Neurol Disord Stroke Int | Volume 3, Issue 1 | Case Series | Open Access

Innovative Tone Normalization Therapy Improves Persistent Contracture in the Non-functional Hand: A Case Series

Liang L, Saunders-Newton C, Sanossian N

Department of Occupational Therapy, Keck Medical Center of USC, University of Southern California, USA Department of Occupational Therapy and Occupational Science, University of Southern California, USA Department of Neurology, Medical School of University of Southern California, USA

*Correspondance to: Liang L 

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Objective: To describe a novel treatment for improving non-functional hand function in participants with chronic (two to eight years) spasticity that failed conventional inpatient and outpatient rehabilitation. Methods: Three participants with history of chronic hand contracture from neurological disease were recruited from an outpatient rehabilitation setting at a university hospital. Innovative Tone Normalization Therapy (ITNT) was administered at sixty minutes per session, once or twice a week; range from 14 to 31 sessions. The primary outcomes were change in Tardieu Scale - Quality of Muscle Reaction (QMR), shortened Disabilities of Arm, Shoulder and Hand (Quick-DASH), Box and Blocks Test (BBT), Goniometry, Manual Muscle Test, and Observation of hand function [1-3]. Result: All three cases demonstrated significant decrease in spasticity in the targeted hand with corresponding improved function, as measured by increased Active Range of Motion (AROM) and strength, and improved Quick-DASH, BBT and hand function. Conclusion: For participants who failed conventional therapy to reduce spasticity, ITNT, when integrated into a multifaceted approach for reducing spasticity improved recovery of voluntary motor action.


Contracture; Spasticity; Muscle memory; Splinting; Mirror therapy; Qigong


Liang L, Saunders-Newton C, Sanossian N. Innovative Tone Normalization Therapy Improves Persistent Contracture in the Nonfunctional Hand: A Case Series. Neurol Disord Stroke Int. 2021; 3(1): 1023..

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