Alan has some good active movement at his shoulder and elbow but due to the increased tone in his hand he has limited functional ability. (For more information on tone, click on the Additional Information box below). There are some positive signs of recovery with flickers of activity in his fingers and wrist but this is hindered by increased tone. Despite intensive therapy (stretches and exercises) his hand and wrist tend to sit in a flexed posture with the fingers pressing into his palm. The skin of his palm tends to sweat and there is an offensive smell coming from his hand. Alan finds cleaning his hand difficult and is distressed by its appearance. You think that by managing his tone you can help his hand hygiene, skin condition and potentially improve his hand activity.
Additional Information
Following a stroke patients may present with abnormal tone which may be decreased (hypotonus), increased (hypertonus) or a combination of the two. A combination of the two occurs where there is increased tone in one muscle group and decreased tone in another.
Tone may be increased temporarily by pain, discomfort, anxiety, effort and certain body positions.
Hypotonus
• Low toned muscles are floppy and sag away from their bony connections leaving the associated joints unsupported and unstable.
•• Low toned limbs feel heavy and drop against gravity when handled if insufficient support is given. The muscle groups will feel flabby to handle and little or no resistance will be felt through the range of the movement. Great care must be taken to ensure adequate support of joints throughout their range of movement to prevent trauma, particularly to the shoulder.
Hypertonus
• High toned muscles are tense and bulky, with tendons visible beneath the skin. Joints spanned by high tone muscles will assume a shortened position rendering the patient unable to relax.
• High toned muscles will resist movement and feel tight.
