Therapeutic intervention for the post-stroke hemiplegic with spastic hypertonia must be individualized to the patient's needs, but generally includes frequent range of motion. Therapeutic exercise, cold, or topical anesthesia may decrease reflex activity for short periods of time in order to facilitate minimal motor function. Casting and splinting techniques are extremely valuable to extend joint range diminished by hypertonicity. Dantrolene sodium is the pharamacologic agent of choice in the United States for the treatment of spastic hypertonia due to stroke. It is the only available drug that acts directly on muscle tissue. Peripheral electrical stimulation may have limited use in diminishing tone and facilitating paretic muscles. Phenol injections provide a valuable transition between short-term and long-term treatments, and offer remediation of hypertonia in selected muscle groups. Tenotomies and tendon transfers offer significant benefit in carefully chosen stroke patients, and the "SPLATT" procedure is one of the most successful rehabilitative surgeries. Achilles Tendon lengthening and release of long toe flexors may complement the SPLATT procedure in the management of the hemiplegic with spastic equinovarus. Key Words: muscle hypertonia, muscle spasticity, brain injury, stroke, neuropharmacology.Spasticity is one of the most important impairments for patients following stroke. Any professional caring for the cerebrovascular hemiplegic is familiar with the common synergic patterns of flexion in the upper extremity and extension in the lower. Before treatment is initiated, however, the physician needs to address several important questions. Is there a functional impairment due to the spastic hypertonia? How is gait disturbed? Does the pain that can be associated with &dquo;spasms&dquo; disturb the patient's sleep? Is the lower extremity extensor tone useful to the patient in supporting him during his gait pattern? A stereotyped therapeutic approach has been proposed (1), but as in many aspects of neurological rehabilitation, treatment is best individualized to a particular patient (2). A daily stretching program is an integral component of any management program for spastic hypertonia. A common bedside observation is that resistance progressively diminishes as one continuously ranges a limb and repeats the motion. Regular ranging of a patient's limbs helps prevent contractures, and can reduce the severity of spastic tone for several hours. The reasons for this &dquo;carry over&dquo; of ranging are not completely clear, but could be related to mechanical changes in the musculotendinous unit, as well as to plastic changes within the central nervous system. These plastic events may correlate with short-and long-term modulation of synaptic efficacy associated with neurotransmitter changes on a cellular level. Habituation of reflex activity has been studied in the marine snail Aplysia californica, which has a simple nervous system. The snail has a reflex for withdrawing its respiratory organ and siphon that is si...