Functional Tone Management Arm Training Program

Updated:Nov 4,2013

Excerpted and adapted from the article, "A Rehab Revolution," Stroke Connection Magazine, September/October 2004. (Last science update March 2013)

Developed by occupational therapists Henry Hoffman and John Farrell, the F.T.M. (Functional Tone Management) Arm Training Program uses an orthotic that helps patients open their hand and grasp and release objects. Even patients who can’t extend their wrists or fingers on their own can still use this orthotic. They do need some shoulder and elbow movement.

Since the F.T.M. Arm Training Program works for survivors with limited movement in their hand and fingers, it can prepare survivors to qualify for constraint-induced therapy.

John Farrell, co-founder of the program, says it uses high-repetition and task-specific exercises to encourage use of the hand and fingers. A 45-minute session can involve as many as 250-400 repetitions using the orthotic to grasp and release objects like rubber balls.

Kim McKenzie was 21 years post-stroke when she started the program. Before she started, she could not open her hand and fingers. After a week of therapy, she regained hand and finger movement. One year after his stroke, John Gooden recovered movement in one hand and fingers after using the orthotic for 45 minutes three times a week, for three weeks.

No clinical studies of F.T.M have been published, but Farrell and Hoffman are currently working with researchers from Emory University and the University of Maryland on the first case study using the orthotic.

“Our motto is ‘no plateau in sight,’” says Farrell. Many survivors come to him after being discharged from therapy. Their therapists or doctors tell them they are not making progress. “Nothing could be further from the truth,” says Farrell. “Survivors can still make significant gains. The truth is, the survivor has not reached a plateau. Instead, it’s the current treatment for the upper extremity that has failed them.”

2006 Update

In our 2004 article we investigated the Functional Tone Management Arm Training Program. The developers now call it Saebo-Flex. This arm-training device is a spring-loaded, purely mechanical system that helps survivors with increased tone keep their hands open. It also helps them gain better control over the muscles that open and close the hand. Since our article in 2004, the FDA has approved it for outpatient use.

The Kessler Medical Rehabilitation Research and Education Corporation and Kessler Institute for Rehabilitation in New Jersey have just completed a study to evaluate use of the Saebo-Flex with patients still in the hospital. “A lot of disability comes from learned non-use,” said Dr. Elie Elovic, director of Kessler’s Saebo-Flex study. “We hope that using this device will improve survivors’ ability to use their affected hand at discharge without negatively affecting their ability to perform their activities of daily living (ADL).

“When survivors can’t open their hands, they can get some tightness and shortening of the muscles and tendons of their fingers. When this happens, long-term function may be lost,” Dr. Elovic said. The Saebo-Flex system, developed by two occupational therapists, prevents this problem by allowing survivors to open and close their hands.

Since our last article, many therapists have been trained in the use of the Saebo-Flex system. According to Janet Snyder, a physical therapist and Saebo-Flex trainer, 20 of the top 25 rehab facilities (according to US News rankings) have at least one staff member trained on the Saebo-Flex.