Understanding Paratonia in Dementia: A Physiotherapy Perspective

When caring for a loved one with dementia, you may start to notice changes in the way they move — perhaps increased stiffness, resistance when trying to help them stand, or difficulty in sitting comfortably. One possible reason for this is a condition called paratonia.

What is Paratonia?

Paratonia is a form of increased muscle tone (also called hypertonia) that is commonly seen in people with moderate to advanced dementia. Unlike other forms of muscle stiffness, such as spasticity (from stroke) or rigidity (from Parkinson’s), paratonia is variable and involuntary. You might feel a sudden resistance when trying to move a limb, but this resistance isn’t consistent — it can vary with speed and intention, making movement feel unpredictable.

This resistance is not under the person’s conscious control and is thought to stem from changes in the brain, particularly the frontal lobes, which affect movement coordination and response.

Why Does Paratonia Matter?

Paratonia can make simple daily tasks more difficult:

• Helping someone stand up or sit out can become more effortful.

• Dressing, washing, or repositioning in bed may take longer.

• It may increase the risk of falls, pressure sores, and discomfort.

This is where physiotherapy can play a vital role.

The Role of Physiotherapy

A physiotherapist can help by:

• Assessing the severity of paratonia and how it affects function.

• Developing a movement plan to maintain joint mobility and prevent stiffness.

• Recommending safe sitting positions and supportive chairs to reduce discomfort and effort.

• Teaching carers techniques for safe transfers and mobility, reducing strain on both the person with dementia and the helper.

Encouraging gentle, regular movement — even passive movement (where the limb is moved for them) — can help preserve comfort and reduce complications. Sitting out, if done safely, is often encouraged to maintain posture, engage with the environment, and improve respiratory and digestive function.

Advice for Carers and Family Members

If you're supporting someone with paratonia, here are some helpful tips:

• Be patient and move slowly. Paratonia tends to increase with fast or unexpected movement.

• Use calm, reassuring communication. Sometimes the resistance is worsened by anxiety or confusion.

• Encourage sitting out of bed when possible, using appropriate chairs with good support. A physiotherapist or occupational therapist can advise on this.

• Protect skin and joints. Be mindful of pressure areas and avoid forcing any movement that feels too stiff.

• Look after yourself too. Use proper lifting techniques and ask for professional guidance when needed.

Can Medications Help?

In some cases, antispasmodic medications (like baclofen or tizanidine) may be considered to help reduce muscle tone. However, these are not routinely used for paratonia, and they come with important risks, especially in people with dementia:

• Fatigue

• Drowsiness

• Increased confusion

• Falls

Because of these risks, medication is usually only considered if the paratonia is severely affecting comfort or care, and non-drug strategies haven’t helped. Always speak to your GP or specialist before starting any new medication.

Where to Get More Help

If you're struggling with managing paratonia or movement issues at home, a physiotherapist can provide tailored support. At Physio at Home, we offer professional home-based physiotherapy to help people with dementia stay safe, mobile, and comfortable in their own space.

Final Thoughts

Paratonia is a challenging but manageable part of dementia care. With the right support and knowledge, family members and carers can make a real difference to comfort and quality of life.