 32 year-old female who was admitted to the inpatient acute rehabilitation unit today.She suffered a stroke while trail running 3 days ago.The patient presents with a flaccid upper extremity.Which of the following tests and measures would you include in your patient exam because it will tell you the most about the quality and level of her upper extremity hypotonia?

A)Berg Balance Scale (BBS)
B)Passive range of motion
C)Fugl-Meyer Assessment - upper extremity motor portion
D)Gross Motor Function Measure