Arm Optimize™ Program
Learn the basics
Understanding your child's arm
Plain-language explanations of muscle tone, movement patterns, hand grasp development, what the arm actually does all day, and why posture comes first.
Tone & synergy
Tone and synergy explain most of what you see when your child tries to use the affected arm. Once you can name the pattern, you can start working around it.
What is tone & synergy?
Muscle tone is the resting tension in a muscle — how much pull it has before your child does anything at all. It is not the same as strength. A child can have very high tone and still be weak, because tight muscles cannot move through their full range or switch off when they should.
Synergy means muscles firing together as one fixed package instead of individually. Instead of choosing "open my hand," the whole arm moves in one stereotyped pattern: the shoulder pulls in, the elbow bends, the forearm turns down, the wrist and fingers curl. The pieces come as a set.
How does it affect your child's ability to use their arm?
Reaching, grasping, and releasing all depend on moving one joint while holding another still. When tone is high and movement comes only in synergy packages, your child loses that independence: reaching forward drags the whole trunk along, opening the hand also straightens the elbow, and holding an object requires so much effort that the rest of the body stiffens. Function suffers long before range of motion does.
The words you will hear
- Spasticity
Tone that increases the faster you move the limb. It feels like a catch or a spring that resists quick movement and then gives way.
Fast reaching and quick release are hardest. Slow, steady, supported movement gets more range.
- Dystonia
Tone that fluctuates and pulls the limb into twisting postures, often worse with effort, excitement, or being watched.
Performance changes hour to hour. Calm setups, midline positions, and weight through the arm reduce the pull.
- Hypotonia
Low resting tension. The limb feels floppy or heavy and joints feel loose.
The child has to fix and brace elsewhere to hold still. Strength, endurance, and compression work matter most.
- Flexor pattern
The bending package: shoulder in, elbow bent, forearm turned down, wrist and fingers curled, thumb tucked in the palm.
Blocks palm-up grasp, hand opening, and any reach above shoulder height.
- Extensor pattern
The straightening package: shoulder out, elbow locked straight, fingers stiffly extended and spread.
Blocks graded grasp — the hand cannot close and hold with control.
- Lack of isolated movement
Not being able to move one joint on its own, without the rest of the arm joining in.
This is the real functional problem, and it is what the daily practice targets first.
What the patterns look like in real life
Flexor synergy — where you see it
- Sitting and reaching forward, or any transition between positions
- Excitement, crying, concentration, or being rushed
- Carrying something heavy in the other hand
- The arm tucks in at the side and the thumb disappears into the palm
Extensor synergy — where you see it
- Standing, walking, and balance reactions
- Being lifted, tipped backwards, or startled
- Pushing against a surface with a locked elbow
- Fingers stiff and spread so nothing can be held
Why it matters for practice
- Break the pattern before you ask for skill: position, align, then move
- Weight through the arm and slow loading calm tone more than stretching does
- Practice the opposite of the dominant pattern — palm up, thumb out, elbow long
- Stop and reset when the pattern takes over; repetitions inside the pattern reinforce it
Clinical synergy & tone diagrams
Use these full-body references with your therapist. Tap or click a diagram to open it full size and zoom in.