High neurological tone (hypertonicity) is one of the most complex and frustrating consequences of spinal cord injury and other neurological conditions—for both the individual experiencing it and the clinician attempting to optimize movement and function. Persistent hypertonicity can obscure true motor capacity, interfere with exercise performance, limit functional carryover, and complicate clinical decision-making. Yet many rehabilitation professionals are left with few practical strategies beyond temporarily suppressing tone before therapeutic intervention.

This course explores a different approach. Rather than viewing hypertonicity solely as a symptom to be reduced, participants will examine the relationship between neurological trauma, autonomic nervous system regulation, movement, and tissue adaptation to better understand the factors that influence the presentation of high tone. Through the lens of Polyvagal Theory and contemporary neuro rehabilitation principles, participants will develop a clinical framework for recognizing when the nervous system may be primed for protection versus readiness for movement.

The course introduces practical, evidence-informed strategies that integrate autonomic nervous system regulation, interoceptive and proprioceptive inputs, fascial training principles, and graded movement progressions to improve movement quality and therapeutic engagement. Participants will learn how to analyze regional tone patterns, select appropriate regulatory interventions, and sequence exercises in a manner that minimizes unnecessary spastic responses while promoting efficient movement and tissue adaptability.

Throughout the course, participants will experience many of these strategies firsthand while gaining practical tools that can be immediately integrated into exercise programming and rehabilitation sessions for individuals with spinal cord injury and other neurological conditions. Concepts are not only discussed but explored experientially, with live demonstration clients allowing participants to observe assessment, decision-making, and intervention strategies unfold in real time—offering a unique opportunity to see the clinical reasoning process in action as it translates into movement changes on the spot.

• Physical Therapists and Physical Therapy Assistants

• Occupational Therapists

• Exercise Physiologists

• Activity-Based Therapy professionals

• Pilates teachers

• Yoga teachers

• Strength and Conditioning Specialists

• Caretakers/partners of SCI

Working in practice settings:

• Out-patient rehab

• In-patient rehab

• Acute care

• Activity-based therapy

• Home therapy services

This course content is not intended for use by any participants outside the scope of their license or regulation.

Instruction Level: Intermediate

This course assumes 1-2 years of experience in working with spinal cord injury clients/patients. If you are new to this demographic, please complete the online Groundwork workshop to familiarize yourself with SCI before attending this course.

At the conclusion of this program, the learner will be able to:

• Analyze patterns of hypertonicity to differentiate neural and mechanical contributors to the presentation of high tone and spasticity.

• Apply principles of the Polyvagal Theory to support clinical reasoning when selecting autonomic nervous system regulation strategies to optimize readiness for movement and therapeutic intervention.

• Analyze movement to identify regional patterns of hypertonicity and their influence on movement quality and function.

• Select appropriate movement, interoceptive, proprioceptive, and environmental inputs to promote autonomic regulation before and during therapeutic exercise, enhancing participation and responsiveness to intervention.

• Apply fascial training principles and loading parameters to promote tissue adaptability, mobility, and elasticity in individuals with neurological injury.

• Introduce new positions and exercises using graded progressions that minimize the likelihood of spasm provocation during therapeutic intervention.

Online module (3 hours, online asynchronous hosted on Teachable) introduces neural and mechanical mechanisms for tone and spasticity after neurological injury and inactivity; PolyVagal Theory; nervous system state analysis.

A Knowledge Check/Quiz confirms completion & and understanding before participation in the in-person labs.

Live, in-person (7 hours)

• 25 page printed guidebook with diagrams, photos and prompts for clinical reasoning and reflection.

• Powerpoint visuals with client case examples.

• Demonstrations on participants and client models.

• Learning through movement experiences.

• Partner labs.

• Hands-on practical application labs with real neuro clients (2 hours).

• Case discussion and presentation of observations & interventions from participants.

This course is highly interactive - and ACTIVE - experience.

Real understanding, competence and confidence comes from full in-person immersion. Come ready for a lot of movement, partner labs, and hands-on practice.

SMALL LABS w/ REAL NEURO CLIENTS:

1 hour observation lab + 2 hours of hands on lab practice with real demo clients provides opportunity for real-time troubleshooting, observation of the quick outcomes from optimal cueing and builds confidence for execution after the course.

HIGH TOUCH GUIDANCE:

Due to the extensive hands-on learning components of this course, we maintain a strict student-to-faculty ratio of 16:1 to provide a high-touch learning experience and comply with many state APTA standards. A Course/Lab Assistant is added to the course for 16+ participants.

DIVERSE LEARNING STYLES:

I strive to deliver the curriculum for a variety of learning styles:

• Kinesthetic (feeling)

• Auditory (discussion)

• Visual (PowerPoint & client demonstrations)

• Experiential (hands on practice)

• Theory/Intellectual (printed Guidebook)

THE PRINTED GUIDEBOOK:

A 25-page printed and bound Guidebook hosts the concepts, theory, and exercises with plenty of space for clinical reasoning notes, application to YOUR clients and reflection prompts to establish deeper integration of the material.

CONTINUED SUPPORT & COMMUNITY:

All course participants are invited to stay connected through the Professional Community social network - a place to ask questions and share client case success.

Participants can also join Office House events, scheduled quarterly, to discuss client cases and gain insights from other professionals in the ZN Network. View the reply of one of our events here.

…how Learning Outcomes are measured and course completion is evaluated.

Earning all CEU’s/Contact Hours require the following:

ONLINE LEARNING MODULE:

The 3-hour online module (asynchronous) must be completed prior to the in-person course.

An eleven question Knowledge Check quiz must be completed with a 100% passing score before participation of the in-person learning.

LIVE ATTENDANCE:

Course participants must be present for all in-person presentation & lab (full day, 7 hours). There is no partial credit available for this course.

COURSE COMPLETION:

Full participation in the Hands On Lab is required. Lab groups will present case findings, interventions and clinical reasoning for programming to the entire group as the final “Course Completion” check.

CERTIFICATE OF COMPLETION:

Upon completion of group presentations, participants certificates are signed by the course presenter. The certificate in the back of the Course Guidebook is not valid unless signed by the presenter in their signature color.

COURSE & PRESENTER EVALUATION:

All participants are asked to provide evaluation and feedback using the form (see included in syllabus). Evaluations are reviewed by the presenter and Course Lab Assistant (CLA) for future curriculum development. Participants can also request additional resources to support their learning in this form.