Prolonged stretch as a HEP for hypertonia

I recently completed a placement in a rehabilitation centre in Malaysia for people who have undergone stroke. Time frames ranged from 3 months to 5 years. Although impairments were various, the majority of patients endured problems with hypertonia (spasticity) in the trunk, upper limb or lower limb. Presentation of the upper limb usually consisted of increased tone in pectoralis major, biceps brachialis, wrist pronators and flexors, and finger flexors. Affected muscles in the lower limb usually included hip adductors, hamstring muscles and muscles of the posterior leg (gastrocsoleus, FHL, FDL and Tibialis Posterior).

There was an apparent difference between those patients who routinely stretched their muscles each day and those who did not. If they came to their treatment session having reduced tone in their muscles, then the majority of the session could be focused on other impairments (muscle strengthening, reduced balance etc) and functional retraining. However if they did not come prepared, the majority of the session was spent conducting prolonged stretches of each muscle until tone was reduced. By the end of the session, fewer outcomes were achieved.

I believe prolonged stretches of muscles with increased tone should be considered as one of the primary home exercises prescribed by the practitioner. They are easy for the patient to administer. And as they take a long time to do, they are inefficient for the practitioner.

I suggest it is a good idea to create a comprehensive muscle stretching program, with written diagrams and explanations, as well as frequent re-assessment to ensure the patient is conducting it effectively.

In an acute setting, this may not be as effective, as the patient is likely to be seen by the physio for up to four hours per day. But it appears effective in the case of long term rehabilitation, where the patient may only see the physio for an hour each week, of which time must be spent wisely.