Date sent: 10/24/99 08:48 AM
The difference between strength and tone....
Hi... I was just rereading what I wrote on Friday. Saturday, we learned a little more
about the movement and loss of movement that Dan has been experiencing.
Normal muscle tissue always has a certain amount of tone... muscle working against
muscle to keep the bone in a particular position, for example, normal resting tone. To
move, more muscle fibers are recruited and more tone is available to some muscles, less to
opposing muscles... movement happens.
Tone is the action potentials holding the muscle in "readiness"... too much
tone makes a muscle spastic or rigid, too little tone makes the muscles flacid.
Ok, in a case like Dan's where there is a "weakness", there is a process that
the musculature goes through. First, it is flacid and heavy, no motion, loose, easy to
manipulate by someone else. Next, as the nervous system reasserts itself, there is
stiffness due to tone, all the muscles are activated so oposing muscle groups don't work
in sync (contract/relax) because all muscles are contracted. Moving intentionally against
tone is extremely difficult, even for someone else to make the movement. However, some
tone is good since it helps the muscles stay healthy. It is also good because some small
motions are then supported by the existing tone.
So, when Dan was able to squeeze his fingers together and not let go, that was
manipulating tone, when he was able to take a couple steps unassisted that was
manipulating tone. The reason the loss of these skills is not an indication of
neurological problem is that he was manipulating tone. If he had been able to actively
squeeze and let go of his fingers, and that lost that ability, that would have been cause
for concern.
The next steps in the process is the loss of some (most? all?) of the tone. Tone masks
some of the "strength", or his muscles ability to move themselves. Now that some
of the tone has subsided, he has fewer skills available. I tried to find out if then the
strength would build and become progressively better.
The PT said that she thought it was a good sign since manipulating tone does require
some ability to initiate a movement, but she was kind of fuzzy about predicting further
return.
So, what is his current state? When we left last night, he had had PT and OT yesterday,
and was able to initiate some movement, but is not very strong. Two activities have put
light in his eyes, both exercise equipment... He has used a stationary bike and an arm
machine. In each case the left side needs assistance to stay on, but he loves the physical
activity.
On the positive side, they are planning to discharge Dan on Friday October 29th in the
afternoon. There are some changes we are making around our house... adding a ramp to the
front, handrails in the hallways and stairs, etc. Dave Greco is working on that (767-7009)
so if you have time to help him (including today), give him a call.
With Love and Apreciation, Abi and Dan
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