Tone- Increase is an Answer after a Brain Damage: But How High Is Good?

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Jan van de Rakt Steve McCarthy-Grunwald



Every neurological disease has an clear reaction of the damaged brain to get again control over the situations that it is copy with. This article focuses on this reaction on that damage of the brain on the restoration of movements, attitudes and balance.

This is on one side, called plasticity or recovery but also is it an great part adaptation.

Necessary is this adaptation to have again possibilities to gone on with their life, certainly when the recovery is stopped and the chronic stage is entering.

Then we see all kinds of problems, especially in the chronic stage that attack the reached recovery levels and much of this people must go on an lower level because they cannot win the fight.

That count also for people that have a degenerative neurological disease as Parkinson, Multiple Sclerosis but also for Dementia.

To hold the level is maybe the greatest challenge for stroke-survivors but also people with an degenerative neurological disease go often at an certain level to fast in their performance back an become total dependent of others on an moment that there is an situation that own movements are very difficult.

This fact, that movement on the own are so heavy that the amount of energy that this movements cost, must be an item that must have our attention and an important item for the treatment.

That looks the conclusion often simple: the tone that is present in the body, is often so high that movement with this high tone cost much energy.

This fact was for us the focus to create an treatment that would try to control the tone and make more and less heavier movements possible.

This by people in the chronic stage and after an stroke, but also by people with the diseases Parkinson and dementia.


Measurement of the tone was common by all survivors of stroke and Parkinson but by people with dementia was this “not done”. Till in 2005 we started with the administrate of all tone measurements by all people with an neurological disease and that were done on divers moments through the day to get an view, what the tone did through the day and to get an impression what the best approach could be, to get control of the own movements so long as possible.

But also, to get an impression what the energy cost where of this people through the day and what the contribution of the tone was.

One of the first data was that for much people with an neurological disease the morning was an “Fight against an high tone and only movement could bring that tone to an lower level, another moment was long sitting or better long in one attitude”.

This fact that the start was difficult, because the tone was (too) high was clear but more important was the fact that starting with movements was essential to get an lowering of the tone.

Thus, tone decrease was good possible with movements and when that movements were not too heavy, should this make an start possible that cost less energy.

Thus, in bed doing light movements, has more effect as starting with an A.D.L. program and transfers.

Movements in the beginning can create an lower tone and has after that, an direct positive effect on the level/speed of the A.D.L. performance and the transfers.

In an period of an half year we train according the principles that was based on combination of Burnnstrom and on the new evidence that was published in the first Guidelines of the stroke- treatment that was published than.

After that period, we treat the same people with an approach that focus on tonus control with as base practice an (modified) Bobath- concept but also with treatment in an environment where the tone stays lower.

This (Modified) Bobath (N.D.T. -Neuro Developmental Treatment)- concept had two important aspects;

  1. Tone control and movement stimulation. The tone control is the modification.

  2. An continue search for a possibility to integrate this movements in the A.D.L. so that the movements were daily used.



The group that in the first treatment-period, react with tone increase and less movements and more dependency, was changeable in the second period in positive result.

This approach to get an tone under control was effective and that by an group that has an tone increase during 6 months. Still an clear(clinic relevance) decrease in 6 months was possible to an lower level and better scores A.D.L. and transfers.

There is no static analyze done by this investigation but the increase in possibilities of the participants was an “prove” that tone control is an essential part of an treatment of people with an neurological disorder and should be an base element.


We have neglected the importance of tone control by people with neurological disorders and that will be the bill that people will pay when the disorder is out of the sub-acute period.

Then will no tone control create mobility loss and an adaptation on an lower level because movement with an high tone asked much more aerobe and anaerobe power.

This is not only the case by movements that involves the whole body and will create a lower walking possibilities and balance but also for movements in the limbs as the mobility of the ankle or that of the hand. High tone will make movements there almost zero and will create mobility loss but also will this let disappear what the arm or leg could after the neurological disorder.High tone will destroy the selectivity that was there!

 Authorship Credit: “Criteria authorship scientific article” has been used “Equal Contribution” (EC)

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How to Cite
RAKT, Jan van de; MCCARTHY-GRUNWALD, Steve. Tone- Increase is an Answer after a Brain Damage: But How High Is Good?. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
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