High neurological tone (hypertonicity) and spasticity are common consequences of spinal cord injury and other neurological conditions and can significantly influence movement quality, exercise performance, and functional mobility.

Changes in the ability to perceive and respond to the environment following damage to sensory pathways can have a significant impact on how individuals move. In addition, changes in muscle and connective tissue elasticity associated with sudden or gradual changes in activity, including periods of disuse, can influence muscle tone and function. For rehabilitation professionals, understanding these changes and selecting appropriate sensory inputs and exercise strategies are important components of a comprehensive approach to tone management.

This course examines the relationship between sensory inputs, environmental factors, nervous system regulation, and states of readiness that may influence muscle tone and functional performance. 

The course introduces general principles of vagus nerve support and nervous system regulation to create conditions that support readiness for therapeutic intervention. Participants will also explore the impact of appropriate sensory inputs to improve muscle tone and motor output.

Exercise selection includes floor-based exercises and positioning strategies that may reduce the likelihood of triggering synergistic spasms, graded exercise progressions to support tolerance of positions or movements that may trigger spasticity, and specific exercise training parameters that support muscle and connective tissue elasticity.

Throughout the course, participants will experience these strategies firsthand and then apply them directly with demonstration clients with SCI and other neurological conditions. This practical application provides an opportunity to observe movement, make programming decisions, and apply exercise and movement strategies while seeing the clinical reasoning process unfold in real time.

• 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:

• Identify common changes in muscle and connective tissue elasticity associated with spinal cord injury and disuse, and consider how these changes may influence mobility, movement efficiency, and fluidity.

• Analyze movement patterns to identify areas of increased tension, restricted mobility, altered coordination, and changes in muscle tone.

• Select targeted sensory, proprioceptive, and environmental inputs to support movement efficiency, fluidity, and readiness for therapeutic exercise in individuals experiencing high tone or spasticity.

• Select exercise parameters, loading strategies, and movement progressions that support tissue mobility and elasticity in individuals with spinal cord injury and other neurological conditions.

• Apply graded exercise progressions and modifications when introducing new positions or movements that may increase spasticity or muscle tone, supporting participation and performance during therapeutic exercise.

• Apply trauma-informed principles to exercise and therapeutic intervention for individuals with spinal cord injury and neurological conditions experiencing high tone or spasticity.

Online Course Module (3 hours): asynchronous study of recorded lectures reviewing relevant background information & research to support presented interventions. View sample of Online Course Portal here.

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

Live, in-person (7 hours)

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

• In-person Lecture/didactic with powerpoint including videos of case examples.

• Clinician first-hand experiences & partner lab (kinesthetic learning).

• Demonstrations on participants and client models.

• Hands-on practical application/lab in small groups (4:1) with client models.

• Case discussion and presentation of lab findings 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.