Hi, If the orthopedist doesn't think that there is calcification or heterotopic ossification in there, have you thought about the possibility of serial casting? I've found that its possible to significantly reduce tone/increase ROM at the elbow with this technique. The outcomes are better if there is underlying active motor control that you can build on during functional activities once you gain the ROM. I also find that significant hypertonus in the arm is often a distal manifestation of tone and control deficits in the trunk. If you can reduce the tone in the trunk and increase the patient's ability to stabilize the trunk during movement, there is less "fixing" in the arm in the form of increased tone. Ann
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