Following a stroke a person tends to present either with a high tone or low tone presentation. High tone means that even at rest certain muscles are contracting. Tone has a neurological cause and needs to be addressed at a neurological level, rather than just physically stretching the muscles. This can be addressed with neuro physio and may include re-orienting the patient to what mid-line is, improving postural control and sensory stimulation.

The leg bouncing or shaking is what is known as clonus. It is a neurological response to a muscle that is stretched too quickly or over-stretched. This is common with certain muscles that are high tone and suddenly placed on stretch, particularly the ankle and calf muscle. Physiotherapy can help lengthen the muscle gradually and improve conscious control of the muscle to help reduce the clonus response.

A stroke may impact a person’s spatial and perceptual understanding. They may or may not realize that they are favouring one side over the other. A skilled physio is able to use the environment and proper supports to help re-educate and re-orient the brain to what middle and what vertical is. Through this a patient is able to more easily stop favouring one side and work towards improving function and strength of the “neglected” side.