강직의 최선 지견과 물리치료와의 관련성
Research Findings and Implications for Physical Therapy of Spasticity
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Spasticity has been defined as a motor disorder characterised by a ve1ocity-dependentincrease in tonic stretch reflexes with exaggerated tendon jerks resu1ting inhyperexcitability of the stretch reflexes as one component of the upper motor neuronsyndrome. Weakness and loss of dexterity, however, are considered to be moredisab1ing to the patient than changes in muscle tone. The discussion includes theimportant role that alterations in the physio1ogy of motor units, notab1y changes infiring rates and muscle fiber atrophy, play in the manifestation of muscle weakness. This paper considers both the neural and mechanical components of spasticity anddiscusses, in terms of clinical intervention, the implications arising from recentresearch. Investigations suggest that the resistance to passive movement inindividuals with spasticity is due not only to neural mechanisms but also to changesin mechanical properties of muscle. The emphasis is on training the individual to gaincontrol over the musc1es required for different tasks, and on preventing secondaryand adaptive soft tissue changes and ineffective adaptive motor behaviours.
Abstract
Spasticity has been defined as a motor disorder characterised by a ve1ocity-dependentincrease in tonic stretch reflexes with exaggerated tendon jerks resu1ting inhyperexcitability of the stretch reflexes as one component of the upper motor neuronsyndrome. Weakness and loss of dexterity, however, are considered to be moredisab1ing to the patient than changes in muscle tone. The discussion includes theimportant role that alterations in the physio1ogy of motor units, notab1y changes infiring rates and muscle fiber atrophy, play in the manifestation of muscle weakness. This paper considers both the neural and mechanical components of spasticity anddiscusses, in terms of clinical intervention, the implications arising from recentresearch. Investigations suggest that the resistance to passive movement inindividuals with spasticity is due not only to neural mechanisms but also to changesin mechanical properties of muscle. The emphasis is on training the individual to gaincontrol over the musc1es required for different tasks, and on preventing secondaryand adaptive soft tissue changes and ineffective adaptive motor behaviours.