Syndrome of increased muscle tone in the practice of a neurologist and its treatment with Sirdalud

Increased muscle tone is a pathological condition of muscle tissue when it remains tense, even if the body is at rest. This condition can appear at any age, depending on the causes of damage in one muscle or an entire group. In adults, the calf and lumbar muscles are most often affected, which is due to the characteristics of life; hypertonicity in childhood most often spreads to the entire body.

The clinical picture can manifest itself in different ways and is different in childhood and adulthood. In children, it most often includes such signs as rolling over only on one side, sleep disorders and excessive excitability, trembling of the chin, slow development of movements and muscles. May also present as excessive sleepiness and quiet behavior. In adults, there is a gait disturbance, atypical postures, impaired motor skills, as well as their stereotypicality. Over time, the acts of swallowing and writing become impaired, squinting appears, and subsequently a complete loss of ability to work is possible.

If therapeutic and preventive measures are not carried out in a timely manner, the state of increased muscle tone will develop and worsen, affecting not only the muscles, but also changing posture, the functioning of internal organs, the emotional-volitional sphere and all areas of life.

Causes of muscle tone disorders

This pathology is associated with disorders in the nervous system, which sends signals of tension and relaxation, and also controls muscle movements.

The causes of increased muscle tone in adults are divided into several types:

• Pathological - arise due to various damage to the nerve fibers that are responsible for flexion and extension of the limbs, as well as due to damage to the muscles themselves. Lesions can be infectious (tetanus, encephalitis, etc.) and non-infectious in nature (pathologies of the central and peripheral nervous system, neoplasms, vascular changes or strokes, epilepsy, torticollis, bruxism and calcium deficiency).
• Physiological – consequences of traumatic exposure or muscle overload, as well as if a person remains in one position for a long time (most often manifests itself in the cervical and lumbar regions). This also includes the reaction to prolonged pain, since the body’s natural reaction to pain is to increase tone in order to overcome a destructive situation. When this condition continues for an excessively long time, muscle tension remains.

Cardiovascular and demyelinating diseases, which affect the functioning of the central nervous system, can also provoke increased tone. Against the background of long-term use of medications such as antipsychotics, antipsychotics, antidepressants and drugs for the treatment of Parkinson's disease.

Excessive muscle tension can also occur in children under one year of age. This is facilitated by congenital pathologies, intrauterine hypoxia and infections, cerebral palsy, encephalopathy, hemorrhages in the cranium, maternal intoxication (smoking, taking alcohol, drugs or medications).

Increased muscle tone in an adult

In an adult, muscle tone is observed as a consequence of disruption of the nervous system; this is one of the indicators of the presence of neurological diseases. There are 2 types of increased tone: spastic (localized) and rigid (applies to all muscles at the same time). Hypertonicity can be caused by:

• demyelinating neurological diseases such as multiple sclerosis;
• pathological processes in the vessels of the brain and spinal cord (stroke);
• cerebral palsy;
• various brain or spinal cord injuries;
• disruption of the functioning of nerve impulses.

With a spastic type of tone, disruptions in the functioning of nerve centers and pathways are observed, and with a rigid type, pathologies of the brain or spinal cord are observed.

Hypertonicity in adults is a sign of a serious neurological disorder resulting from the presence of severe diseases of the nervous system. In this case, it is most rational to use complex therapy. Along with traditional medicine, osteopathy can come to the rescue, which significantly alleviates the patient’s condition. Osteopathic techniques are very gentle, they bring the patient a feeling of relaxation, tranquility, and warmth. With his hands, an osteopathic doctor can improve muscle function, blood flow, and influence bones and joints, while he fights not the clinical manifestations of the disease, but its cause. The osteopath triggers the necessary mechanisms that, like a clockwork, normalize the functioning of the entire body as a whole.

Types of muscle tone disorders

Muscle tone disorders can be of several types:

1. Spasticity is muscle tension and tightness; resistance is felt when performing movements. Additionally, contractures, deformations, and emotional disturbances may form. This condition, without proper treatment, can lead to paralysis.
2. Rigidity – intermittency is felt during extension, tone increases when performing passive movements.
3. Hypotonia is manifested by flabby and flaccid muscles, there is no resistance during passive movements, coordination is impaired, problems with balance and emotional states.
4. Dystonia. Hypertonicity manifests itself in individual muscles, often combined with hypotonicity of other muscles. It is felt, first of all, at the beginning of the movement, as resistance, which then very abruptly passes.

The diagnosis should be made by a doctor after a thorough examination, as well as obtaining data from laboratory and computer studies. It often happens that muscle tone disorders are localized in several places or can have different manifestations, for example, the tone is increased on one side of the body and decreased on the other.

Muscular dystonia in palliative practice

Contents Relevance of the problem of caring for patients with spasticity

Types of dystonic tone disorders

Drug dystonia

Dystonic attack and convulsions - how to distinguish?

Chronic spastic conditions

Prevention of complications of spasticity

Principles of positioning a person with limited mobility

In palliative medicine, the number of patients with neurological pathologies is growing. But diagnosing spastic conditions with convulsive attacks, neurolepsy, and pain syndrome is often difficult, especially in nonverbal patients.

Anastasia Evgenievna Primakova talks about acute and chronic disorders of muscle tone, drugs used in different cases, and non-drug methods for the prevention and correction of spastic conditions

, neurologist, Moscow Multidisciplinary Center for Palliative Care, Department of Health.

The article was prepared based on the materials of the webinar “Spasticity in palliative care, why it is dangerous and how to avoid it.”

Relevance of the problem of caring for patients with spasticity

More and more patients with neurological problems are appearing at the Moscow Multidisciplinary Palliative Care Center. Their life expectancy is higher than that of terminal cancer patients, and their management should be structured differently. At the same time, spastic conditions can occur in almost all immobile bedridden patients.

What help do patients with spasticity need? Care, positioning and symptomatic treatment.

First of all, spastic conditions lead to the development of contractures and stiffness. And this happens surprisingly quickly. Dislocations also occur, such as paralytic dislocation of the hip joints. The hip joint is large. It can withstand a heavy load, but in a state of dysregulation it enters a virtually irreversible state, which provokes pain. When the patient's body is deformed, he also experiences psychological suffering - it is difficult to see his body as completely different. The entire microsociety of the patient, especially his family, also suffers when they see how the person has changed overnight. It is especially difficult when it comes to young post-traumatic patients, when changes occur tragically, quickly and irreversibly.

The inability to change position also leads to trophic disorders.

Simple manipulations, such as a pillow under the knees and the like, are a means of preventing pain, deformities, and bedsores. This is not difficult, but often such moments are simply not given attention, and dealing with the consequences is much more difficult than doing prevention.

Types of dystonic tone disorders

In neurological patients, chronic spastic conditions predominate (spasticity, hyperkinesis, atony), but acute ones also occur - dystonic attack, serotonin syndrome. Local dystonia occurs in our patients, mainly as a consequence of drug overdose.

What is an acute dystonic attack

? This is a sharp involuntary increase in muscle tone to the point of rigidity. It is especially important to differentiate a dystonic attack if the patient is nonverbal.

What can trigger an acute dystonic attack?

• Pain
• Fear
• Negative emotions
• Maintaining one pose for a long time
• Constipation
• Gastroesophageal reflux disease (GERD) at night
• Initiation of movement
• Neurodegenerative conditions
• Hypoglycemia

Treatment of mild, moderate and severe pain in palliative patients Tatyana Vladimirovna Kravchenko, chief freelance palliative care specialist in Moscow, talks about the features of drug therapy in palliative patients with different types of chronic pain Tatyana Kravchenko

Anesthesia

If a patient has a stomach ache, if he has constipation or heartburn, you will always see either a localized or a generalized increase in muscle tone. This is one of the symptoms included in the nonverbal pain rating scale.

If a person lies in one position for a long time, especially a person with limited mobility who cannot roll over onto his back on his own, this can lead to the development of a dystonic attack - simply because the patient cannot change position. Even healthy people experience this: when you wake up at night, it is sometimes difficult to turn around right away.

Communication skills with patients 10 tips for doctors during consultations Anna Sonkina-Dorman

Communication

In some patients, especially small and thin patients, a dystonic attack can be triggered by an incorrect movement by a nurse or caregiver. For example, you wanted to change a person’s diaper or examine his stomach, you sharply pulled his knee, and in response he suddenly moved somewhere. This can happen because regulation is disrupted, and the person responds as best he can. Mostly generalized. The simpler and more archaic a person’s reactions are, the more generalized they are. And vice versa, the older the patient is, the more mature his cerebral cortex, the more differentiated his reactions are. Therefore, always try to warn the patient, say: “Now I’ll take you by the leg,” then gently touch this leg and show what you are going to do, do not rush.

In neurodegenerative conditions, when dysregulatory disorders increase, the patient eventually returns to those archaic reactions that I spoke about. This is very difficult to observe, because usually these are patients with intact intelligence - for example, with multiple sclerosis - and for them it is very difficult.

Hypoglycemia also sometimes causes not only psychomotor agitation, but also tension with tremor. This can be seen in severe, bedridden patients. When a person has not eaten for a long time or was given insulin without giving him breakfast, and he is shaking and is all wet - this may simply be a manifestation of hypoglycemia. In this case, you need to feed the person as soon as possible.

Drug dystonia

Violation of tone can be associated with the use of medications: polypharmacy in palliative practice is common, and many medications in combination with each other increase muscle tone.

There are acute and chronic drug-induced dystonias.

Acute drug-induced dystonia

Many drugs acting on nerve and muscle conduction can cause:

• Tricyclic antidepressants
• Levodopa preparations
• Antiepileptic drugs, phenytoin, carbamazepine
• D-receptor blockers: neuroleptics, cerucal

For example, antiepileptic drugs are often used in the adjuvant treatment of chronic pain syndrome. We must remember that in large doses they can cause dystonic attacks. Neuroleptics also cause a very diverse range of reactions, including neuroleptic syndrome, especially if they are given without an anticholinergic corrector, Akineton, or cyclodol - this can even lead to death. Haloperidol should be used carefully in older people.

Serotonin syndrome often occurs with an overdose of such drugs in combination with adjuvant antidepressant therapy. They can cause complications such as oculogyric crisis (rolling of the eyes for up to several hours), myoclonus, local or generalized tics, orofacial dyskinesia (often caused by metoclopramide in children).

Chronic conditions, such as extrapyramidal hyperkinesis, are seen in psychiatric hospitals and in psychiatric hospitals. Therapy adjustment is sometimes not carried out there, and patients receive the same dosage for years.

Early

(at the beginning of antipsychotic therapy) and
late
(malignant neuroleptic)
neuroleptic syndromes
are the most severe complications of antipsychotic drugs: they cause cardiac and multiple organ failure, hyperthermia, agitation, and arterial hypertension. This condition is very difficult to correct.

Serotonin syndrome

(serotonin intoxication) is a consequence of an “overdose” of narcotic drugs, antidepressants, or the simultaneous use of narcotic drugs and amitriptyline. Its manifestations are similar to pain syndrome in nonverbal patients. This happens when it seems to us that the patient is unwell, and we increase the dose of narcotic drugs, but he gets worse. The most pathognomonic symptom of serotonin syndrome is extremely oily, greasy skin. Other symptoms:

• hyperthermia,
• arterial hypertension,
• tachycardia,
• sweat,
• mydriasis,
• hyperreflexia,
• diarrhea,
• clonus,
• excitation,
• muscle rigidity.

In general, the whole complex of acute multiple organ failure. This is a difficult situation, and it is important to keep it in mind if the doses of drugs are already at their maximum and the patient is not getting better. In this case, if possible, you need to reduce the dosage, maybe (with caution!), change the antidepressant to another, maybe remove it altogether - an individual approach is needed here. This condition is relieved with diazepam, clonazepam, i.e. drugs that reduce muscle tone. But the first step is to reduce the dosage.

Dystonic attack and convulsions - how to distinguish?

Any dystonic attack is tension, decreased cell excursion and hypoxia. And hypoxia is a trigger point for the development of seizures: we can see a person with a dystonic attack, and after 20 minutes he may have a seizure. This is not uncommon.

What is the difference between a dystonic attack? First, we need to think about the history: Seizures are more likely to occur in a patient who has a history of epilepsy or has been diagnosed with a brain tumor. A manifestation of general cerebral symptoms may be convulsions (then we will see vomiting, and so on).

A convulsive attack has a distinctly acute onset, and a dystonic attack can last for hours.

As a rule, during a dystonic attack the patient shows that he is ill, and during convulsions he is unconscious - if we open his eye, we will see miosis. Dystonic attacks are longer: a convulsive attack lasts 5-7 minutes and ends, and a dystonic attack can last for a long time, as long as the patient has the energy to keep the muscles tense. After a seizure, a person usually falls asleep.

In a hospital setting, to treat a dystonic attack, it is most convenient to give the patient diazepam. In pediatric practice, we often give Relanium either as an enema or intranasally - this is a convenient route of administration. In this case, the absorption is the same, the dose does not need to be increased, as with oral administration. Any of these conditions can be easily treated with anesthetic drugs.

Chronic spastic conditions

Unfortunately, spasticity is an integral problem in almost all acute neurological deficits, except for spinal muscular atrophy and ALS (although contractures and spastic disorders can also occur with them). With neuropathy in the later stages, Guillain-Barré syndrome, dystonic states, in particular, painful hyperkinesis, can also develop. This is very difficult for patients: they develop depression, apathy, and lack of volition.

How to deal with such cases? The most basic approach in palliative medicine is that when we see something we don’t understand, we first need to relieve the pain.

Pain syndrome can manifest itself in different ways, especially in non-verbal patients: one lies and suffers silently, while the other will scream if the heel is simply itchy. You should always keep in mind that a person may be in pain, because pain is subjective.

Half the cases of spasticity that I see in children are relieved by pain relief. When children live in a family, they know how to show that they are uncomfortable, because those close to them react to it. And deprived children who live in boarding schools often have no experience of positive communication. Therefore, we start with pain relief, then see what remains of this spastic state: it may pass. If some spasticity remains, we will work with it.

There are not many conservative methods: only three drugs that relieve spasticity are widely used: mydocalm, sirdalud and baclofen. They act in different ways, so they can be combined to affect different “floors” of muscle tone regulation.

Mydocalm

- a systemic drug. It works for quite a long time, but we cannot vary the dose widely because its maximum dose is not high.

Sirdalud

is a good drug, but it is fast-acting and can cause breathing problems and a drop in blood pressure. If there is a need to maintain the effect throughout the day, then the dose should be divided into 4-5 parts. There is no point in giving sirdalud twice a day unless it is a long-acting form. This drug is used for defence, for radiculitis as symptomatic therapy. The effect of sirdalud wears off quickly, so it is inconvenient to give it for a long time. But at night, for example, it’s quite appropriate. If the patient lives on baklosan, you can give him sirdalud at night so that he can sleep.

Clonazepam

has many side effects, and it is not always appropriate to treat muscular dystonia with them.
But if the patient has muscular dystonia combined with epilepsy, this drug will be enough to relieve tone and have an anticonvulsant effect. diazepam
can also be given in a short course of five days.

Dantrolene is used for spasticity

. This is a calcium blocker, the only drug that suppresses malignant hypothermia.

Trunxen

It is convenient because it is similar to clonazepam, but does not have the same sedative effect. It is not available in Russia yet.

Radical treatment methods

Dystonic attacks are not yet used in our country.
The only thing that could be used in palliative practice is botulinum toxin.
It facilitates patient positioning and care, and reduces pain. In other words, this is what the future is.

After all, when we give tablet drugs that reduce tone, we increase dysphagia, and aspiration begins in a patient who could swallow. And this is how we “bypass” swallowing.

Methods for assessing dysphagia and preventing aspiration in palliative patients What nuances should be taken into account when conducting the “three sips test” in palliative patients, what are the predictors of dysphagia, how to assess and prevent the risk of aspiration Varvara Brusnitsyna

Symptomatic treatment

In general, drugs that reduce tone are given to control swallowing function. The easiest way to control it is with the “three-sip test”: give the patient a glass of water and ask him to take three sips. We note at what sip he choked. This will mean that dysphagia is present, and we need to think about what to do with this patient.

If this is a patient with multiple sclerosis, it is better not to wait until he starts choking and gets pneumonia, but to plan to place a gastrostomy tube at a time when the patient is still in good condition, while there are no aspiration problems. There is no need to torture a person so that he starves or is afraid to drink (such patients are afraid that they will choke, which is why they eat only pureed food and do not drink water, which causes dehydration). It is necessary to place a gastrostomy tube on time and not torment the patient with tubes for a long time.

Chemical neurolysis

- This is an “ancient” procedure, but nevertheless, it makes sense in the case when neuromuscular transmission is interrupted at the level of the trunk. This has been used for patients with neuroma in the stump after amputation.

Prevention of complications of spasticity

Prevention includes:

• Correct patient positioning
• Active and passive gymnastics
• Involving the patient in self-care
• Psychological help
• Establishing alternative communication with the patient
• Team approach to the patient
• Treatment of infections
• Individual route of assistance

First of all, preventing complications comes down to correct positioning and selection of shoes. For example, in hospices in Hannover (Germany) all patients wear special sneakers to prevent foot deformities. It works like this: in the morning the patient woke up, he was dressed in a casual dress and shoes were put on his feet. Even if this is a bedridden patient, he is dressed - after all, it is daytime and he is awake. And in Russia, patients lie without panties for years, because it is believed that since they are lying down, they are in bed. It’s as if they don’t live, but sleep all the time. This approach needs to be changed.

We must remember that the foot can become deformed in 10 days! To prevent foot deformities, you need special shoes for waking and soft orthoses for sleeping. Any shoe with a firm heel will do. For example, a thumb abductor orthosis can be made from any cardboard; it does not require large financial investments. It’s a simple thing, but at night a person sleeps with such a device, and in the morning his finger is more mobile.

Gymnastics, occupational therapy, self-care and overall patient independence are very important.

In the context of psychological assistance, I would like to talk about alternative communication. For people who do not speak, it is very important to convey their message to others. Among our patients there are many people with motor aphasia: they understand everything, but cannot say anything. Such patients are constantly in a depressed state - they are tormented by the inability to speak. Therefore, we must try to figure out how a person can communicate if he has at least one hand or finger.

There is such a technique in the practice of pediatric palliative care. We ask: “Are you thirsty? Do you want to sleep? Your right hand means yes, your left hand means no. Look at your right or left hand!” This does not require expensive equipment or a computer. Some children have “yes” and “no” stickers placed directly on their knees. We need to think about this, we need to involve specialists in alternative communication.

It is necessary to ask the patient's opinion about the simplest things: do you want to wear these pants or others? Do you want me to open the window or close it? This is respect for the individual. We often don’t think about this; it would be faster for us to dress, undress, and turn a person. This passive position insults the person. As a result, he usually becomes autistic and becomes depressed. We should try to avoid this.

Principles of positioning a person with limited mobility

Video: Moving a patient in bed How to correctly pull a person in bed and move him from one end of the bed to the other

Lena Andrev

Care

Positioning

- this is a separate big topic. The more comfortable the patient’s position, the fewer problems he will have: correct positioning is the prevention of contractures and the prevention of pain.

It is recommended to place a chart of positions above the patient's bed in accordance with their daily routine. Our patients mostly lie down. From time to time we sit them down: they sit for a while, then lie down again. An occupational therapist or physical therapy doctor can hang a note above the patient’s bed with pictures of pillows or bolsters. Each of them is numbered, and it is indicated in what place and in what position to place them. The physical therapist comes only once to try everything on the patient. And then: the pillows are numbered, and the staff understands how and what to do - there is no need to invent a wheel every time. There is also a mode for changing positions. There is a rule that you cannot feed a person in a lying position. Even a person with a gastrostomy tube must be fed in a sitting position.

There are also many lying positions. When a person lies flat on his back, as most of our patients do, his head and shoulders are high on the pillow, his legs are extended, his anterior abdominal wall is taut. Thus, tidal volume is reduced by 40% and spasticity increases. When we gather him “in a pile” and place two pillows in the letter “A”, bring his shoulders up, pick up his knees, the tidal volume increases. Even though he has a rigid chest and its excursion is zero. That is, this is the prevention of respiratory complications.

Supine position (for resting, not for feeding)

The main thing is to remember one simple law: what hangs gets tired, what lies down relaxes. If the hand hangs, it will get tired, which means our task is to put something under it. Then she will relax.

Therefore, the basic principles of positioning are as follows:

• Everything is bent
• Everything leans
• Nothing hangs

When a person who has been lying on his back for years is placed on his side and stomach, his back is finally rested.

Side lying position

The side position is a comfortable position for rest and activity, since it is possible to perform manipulations with your free hand. To comfortably position a person on their side, the following conditions are needed:

• Support along the back, between the legs
• It is convenient to use a Y-shaped pillow according to the patient’s height, so that continuous support creates a “nest” around the body and gives a feeling of full support. But such a pillow should not be thicker than the patient.
• The upper leg should rest completely on the support (anything that hangs gets tired)
• Sometimes an analogue of “swaddling” helps with hyperextension of the arms, a wide scarf around the body, a figure of eight around the legs.

The prone position, in addition to rest, can be used to facilitate the evacuation of sputum. But it is not enough to just turn him over on his stomach; pillows must be placed under him in a certain way to create a kind of “shaft” on which the person is placed on top. How is this positioning accomplished?

• A large cushion is placed under the stomach, sometimes under the forehead too - to provide support and so that the head does not hang down,
• Sometimes a bolster or wedge under the chest is enough if the person holds his head himself.

Stomach pose

The position is as if a person is on all fours. The “on all fours” position is very comfortable, patients love it. Gastrostomy and tracheostomy are not contraindications for lying on the stomach and side.

Pose in a stroller.

The basic principles for positioning the patient in a wheelchair are as follows:

• To sit in a wheelchair, the patient must be able to support his head, or a head support is used.
• If the stroller is too wide for the patient and the pelvis dangles, long-term sitting will lead to fatigue, pain, and spinal deformation.
• Thick pads must be placed between the walls of the stroller and the pelvis. If a person does not hold a sitting position well, then up to the armpits.
• The patient must be restrained. Even the weakest patient can suddenly bend over, move, or flinch.

In general, posture in a stroller is a difficult question, because strollers are the same, but people are different. Let’s say a patient with amyotrophic lateral sclerosis has no control over her body at all. It “folds” on the chair: as you sit it, it moves in that direction. Therefore, our task is to hold the patient, place bolsters tightly on the sides between her and the stroller, so that she does not fall over or slide off.

For patients with severe deformities, there is such a technique: for them, a backing from a special material is cut out from a cast of the body. It's expensive, of course, but it's worth it.

Proper positioning does not always require complex and expensive items. The main thing is attention to the patient and understanding how comfortable and convenient it is for him to be in a particular position.

Another problem is that medical staff often do not take care of themselves and do not use available means to move patients. Our employees are the most valuable thing we have, so we need to make their work easier: use lifts, ceiling systems, transfer boards, and other means of moving. It is unacceptable for nurses to turn patients around alone.

In films about Western hospices, I saw how a physical therapist or nursing staff easily climbs onto the bed, kneels behind the patient and quietly moves the patient. I didn’t believe that I could single-handedly transfer a rather heavy-set woman from a lying position in bed to a chair. But if you use force correctly - do not tear the patient’s arms from the front so that she falls on you, but simply climb onto the bed, behind her, kneel in a certain way and so, turning her from one side to the other, bring her to the edge of the bed, climb over forward and transfer her to a chair. This is possible, this can be learned, but until we know how to do this, our task is to do such things not alone and not to strain ourselves.

By the way, very soon Anastasia Evgenievna will be able to visit in person.

On July 28-29 , she will be one of the speakers at an interactive online intensive for specialists on the topic “Assessment and treatment of neurological deficits in palliative care . It is conducted by the Moscow Multidisciplinary Center for Palliative Care in the format of a video conference on Zoom.

You can find out more details and register here.

The text was prepared using a grant from the President of the Russian Federation provided by the Presidential Grants Foundation for the portal About Palliative, an educational project about palliative care of the Vera Charitable Foundation.

Diagnostic methods

Increased muscle tone in adults has the following symptoms: discomfort when performing habitual movements, which results in muscle stiffness during mobility. Muscle density increases, and there is a constant feeling of tension, tightness or stiffness of movement.

In a child, symptoms of hypertonicity are manifested by clenched fists, legs, and arms pressed to the chest. Also, in a baby, signs of impaired tone are the fetal position, which lasts longer than 2 weeks, the fact that the baby holds his head straight, and resistance is felt during gymnastics.

The following methods are used to make a diagnosis:

• Examination by a neurologist, therapist, endocrinologist, possibly a psychiatrist;
• Assessment of childbirth in the mother, as well as clarification of the characteristics of intrauterine development;
• General and biochemical blood test;
• Determining the absence of epilepsy and paralysis, as well as taking medications that can provoke an increase in muscle tone;
• EMG;
• CT or MRI;
• Ultrasound of the brain and neck;
• X-ray of the spine;
• Study of cerebrospinal fluid, levels of electrolytes and CPK in the blood.

It is mandatory to establish the root causes of the development of the pathological condition, after which an individual rehabilitation program is drawn up.

Treatment of muscle tone disorders

Impaired muscle tone is a dangerous condition that can lead to dysfunction of the entire body, but it is completely reversible in the early stages. In case of serious disorders associated with intrauterine development, disruption of the central nervous system and other serious pathologies, the main goal of treatment is to stop the development of pathological processes. This makes it possible to better coordinate movements, as well as prevent the development of paresis and paralysis of varying degrees of severity. The treatment complex includes the following methods:

• Medications – muscle relaxants, antidepressants, sedatives, vascular and anticonvulsants.
• Exercise therapy, swimming and massage help relieve excess tension and restore normal movement.
• Paraffin and ozkerite applications.
• Electrophoresis and acupuncture help restore the normal functioning of conducting neurons.
• Baths with herbal decoctions (sage, valerian, chamomile) or essential oils (pine needles, sedative complex), which have a general calming, relaxing effect, strengthen the nervous system.
• Sleep and rest mode - active walks in the fresh air, breaks between work, sleep for 7-8 hours.

The effectiveness of treatment is possible only with complex effects. If you limit yourself only to medications or baths, there will be no result. Treatment methods, their intensity and sequence may vary, because... the doctor constantly monitors the effectiveness of rehabilitation measures over time. To obtain a quick and high-quality result, you must strictly adhere to the regimen developed by a specialist, do not skip scheduled diagnostic appointments, and also do not adjust the treatment yourself.

It is necessary to change the previous lifestyle that caused an increase in muscle tone, especially if this applies to patients who work a lot at the computer or have become overstrained due to excessive exercise. Treatment for increased muscle tone should be prescribed by a doctor, taking into account all the characteristics of the patient’s body and the reasons that provoked the pathological condition.

Increased uterine tone in pregnant women

Many pregnant women face the problem of hypertonicity of the uterus, which is a muscular organ. Excessive tension in the uterus of a pregnant woman can be dangerous for the unborn child and cause abortion, especially in the early stages, when the embryo has not yet attached well enough to its walls. The body perceives the embryo as a foreign object and tries to get rid of it, push it out of the uterus through its contractions. Sometimes a woman may not feel any tone at all, but most often its signs are:

• nagging pain in the lower abdomen or lower back;
• “petrification” of the abdomen, it becomes hard and changes shape;
• Uncharacteristic discharge, sometimes bloody.

Since the consequence of uterine tone can be a miscarriage, you should consult a doctor at the first signs. Based on the results of the examination, tests, and ultrasound, the doctor determines the cause of this pathological condition and prescribes the necessary treatment.

Causes of uterine hypertension during pregnancy:

• physical exercise;
• overwork;
• stress, nervous state of the pregnant woman;
• diseases of the female reproductive organs such as fibroids, endometriosis, inflammation;
• infectious disease of a pregnant woman;
• hormonal disorders, for example, the level of the male hormone is higher than the female one.

When eliminating uterine tone in pregnant women, the doctor needs to find the cause of this phenomenon. Basically, women require inpatient treatment, complete rest, a minimum of movements and physical activity, and emotional balance. A pregnant woman must understand that she is responsible not only for her life, but also for the life of her unborn child, so you should not self-medicate, but seek medical help at the first suspicion.

Prevention of muscle tone disorders

Increased muscle tone is not an independent disease - it is a sign of an unhealthy lifestyle or serious disturbances in the functioning of certain systems. If the disease is not congenital, then preventive measures are very effective to avoid high muscle tone. The following is recommended:

• Lead a healthy and active lifestyle. Avoid the use of alcohol, nicotine and stimulants.
• For those who work at a computer or in one position for a long time, be sure to do gymnastics every half hour, walking for at least 5 minutes.
• It is recommended to increase the amount of physical activity - walking in the evenings or walking home from work, gym, swimming.
• Follow a daily routine that requires 8 hours of healthy sleep, exercise, physical activity and a balanced diet.
• Regularly attend preventive general massage. It is recommended to take a course of 10 sessions every six months.
• If the main activity is related to heavy physical labor or sports, then it is necessary to undergo routine diagnostics, ensure quality rest and good sleep.

To avoid the development of hypertension due to non-physiological reasons, it is necessary to lead a healthy lifestyle, undergo regular medical examinations, promptly treat or prevent chronic diseases, increase immunity, and not have contact with patients with various infectious diseases.

In order to reduce the likelihood of intrauterine causes of hypertension in children during pregnancy, it is necessary to exclude the use of alcohol, narcotic and medicinal substances, and nicotine. It is necessary to adhere to an active lifestyle, monitor a balanced diet, undergo timely examinations, and avoid stress, nervous tension and overwork.

Hypertonicity of the back muscles: classification, diagnosis, treatment and prevention

This condition manifests itself in the form of constant tension in the back muscles. pain
in the back
occur predominantly . In addition to these symptoms, patients experience involuntary convulsive contractions of muscle tissue, accompanied by aching pain, which leads to difficulty moving.

Increased muscle tone in the back - what is it?

If symptoms of this disease appear, you should not engage in independent treatment or diagnosis. You need to seek qualified medical help as soon as possible. With correct and timely treatment, the prognosis is favorable.

This process is reversible and therefore treatable. However, if you ignore the condition for a long time and do not start treatment, this can lead to disruption of blood flow to the muscle fibers and the formation of a compaction in this area, which is determined by palpation.

In order to prescribe the necessary therapy, it is important to determine the cause that led to increased tone of the back muscles, even in a relaxed state.

Etiology

There are two factors that cause this condition:

• Physiological;
• Pathological.

Physiological reasons include excessive physical activity and prolonged exposure of the body to an uncomfortable or the same position. The occurrence of pathology can be caused by bruises and injuries, a functional change in the usual body position, emotional distress and nervous tension. Diseases accompanied by severe pain can also cause muscle tension. These include meningitis, hypoxia, stroke and others.

Pathological factors are based, as a rule, on ailments associated with disorders in the vascular system or neurology, namely:

• Cerebral palsy;
• Epilepsy;
• Parkinson's disease, multiple sclerosis;
• Stroke;
• Neoplasms of the brain and spinal cord;
• Torticollis;
• Radiculitis, arthrosis.

Depending on the affected area, there are two types of this pathological condition:

• Extrapyramidal (rigid) – accompanied by tension in all muscle groups at once. It appears in various diseases of the brain and spinal cord.
• Pyramidal (spastic) – accompanied by periodic tension of individual groups of back muscles. Occurs when neural chains in the pyramidal system are damaged. The main symptoms here include speech impairment and stiffness of movement.

To determine the cause of the disease, it is necessary to conduct a thorough and complete examination prescribed by a specialist, since hypertonicity of the spinal muscles is one of the symptoms of a serious pathology - brain damage. The process of establishing a diagnosis is of great importance in further treatment.

Examination methods

Examination of the patient will help to correctly identify the source of the disease and eliminate it in time.

To begin with, the doctor identifies complaints and collects information regarding the patient’s life and diseases. Then he examines the patient, and, thanks to the palpation method of examination, determines the tension of the muscle fibers, when palpated, pain occurs.

The process of establishing a diagnosis is formed on the basis of objective data and laboratory research methods prescribed by the doctor:

• The level of Mg, Ca, K, Cl, Fe, Na, P in the blood will be determined using a biochemical and general blood test.
• The speed at which excitation moves along the nerve fiber will be determined by electromyography.
• MRI and CT will determine clear visualization of the structures of the back muscles and brain.
• Muscle biopsy and specialist consultation are rarely necessary.

Treatment methods

The duration and methods of selected treatment depend on the type and etiology of the disease. The prescribed therapy is complex, that is, several methods are used simultaneously. In addition, the presence of a pathological process that prevents the use of such treatment in the patient is taken into account.

First, medications are prescribed in tablets or injectable solutions in order to relieve aching pain and prevent damage to the nervous system. These drugs include muscle relaxants and antipsychotics. These medications should be taken in a strictly specified dosage and duration, without stopping them when the condition improves. Vitamins, nutrition and a healthy lifestyle recommended by a doctor will contribute to a speedy recovery.

Therapeutic physical education classes are the next stage of treatment. Performing a set of simple exercises will help restore blood flow and mobility in the muscles.

Bends, stretching and bending of the body, exercises with a fitball help strengthen the upper musculoskeletal system in general. Exercises should be done according to a schedule, but it is not recommended to overexert yourself physically.

To make the patient feel better, the following is additionally used:

• Swimming lessons.
• Therapeutic relaxing massage.
• Paraffin applications.
• Physiotherapy with muscle relaxants.
• Baths and saunas (only after an acute period).

It is quite possible to prevent the occurrence of increased muscle tone. Preventive measures should be taken.

Disease prevention

The main measures to prevent the disease include:

1. Healthy lifestyle – maintain proper wakefulness and sleep patterns.
2. Avoid physical fatigue.
3. Avoid emotional distress and anxiety.
4. Periodically take preventive massage courses.
5. Listen to your body and contact a specialist if alarming symptoms appear.

Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Benefits of going to the clinic

Self-treatment of increased muscle tone may be ineffective or lead to complications, so you need to contact a clinic with a team of specialists. The doctor will prescribe examinations, conduct an examination and identify the exact cause of the pathology. Experts will also help determine whether the complaints are related to increased muscle tone or whether the problem of poor health lies elsewhere.

After the diagnosis is made, an individual treatment complex is selected that suits the specific patient. In case of physiological disorders and poor lifestyle, physiotherapeutic methods and regulation of periods of activity and rest are chosen for treatment. In case of internal or infectious disorders, drug therapy is added and a whole range of rehabilitation measures is developed.

A specialist can also provide advice on preventative measures if you notice that your lifestyle may be contributing to the development of muscle hypertonicity.

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How is muscle tone assessed?

Clinically, atypical muscle tone can be assessed at rest and in an active state. Resting muscle tone can be assessed as resistance to passive stretch as the child attempts to maintain a relaxed state of muscle activity. Resistance is determined partly by mechanical factors of the musculoskeletal structures and partly by the tonic stretch reflex. To standardize the influence of the neurological factor, it is important to monitor postural loading (eg, assessing in a supine position), and other internal and external stimuli (eg, examining the child in a quiet state of wakefulness without unwanted sensory stimulation. Electromyographic monitoring can be used to detect unwanted myoelectric activity. In clinical practice, it is very important to record the state of arousal and the child's ability to relax.Active tone can be defined as the ability or willingness of a human child to respond to the demands of the environment.Measurement of active muscle tone is done by observing how the child interacts with and responds to the environment, especially when exposed to gravity, or during independent movement, sensory stimulation, or physical manipulation of the limbs.