Hello ICU PT,
Thanks for the discussion question. I believe the answer may lay in the way the stretch is applied. A stretch reflex will occur if the muscle spindle detects a quick movement into elongation or if the spindle is approaching
an excessive stretch for its length. Should stretching be carried out slowly and not to excessive lengthening of the spindle then a strong reflex would not occur, reducing tone side effects.
Also, if the antagonist muscle is stretched first to elicit a stretch reflex in it then the accompanying inhibitory effect supplied to the muscle spindle that you really want to stretch will be reduced.
There are other physio techniques that can also reduce tone in muscles. A careful application of tone reduction techniques along with ongoing assessment of the patients tone during treatment can achieve
the desired result.

Unfortunately a lot of treatments are not black and white in the balance between wanted and unwanted effects. If the overall improvement in a patients outcome (increased function, active voluntary movements, decreased
retraining of neuro-muscular patterning etc) is possible, short term and controlled increases in tone should not be problematic.

Tonal balance is important between the flaccid muscle and the normally toned muscle, with upper limb flexion postures and lower limb extension postures.
To summarise; the difference between central and spinal tonal changes as they affect function need to be kept clear. Sometimes treating one area will impact negatively upon the other area in neurological rehab, but compromise
will be necessary. As a patient progresses the balance / emphasis of treatment will change. Acute, semi acute and longer term rehabilitation present different challenges often dependent upon the severity of the original damage, patient age and other factors (psychological, general health). My thoughts are that in the acute phase it is important to preserve the movement patterns then deal with the rest as assessment indicates.

I look forward to hearing from others working in this field.
MrPhysio+