If the limb has low tone (Hypotonus), joints should be well supported when moving the limb
If the muscles are high toned (Hypertonus) the joints and limb should be moved slowly.
Irrespective of the tone, when handling the arm adequate alignment of the joints should be maintained throughout the range to prevent damage to rotator cuff muscles i.e. ensure adequate scapular movement and lateral rotation of the shoulder when raising the arm.
Like a stereo the body has to be in balance.
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Video notes
0:07 You will see Allan using different walking aids.
Think about the implications of each one and observe the walking symmetry and spasticity reactions in his affected right side.
0:19 The Tripod. Where is Allan’s centre of gravity?
What tone changes can be seen in his right arm and leg?
1:30 Raising the height of the tripod. How does this affect his centre of gravity?
What tone changes can you see now?
1:58 Stick. Where is the centre of gravity now Allan is using a stick?
What is happening to his tone?
2:29 Walking with an Ankle Foot Orthosis and hand splint.
Where is Allan’s centre of gravity now?
What changes can you see in his right arm and leg?
Video transcript
Walking and tone
M. Ok, Allan, so this is the stick you have been using at home. It’s called a tripod. It’s got three feet on it and it gives you a lot of support. I’d like to see how you walk with that. Just a few steps if you can. OK and stop there. So what I’m seeing is a wee bit like when we were standing up from the chair. You are taking a lot of weight through your left hand. So that’s actually meaning you are not having to take so much weight on your right leg. What we are seeing is that it generates a bit of increased activity in your right arm.
A. Yeah.
M. OK Allan. I’d like to see if raising the height of this has any influence. Because it will mean that you can’t take quite as much weight on the left arm. So it will encourage your right leg to work a bit more. I’m just going to raise this up a bit higher. Just put your hand on here. Maybe just one more? Just lightly on there. Ok, so just let your elbow come in by your side and just stay a little bit closer to it. OK Allan so we have raised the height of that cane a little bit so we’ll see what influence that has on your walking. OK so just in your own time you can take a few steps. OK and I think we find that you are getting a bit more weight on to the right leg and a bit less weight on to the left arm. So it’s making you a bit more symmetrical.
A. Yeah.
M. But you know what. I don’t think you need a cane that’s as supportive as that so we will try something else.
A. OK. That’s great.
M. OK Allan so this is a different type of stick. This is just a single point cane. I have deliberately left it a bit high so that it’s not so easy to push down on. Have a wee walk with that and see how it feels. In your own time.
A. That’s a lot better.
M. That’s certainly much more symmetrical walking and more weight on your right leg.
A. That’s right.
M. Which is great. OK.
M. OK Allan so we have tried a few walking aids. You are now wearing the Ankle Foot Orthosis that was made for you. You also have a rest splint on your hand and wrist which is helping to control the position of that. So what we’d like to try is using the same technique that you used for standing up earlier before you walk and we will try walking without the stick but with the splint.
A. Fantastic.
M. So in your own time if you’d just like to bring your weight forward from the hips. Take your hands down towards the floor. Just when you are ready come up to stand on both legs. OK just get your balance. Get yourself nice and relaxed. Nice and comfortable. Then when you are ready just have a walk. So it’s interesting that, we’ll stop there. When you don’t have to use your left arm and your right foot and ankle are well controlled, your arm is much more relaxed.
A. It’s pretty much the same.
M. And you are more symmetrical.
A. Yeah.
M. I think that is a better way of walking for you than using a stick in your left hand if you can do that.
A. Yeah it is less restrictive as well.
M. Because you can use your left hand when you are on you are on your feet. Absolutely. So we have shown I think a good way of controlling the tone in the muscles on your right side while you are walking.
A. Yeah, brilliant.
M. Which is going to be helpful for you hopefully?
A. Thank you.
M. You are welcome.
Managing tone interactive
Like a stereo the body has to be in balance.
Scene 1
Equal balance: grading left/right activity/sound
Scene 2
Compensatory push increases over-activity of the right side which overpowers the left side.
Before treatment this patient feels he is falling to his unaffected right side. In fact the opposite is the case, we need to reduce the over-activity in his right.
Left hemiplegia – when we reduce the over-activity in the unaffected side (right) this helps to restore balance and reduce spasticity in the affected left side.
Need to reduce right to increase left and restore balance – the same patient 1 hour later.
Scene 3
Need to reduce right to increase left and restore balance – the same patient 1 hour later.
- Hips are central in his chair.
- By positioning the bed to his right he no longer fears he is falling to his unaffected side.
- He is now able to use his right arm functionally.
His affected arm is now supported to reduce his tone.
Page last reviewed: 05 May 2020
