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Gegenhalten Tone

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Have you seen Gegenhalten tone in your late/end stage Alzheimer’s patients?  It’s actually considered a primitive reflex, no longer inhibited due to bilateral dysfunction of the mesial cortex and frontal lobes (premotor cortex)  Theoretically, we used the reflex in utero as fetuses to push of our mothers’ uterine wall:
•  Paratonia or gegenhalten is defined as “a form of hypertonia with an involuntary variable resistance during passive movement”.
•  Attempting to move the limb of a person with paratonia will result in that person involuntarily resisting the movement.
•  The amount of resistance is determined by the speed of movement: faster, more forceful movements will result in greater amounts of resistance.  It is also present regardless of the direction of the movement.
•  Paratonia develops during a period of dementia and the degree of effect is dependent upon the disease’s progress.


*** Gegenhalten tone has become a buzz word in the therapy world as a way to measure the severity of the disease process.  Its presence alone is indicative of extensive brain damage and end stage disease.

Hobbelen, JS; Koopmans, RT, Verhey, FR, Van Peppen, RP, de Bie, RA (2006). “Paratonia: a Delphi procedure for consensus definition.”. Journal of geriatric physical therapy (2001) 29 (2): 50–6. PMID 16914066.

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