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Friday, March 3, 2017

Low Muscle Tone—What is it? What Can be Done to Improve It? By Trisha Roberts

Muscle tone refers to the amount of tension resident in a muscle at rest or a muscle’s resistance to stretch.  There is a great range of what is typical muscle tone, but those on the very low end are considered people or babies with low muscle tone or “hypotonia” and those who have more muscle tension have high muscle tone or “spasticity”.  Hypotonia is usually accompanied by low muscle strength as well, but the two are not synonymous terms. Low muscle tone is often referred to as “Floppy Baby Syndrome” in the young child or infant.  There are many genetic syndromes and conditions that are characterized by low muscle tone (Down Syndrome and Pratier-willi, to name a few), but for many children with low muscle tone there is not an identifiable genetic cause, hence “etiology unknown” or of “idiopathic origin”.

Floppy Baby with Low Muscle Tone

A baby with typical muscle tone feels solid when picked up.  As a young infant, they make attempts to hold their head steady when snuggled against your shoulder.  At 6-7 months of age they can grip you with their legs when you hold them on your hip.  Lift the arm or leg of a child with low muscle tone or hypotonia, and it feels like a water balloon.  A child with extremely low muscle tone feels like a half-filled water balloon!

Hypotonia in muscles feels like a water balloon
Muscles with poor tone feel like water balloons

Low Muscle Tone Can Lead to Many Problems

Gross motor skills are frequently delayed in children with low muscle tone; babies have a harder time rolling over, sitting alone, crawling, learning to stand and walk.  There may be poor breastfeeding skills (inability to “latch on” or fatigue after a few sucks), increased drooling, poor head control, poor suck-swallow response, choking on food, hypermobility or laxity of the joints, poor sitting posture, and poor attention span in older children with difficulty sitting at a school desk. Babies with low muscle tone frequently "W-sit", walk with a wide base of support, and pronate their feet (feet roll in).

Pronation of feet often occurs in children with hypotonia
Pronated Foot

Low muscle tone leads to increased joint mobility
Hypermobile Fingers

Children often W-sit when they have low muscle tone or hypotonia

Early Intervention in the form of Physical Therapy or Occupational Therapy is extremely important to address these deficits and delays. Exercise will not precisely change muscle tone, but exercise can improve muscle strength and a child's postural control or the ability to move through space with precision and balance. Therapists work with families, providing activities and exercises to encourage the baby to develop and advance. Your therapist may prescribe a special garment, orthotics, or use kinesiotape with your baby, depending on the type of problems your child is experiencing.

Therapy Ball Work with Baby

Activities that are fast and arrhythmical are stimulating. (Activities that are slow and rhythmical tend to be relaxing).  One of the activities I frequently use in my Pediatric Physical Therapy practice is bouncing on a therapy ball (or physio ball, Yoga Ball, exercise ball).  As joints are compressed, there is a reflexive response from the brain that tells the muscles surrounding the joint to contract.  When bouncing on a therapy ball in sitting, the vertebral bodies (joints in the spine, if you will) are compressed; as a result, the trunk musculature is stimulated to respond, thus providing increased tension in the core muscles and improving trunk stability.  Your baby’s therapist can show you how to safely use the therapy ball to stimulate improved head and trunk control in your child.

 Blog Administrator:  Trisha Roberts

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