Managing spasticity and restoring functional mobility remain two of the most persistent challenges in neurorehabilitation, particularly for patients in the chronic phase of stroke recovery. While standard physical therapy protocols are essential, clinicians are increasingly looking toward adjunctive modalities to break through recovery plateaus. A recent Randomized Controlled Trial (RCT), published in Physiotherapy Research International (April 2026), investigates the efficacy of High Tone Power Therapy (HTT) combined with conventional rehabilitation for middle-aged male patients with chronic stroke.
Addressing the Chronic Plateau
Spasticity often hinders gait re-education, creating a cycle of immobility and compensatory movement patterns. The study by Mahmoud et al. aimed to determine if HTT—a specialized form of electrotherapy designed to affect cellular metabolism and muscle tone—could offer superior outcomes compared to physical therapy alone. The researchers recruited 34 male patients, all non-obese and at least six months post-stroke, ensuring a homogenous group for analysis.
Participants were randomly assigned to two groups:
- Intervention Group (G1): Received 30 minutes of High Tone Power Therapy followed by 30 minutes of a selected physical therapy program.
- Control Group (G2): Received 60 minutes of the selected physical therapy program only.
Both groups attended sessions three days per week for three months.
Significant Improvements in Tone and Speed
The outcomes assessed included clinical spasticity measures using the Modified Ashworth Scale (MAS), neurophysiological assessments via the H/M ratio, and functional mobility using the 10-meter walk test (10MWT) for both self-selected and fastest walking speeds.
The results highlighted a statistically significant advantage for the combined approach. The intervention group demonstrated marked improvements across all parameters (p < 0.05). specifically, improvements in spasticity were clinically substantial (mas: p="0.017)" and neurophysiologically validated (h/m ratio: p="0.0001)." this suggests that htt may influence neural excitability levels that manual therapy alone might not reach in the chronic stage.
Furthermore, gait mechanics showed drastic improvement. The HTT group achieved significant gains in both self-selected comfortable walking speed (p = 0.0001) and fastest walking speed (p = 0.0001). In contrast, the control group, receiving only conventional physical therapy, showed no statistically significant improvements in spasticity or gait speed within the group over the three-month period.
Clinical Implications and Future Research
For the clinician, these findings suggest that integrating High Tone Power Therapy into standard care could be a catalyst for motor recovery in patients who have otherwise plateaued. The reduction in H/M ratio indicates a normalization of spinal reflex excitability, which likely contributed to the improved voluntary control required for faster walking speeds.
However, the authors note important limitations. The absence of a sham control group and the structural differences in the therapeutic programs prevent definitive isolation of the HTT effect. Future studies utilizing dose-matched and sham-controlled designs are necessary to solidify these findings. Nevertheless, for patients struggling with chronic lower limb spasticity, HTT represents a promising, evidence-based adjunct to manual physiotherapy.
References
Mahmoud, J. M., Fayez, E. S., Ahmed, S., Gelany, F. M., Hassan, I. M., & El-Zanaty, M. Y. (2026). Impact of High Tone Power Therapy on Lower Limb Spasticity and Gait Speed in Patients at Least Six Months Post-Stroke: A Randomized Controlled Trial. Physiotherapy Research International.
https://pubmed.ncbi.nlm.nih.gov/41721793/
