You should now have an understanding of how muscle works and how changes after stroke can affect muscle tone including the possible development of spasticity. You should know when to refer to specialist spasticity services for intervention.
Each member of the multidisciplinary or care team looking after a stroke patient will influence tone by their actions. This influence can be helpful or not and may affect long term recovery. Early active interventions such as positioning, stretching, functional techniques, use of appropriate equipment and medications can make a significant difference to the patient’s outcome. You should be aware of the signs which indicate a change or exacerbation of tone problems and the potential trigger factors which could cause them. Undesirable actions or poor communication could cause adverse outcomes for tone and the patient’s recovery.
It is also important to manage tone effectively for health economic reasons. NHS inpatient costs can range from £2900 to £3653 for a short episode of treatment. Specialist neurorehab services can cost £656 per day. These costs also apply to community services for example a visit from a reablement team has an average cost per service user of £2131 and adult day care for physical support costs £87 per person per visit (all 2016 data from PSSRU Personal Social Services Research Unit).
Successful stroke management, including tone management, requires every person who is in contact with the patient and their carers to do the right thing at the right time from day one. Every patient contact has the potential to have a positive or negative effect on the management of muscle tone.
Key aspects of good practise when treating abnormal tone following stroke are:
- Careful observation
- Early interventions
- Recognise and treat factors which exacerbate tone issues such as pain or infection
- Regular review by all the multidisciplinary team
- Communication within your multidisciplinary team
- Working with your patient and their carers to encourage self-management of tone
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Page last reviewed: 06 May 2020
