Noodle is Spastic!
Spinal Cord Injuries and Tone
Tone is a tough term to define but I think an important concept for rehab following multiple injuries including strokes, traumatic brain injuries and like Noodles spinal cord injury.
Tone is the resting state of our muscles. We all have tone but it is well controlled and regulated due to the constant feedback from muscle fibers to spinal cord to brain and back. We have the voluntary ability to control our muscle tone with each movement of our body.
When there is what we call an upper motor neuron injury (injury of brain or spinal cord tissue), tone can significantly change. Most often with these injuries tone increases resulting in spasticity of a muscle. The persons ability to move freely by contracting say your bicep while relaxing your tricep, no longer is a process that is easily completed or often can be impossible. Tone is also speed dependent meaning the quicker a muscle is stretched or moved then the more increase in tone or spasticity you will see.
Noodle’s spinal cord injury has resulted in increased tone in her back legs. When in her scooter her back legs reflexively kick up/down similar to a walking motion again this is due to tone and spasticity. Most people will see this and say to Kyle or I, oh look, she is trying to walk again. In fact when we first adopted her we hoped this was the case as well but deep down we knew this was spastic movement. We have accepted that and have talked at length with her vet and rehab support team.
Humans can usually learn, to varying degrees, how to use their tone to their advantage. Often a patient who is recovering from a stroke will have high tone in the muscles that extend their legs, as therapists, we can help train the person to use this tone for activities such as standing.
On the flip side tone can also increase risk of skin breakdown if positioning is prolonged or poorly supported. Tone and spasticity can also cause contractures of muscles, which is a rather permanent shortening of a muscle. This can lead to hygiene problems, pain, and severely limited joint movement of a leg or arm.
Look at the left back leg and how it is "stuck" upright. This is due to Noodle's high tone.
Noodle can use her tone sometimes to push up to stand. Especially when motivated to eat, and when moving outside of her cart she will often be able to push halfway up on her back legs. This is her using the tone to her advantage for faster movement out of the cart.
To keep Noodle’s body healthy and to keep her able to use tone to her advantage she needs a regular stretching program. Remember tone is speed dependent so slow stretching is key, we don’t want to inadvertently increase her tone/spasticity when we are trying to stretch. The hydrotherapy treadmill is also great for tone management. Human research has demonstrated that water therapy reduces need of tone managing drugs like baclofen (1).
For Noodle, and any other animal or human dealing with tone and spasticity, the key is management. Increased tone is there, it will not go away but daily stretching, medications and hydrotherapy can help keep the tone reduced. Prevention of muscle contractures is the upmost importance in this management. Humans can be educated on the daily management techniques. Noodle cannot be taught and often has to be bribed with treats to lay still for her stretching program. Its safe to say she is a much better at her role as puppy than she is as a patient.
1. Kesiktas, N and Paker, N. et al (2004) The use of hydrotherapy for the management of spasticity. Neurorehabil Neural Repair(4)268-73
Written by Bree Corbin, MPT