Muscle Tone

The term muscle tone refers to how tense a muscle is at rest. This tension is set to a certain degree for every person. Abnormal tone is that which is either lower or higher than normal. Muscle tone is controlled by the brain which adjusts the tone according to what is happening.  Tone is sometimes changed when there is brain damage, but not all muscle tone is caused by brain disorders or damage. Some genetic disorders have low or high tone associated with them. Tone can be high, low, or mixed.

What is “high tone” (hypertonia)?

One way to think about high tone would be to imagine you just found out you won a big lottery prize, and you are jumping around excited. The adrenaline and alertness that you feel would be similar to how a child with high tone feels in his or her muscles. The muscles are very easily excited and cannot calm back down easily. High tone has a lot of variety and can be mixed. Many times you will hear terms like “extensor thrust,” which is associated with high tone much of the time. This means that the child extends or straightens his or her extensor muscles. This means the child may straighten legs, arch back, and straighten arms all when he or she tries to move. Sometimes this is fairly severe, and sometimes it may only involve one arm or leg. Some brain disorders are associated with high tone, such as cerebral palsy.

Some characteristics:

1.) Your child may have difficulty chewing or swallowing and may gag easily.

2.) Your child may be difficult to carry and seem to stiffen and hold arms and legs stiff when you try to carry him or her.

3.) You may notice that your child arches his or her back a lot when trying to move on the floor.

4.) Your child may thrust his or her tongue a lot.

5.) You may have difficulty opening your child’s legs during diapering or dressing.

6.) You may notice that your child moves differently from other children and particularly with trying to roll or crawl.

7.) Many times high tone kids have difficulty gaining weight because their muscles burn so many calories and they may have feeding difficulties as well.

Other considerations are the effects of high tone on muscle length. In other words, your child’s muscles may shorten and cause problems with every day tasks such as diaper changes. Sometimes bracing is used with a good stretching program, while other times medicines or even surgery may be required. This is a partial list– remember that muscles control all of our movements and high tone can be lead to symptoms in any of these areas.

What do we do to treat this and can it go away?

Tone is what you are born with and it will not change.  Tone can be influenced by our touch and handling techniques as well as positioning and many other manual techniques that your therapist can show you. There are many medical treatments and some possible surgeries and medicines that may become part of your doctor’s treatment plan in the next several years. Right now, focus on what your doctor and therapist teach you. You may be surprised how much your child can learn and develop from these seemingly simple things.

Things to remember…

— Being high tone does not mean your child will have all of the symptoms or problems here. Your child can have only a few mild symptoms or have mixed problems with high tone as a part of the whole picture.

—Children with high tone tend to get very frustrated trying to move or communicate.

—It takes time to retrain your child in how to move. Be patient and celebrate each new skill. Your therapist will help point out small accomplishments. Together these small improvements will add up to bigger skills.

—Don’t forget that movement almost always increases skills with speech and feeding as well.  Increased arm strength leads to increased self feeding skills and play skills. So if movement is delayed, it is more likely that all of these areas will be behind as well.

Always remember that movement that looks different is not always considered wrong, and your therapist may chose to work on ways to use what your child is good at doing to  accomplish a bigger task. Never be afraid to ask questions and learn. You and your therapist are a team.  Remember you are the one who spends the most time with your child. It is very important that you feel comfortable and secure with the strategies you use so that you can help your child every time you interact.

What is “low tone” (hypotonia)?

One simple way to think about low tone is to imagine that you are about to fall asleep but you need to get up to turn off the lights. You are very tired and having difficulty motivating yourself to do this and you want to go on to sleep. This would be like having low tone. Your muscles are overly relaxed and movement seems like a great deal of effort. Many kids with low tone are like this. They feel “floppy” and seem to tire easily.  There are some genetic syndromes, like Down Syndrome, that are associated with low tone. There is a wide range of low tone and only your therapist can tell you exactly where your child is on this range.

Some characteristics:

1.) Always a “good” baby–very content in one spot and doesn’t try to move away.

2.) Your child may sit with a rounded back.

3.) Your child may sit in a “W” sit pattern

4.) Your child may lock his or her legs and seem frozen in sitting, not being able to move well from here. You may even think your child has high tone in his or her legs due to how stiff he/she holds them straight.

5.) Your child may hold his or her mouth open a lot and drool more than other kids their age.

6.) Tummy time may be his or her least favorite position.

7.) Your child may or may not need more sleep or seem to tire quicker than other children the same age.

8.) Your child may have difficulty eating (sucking, chewing, swallowing) and may have a lot of problems with their digestive system (reflux, constipation, etc).

9.) Your child may have difficulty being carried and not lock his or her legs/arms around you and actually dangle either his or her arms and/or legs (floppy baby).

10.) Your child may have little to no facial  expressions and rarely smile.

Many times, your child will have very loose joints that may required some additional therapeutic techniques as well as bracing. This is a partial list. Remember that muscles control all of our movements and low tone can be lead to symptoms in any of these areas.

What do we do to treat this and can it go away?

Tone is what you are born with and it will not change. Tone can be influenced by our touching and handling techniques as well as positioning and many other manual techniques that your therapist can show you. Strengthening can be done to increase your child’s function and overcome many of the problems and delays that the low tone has produced.  Right now, focus on what your doctor and therapist teach you.  You may be surprised how much your child can learn and develop from these seemingly simple things.

Things to remember…

— Being low tone does not mean your child will have all of the symptoms or problems here. Your child can have only a few mild symptoms or have mixed problems with low tone as a part of the whole picture.

—Children with low tone tend to tire more easily and require more rest. They sometimes need more motivation to move and sometimes they are very motivated and become frustrated that they cannot.

—It takes more repetitions to gain strength when a child is low tone. Be patient and celebrate each new skill. Your therapist will help point out small accomplishments. Together these small improvements will add up to bigger skills.

—Don’t forget that movement almost always increases skills with speech and feeding as well as arm strength leads to increased self feeding skills and play skills. So if movement is delayed, it is more likely that all of these areas will be behind as well.

–As your child gets older, he or she may need warm-up activities to stimulate muscles for better response before an activity. This may as simple as some bouncing activities before sitting to promote better posture. Your therapist will teach you what is appropriate at each age.

What is “mixed tone”?

Some children have a mixture of the types of tone above. Most often, it is high in the arms and legs and low in the trunk.

For information on a books that are available to help with gross motor development, click HERE

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