Spasticity
- Caused by lesions in the pyramidal tract (i.e. upper motor neurons) such the corticospinal tract
- Stroke
- Spinal cord compression
- Motor neuron disease
- Weakness present
- More resistance in one direction the other direction
- More tone in initial part of movement – “Clasp knife spasticity”
- It is velocity dependent (i.e. more noticeable with fast movements)
Is clasp knife spasticity or rigidity?
Clasp knife rigidity describes the phenomenon in a spastic limb where, after an initial resistance to passive movement of a joint, there is a sudden reduction in tone and the limb moves quite freely through the rest of the range of the particular movement.
What diseases do you see clasp knife upper motor neuron rigidity and spasticity?
With upper motor neuron lesions the muscles, after an initial period of rigidity and resistance to movement, suddenly relax or give way, the so-called “clasp-knife” rigidity. Additionally, patients with Parkinson's disease may show a cogwheel type of rigidity.
How do you elicit clasp knife rigidity?
0:000:44Simulation of Clasp knife and Cog wheel rigidity - YouTubeYouTubeStart of suggested clipEnd of suggested clipBut gives away abruptly to allow easy flexion on exertion of further pressure this movementMoreBut gives away abruptly to allow easy flexion on exertion of further pressure this movement resembles that of a clasp neck. A series of caches appears during passive flexion of the extremities.
Is there any neurological condition in which extended limb show clasp knife reaction?
Clinically spasticity manifests as an increased resistance offered by muscles to passive stretching (lengthening) and is often associated with other commonly observed phenomenon like clasp-knife phenomenon, increased tendon reflexes, clonus, and flexor and extensor spasms.
Where is clasp knife rigidity found?
Clasp knife rigidity describes the phenomenon in a spastic limb where, after an initial resistance to passive movement of a joint, there is a sudden reduction in tone and the limb moves quite freely through the rest of the range of the particular movement.
What's the difference between rigidity and spasticity?
Whereas spasticity arises as a result of damage to the corticoreticulospinal (pyramidal) tracts, rigidity is caused by dysfunction of extrapyramidal pathways, most commonly the basal ganglia, but also as a result of lesions of the mesencephalon and spinal cord.
What is clasp-knife deformity?
Enlarged downward projecting spinous process of L5 vertebra extending up to sacral vertebrae with associated bifida defects is known as "Clasp-knife deformity". It is often the cause of backache particularly during bending movements and called "Clasp-knife syndrome".
What is rigidity in Parkinson's?
Rigidity is one of the leading symptoms of Parkinson's disease and it's characterized by muscle stiffness. While the level of severity varies, there are treatment options available that can lessen the intensity and slow the progression of rigidity.
How do you assess rigidity?
Examination. The examiner should hold the hand of the patent above the wrist with one hand and keep it fixed. With other hand he grasps the fingers and the palm and then slowly rotate along the long axis of the hand. If there is rigidity, the examiner will experience resistance during the movement.
What is Cogwheeling rigidity?
Definition. A type of rigidity in which a muscle responds with cogwheellike jerks to the use of constant force in bending the limb (i.e., it gives way in little, repeated jerks when the muscle is passively stretched). [ from HPO]
What part of the brain causes spasticity?
Spasticity is a result of disrupted communication between the brain and the muscles. The source of that disruption is usually the cerebral cortex (the region of the brain that controls movement) or the brainstem, where nerves connect the brain to the spinal cord.
What is the other name of clasp knife reflex?
Called also paradoxical pupillary reflex.
What are upper motor neuron diseases?
Some diseases that can damage upper motor neurons include cerebrovascular accidents, amyotrophic lateral sclerosis, primary lateral sclerosis, multiple sclerosis, Brown-Sequard Syndrome, vitamin B12 deficiency.
Is ALS the same as motor neuron disease?
Amyotrophic lateral sclerosis (ALS), also called classical motor neuron disease, affects both the upper and lower motor neurons. It causes rapid loss of muscle control and eventual paralysis. Many doctors use the term motor neuron disease and ALS interchangeably.
What causes upper motor neuron signs?
The upper motor neuron syndrome signs are seen in conditions where motor areas in the brain and/or spinal cord are damaged or fail to develop normally. These include spinal cord injury, cerebral palsy, multiple sclerosis and acquired brain injury including stroke.
What are the signs of an upper motor neuron lesion?
Symptoms of upper motor neuron lesionsmuscle weakness.increase in muscle tone.increased muscle stretch reflex.clonus, or involuntary and rhythmic muscle contractions at the ankle, patella, triceps, wrist, jaw, and biceps.temporary flaccid paralysis.muscle spasms.Babinski sign.
What is a clasp-knife response?
The clasp-knife response describes an initial resistance when attempting passive movement (i.e., movement performed by another person) of the extre...
What causes a clasp-knife response?
The clasp-knife response indicates an upper motor neuron lesion or damage. The upper motor neurons originate in the cerebral cortex (i.e., the oute...
How is the clasp-knife response assessed?
The clasp-knife response is assessed during a neurological exam by a healthcare provider. The provider will be able to visualize the reflex while p...
What are the most important facts to know about the clasp-knife response?
The clasp-knife response describes an initial resistance when attempting passive movement of the extremities, followed by a rapid decrease in resis...
What is rigidity in motor neuron?
Definition. Rigidity is a hypertonic state characterized by constant resistance throughout range of motion that is independent of the velocity of movement. It is the result of excessive supraspinal drive (upper motor neuron facilitation) acting on alpha motor neurons; spinal reflex mechanisms are typically normal.
What is lead pipe rigidity?
Lead Pipe Rigidity - Refers to hypertonic state throughout the range of motion i.e simultaneous co-contraction of agonists and antagonists and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint.
What happens when the balance of inhibition and excitation in the basal ganglia and motor cortex is upset?
When the balance of inhibition and excitation in the basal ganglia and motor cortex is upset, the symptoms and signs of rigidity and involuntary movements supervene along with abnormalities of posture and associated movement.
How to determine if a patent is rigid?
The examiner should hold the hand of the patent above the wrist with one hand and keep it fixed. With other hand he grasps the fingers and the palm and then slowly rotate along the long axis of the hand. If there is rigidity, the examiner will experience resistance during the movement. If the cogwheel phenomenon is positive, the examiner will experience interruption or repeated catch during the movement and if present throughout without any interruption or change with respect to velocity, it is lead-pipe rigidity. Generally in case of idiopathic Parkinson disease only unilateral rigidity is seen which can be compared during the examination with the contralateral side.
What happens if the cogwheel phenomenon is positive?
If the cogwheel phenomenon is positive, the examiner will experience interruption or repeated catch during the movement and if present throughout without any interruption or change with respect to velocity, it is lead-pipe rigidity.
Is muscle tone normal in rigidity?
In rigidity, muscle tone is increased even at rest and is usually presents during passive range of motion in all directions across individual joints. The plantar reflex and tendon reflexes are usually normal. There is absence of synergy.
Is rigidity a disease?
Rigidity, which is often used as a synonym to Hypertonia by many authors, is a common muscle tone disorder in which there is resistance to passive movement irrespective of posture and velocity. It is one of the cardinal features of Parkinson's Disease and is usually present in extrapyramidal disorders.
What is clasp-knife rigidity?
clasp-knife rigidity increased tension in the extensor of a joint when it is passively flexed, giving way suddenly on exertion of further pressure; seen especially in upper motor neuron disease. Called also clasp-knife reflex.
What is clasp knot?
clasp-knife spas·tic·i·ty. a type of increased muscle tone due to a pyramidal tract lesion, in which abnormally increased resistance to passive stretch of a muscle abruptly decreases; typically, this appears near the end of the range of joint excursion. See also: lengthening reaction.
What is cogwheel rigidity?
cogwheel rigidity tension in a muscle that gives way in little jerks when the muscle is passively stretched; seen in parkinson's disease. decerebrate rigidity see decerebrate rigidity. decorticate rigidity see decorticate rigidity.
Why is the extensor muscle so rigid?
Initial increased resistance to stretch of the extensor muscles of a joint that give way rather suddenly, allowing the joint then to be easily flexed; the rigidity is due to an exaggeration of the stretch reflex.
What is paratonic rigidity?
paratonic rigidity an intermittent abnormal increase in resistance to passive movement in a comatose patient.
What is the clasp knife phenomenon?
Clasp - knife phenomenon: The limb experiencing spasticity suddenly gives way after an initial resistance to movement. Much like how a clasp-knife slightly resists before folding in. This can be caused by over-stretching the joint or muscles (during initial movement), the inverse stretch reflex (during sustained movements), and eventually contractures (a condition wherein muscles shorten/harden).
What causes spasticity vs rigidity?
rigidity. Spasticity is generally caused by damage or trauma to the portion of the spinal cord or brain which controls voluntary movement , namely the corticospinal tract . This can lead to an imbalance and ‘disconnection’ between the muscles and the nervous system . This can be caused by the following instances:
How is rigidity different from spasticity?
Rigidity is different from spasticity in that resistance to movement in joints is felt regardless of the speed or direction the joint is moving. Rigidity is bi-directional, meaning that one may experience resistance to movements regardless of which direction the joint and muscles are moving in.
Which muscles are affected by spasticity?
Distribution: The sensation of spasticity is distributed differentially, often affecting antigravity muscles (muscles which are the extensors of the back, hips, and knees, which help to maintain proper posture by resisting the pull of gravity).
What are the two subtypes of rigidity?
2 subtypes: Lead pipe rigidity, which is descriptive of an unvarying increase in tone, and cogwheel rigidity, which often results from a tremor pertaining to the central nervous system.
What is the difference between spasticity and velocity?
Spasticity is often uni-directional, meaning that resistance to movement is only felt when one’s joint or muscle moves in one specific direction. Spasticity is velocity-dependent, meaning that the faster one moves or straightens a joint, the more resistant, tight, or spastic the muscle feels.
Overview
Clasp-knife response refers to a Golgi tendon reflex with a rapid decrease in resistance when attempting to flex a joint, usually during a neurological examination. It is one of the characteristic responses of an upper motor neuron lesion. It gets its name from the resemblance between the motion of the limb and the sudden closing of a claspknife after sufficient pressure is applied.
Cause
When a joint is passively flexed, the resisting force comes from the stretch reflex (or sometimes called tendon reflex) resulting from the extensor muscle being stretched. In upper motor neuron lesions, muscle tonus may increase and resistance of muscle to stretch increases. However, if sufficient force is applied, limb resistance suddenly decreases, presumably mediated by the Golgi tendon reflex (also call autogenic inhibition).
Mechanism
This reflex is observed in patients with upper motor neuron lesions. It was frequently attributed to the action of the golgi tendon organ, likely because of early studies showing that tendon organs are activated by strong muscle stretch and inhibit motoroneurons of the stretched muscle. It was thought that this was a protective reflex, preventing application of so much force that muscles become damaged. More recent work strongly suggests that tendon organs are not involved in th…
Example
Passive flexion of elbow meets immediate resistance due to stretch reflex in the triceps muscle. Further stretch activates inverse stretch reflex. The resistance to flexion suddenly collapses, and the elbow flexes. Continued passive flexion stretches the muscle and the sequence may be repeated.
As the muscle tone increases, resistance against flexion of the limb increases as well. However, …
See also
• Hypertonia
External links
• Lib.mcg.edu
Introduction
- Rigidity, which is often used as a synonym to Hypertonia by many authors, is a common muscle tone disorder in which there is resistance to passive movement irrespective of posture and velocity. It is one of the cardinal features of Parkinson's Diseaseand is usually present in extrapyramidal disorders. It affects the agonists and the antagonists equally. It can be seen in - …
Definition
- Rigidity is a hypertonic state characterized by constant resistance throughout range of motion that is independent of the velocity of movement. It is the result of excessive supraspinal drive (upper motor neuron facilitation) acting on alpha motor neurons; spinal reflex mechanisms are typically normal.In parkinsonian rigidity, tendon jerks are usually normal 'Rigidity" is defined as h…
Anatomy
- The “basal ganglia” refers to a group of subcortical nuclei responsible primarily for motor control, as well as other roles such as motor learning, executive functions and behaviors, and emotions. The classical basal ganglia model shows how information flows through the basal ganglia back to the cortex through two pathways with opposing effects for the proper execution of movement.
Pathology
- Rigidity is the result of excessive supraspinal drive (upper motor neuron facilitation) acting on alpha motor neurons; spinal reflex mechanisms are typically normal. There is a disruption of normal reciprocal inhibition. When the balance of inhibition and excitation in the basal ganglia and motor cortex is upset, the symptoms and signs of rigidity ...
Types of Rigidity
- The rigidity of Parkinson disease may be characterized as either “lead pipe” or “cogwheel.” 1. Cogwheel Rigidity - Refers to a hypertonic state with superimposed ratchet-like jerkiness and is commonly seen in upper extremity movements (e.g., wrist or elbow flexion and extension). The cogwheel type of rigidity is a combination of lead-pipe rigidity with tremor. 2. Lead Pipe Rigidity …
Difference Between Spasticity and Rigidity
- Spasticity generally occurs only during muscle stretch (i.e., not at rest) and is usually accompanied by increased tendon reflexes and a Babinski’s response. There is usually a difference between resistance in one direction of movement as compared to the opposite direction and some patients may represent with Clasp-Knife phenomenon (sudden release at en…
Examination
- The examiner should hold the hand of the patent above the wrist with one hand and keep it fixed. With other hand he grasps the fingers and the palm and then slowly rotate along the long axis of the hand. If there is rigidity, the examiner will experience resistance during the movement. If the cogwheel phenomenon is positive, the examiner will experience interruption or repeated catch d…
Management
- Medical management
Treatment of Parkinson disease with levadopa (L-Dopa) in these various combinations is extremely helpful in reducing bradykinesia and rigidity. Deep Brain Stimulationin Globus pallidus stimulation and Sub thalamic nucleus stimulation has been demonstrated to improve rigidity - Physiotherapy Management
For most patients, treatment proceeds better if rigidity is decreased early in the treatment session. Thus, movement therapy interventions appear to have more lasting effects when the treatment is performed during the “on” phase of a medication cycle. Relaxation techniques appe…