Date Presented 04/21/2023

There is limited evidence to support interventions for hypertonicity, leading therapists to utilize a multifactorial approach. This study examines the effects of clinical perceptions, reasoning, and expertise on decision making for this population.

Primary Author and Speaker: Yvonne Monti

Additional Authors and Speakers: Maddison Wrigley, Janessa Chichelli, Chloe Dow, Emily Stewart

There is a lack of supporting evidence on specific OT interventions to successfully manage upper extremity hypertonicity leading therapists to rely on other factors to make decisions. Therapists often rely on experience, expertise, and diagnosis specific reasoning to make clinical decisions regarding management of hypertonicity. The aim of this systematic review was to determine the effect that occupational therapists’ perceptions, clinical reasoning, and expertise have on decision making regarding interventions for hypertonicity.

METHODS: Search terms were developed and an exhaustive search of databases was completed. Inclusion/exclusion criteria was applied to180 articles. Seven articles were included in the study. Data was gathered, coded, and analyzed by multiple researchers.

RESULTS: Expertise in treatment of hypertonicity was not influenced by work setting, years of experience, or caseload. Expertise, measured by years of experience, did not positively influence decision making regarding hypertonicity; however, the level of therapists’ experience was influenced positively by the number of professional development activities completed. Therapists utilize a limited number of factors when decision-making, despite multiple factors to be considered. The most important factor influencing clinical reasoning by therapists was severity of spasticity. The more severe the spasticity, the more likely the therapist was to recommend more invasive treatment. Therapists perceived hypertonicity to be complex and individual. Transfer of knowledge from prior interventions to future practice was perceived to be crucial in making decisions.

CONCLUSION: Years of experience is not a reliable criteria when identifying expertise in this specialty area. Although therapists perceive the diagnosis to be complex, they consider few factors when making clinical decisions. Expanding knowledge through continuing education may improve clinical reasoning and decision making.


Colclough, S., Copley, J., Turpin, M., Justins, E., De Monte, R. (2015). Occupational therapists’ perceptions of requirements for competent upper limb hypertonicity practice. Disability and Rehabilitation, 37(16), 1416–1423.

Rassafiani, M. (2009) Is the length of experience an appropriate criterion to identify level of expertise? Scandinavian Journal of Occupational Therapy, 16, 247–256.

Rassafiani, M., Ziviani, J., Rodger, S., Dalgleish, L. (2008). Occupational therapists’ decision-making in the management of clients with upper limb hypertonicity. Scandinavian Journal of Occupational Therapy, 15, 105–115.