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Article of Interest - Fact Sheet: Hypotonia

By Elizabeth Mueller
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What is hypotonia?
Hypotonia is an abnormally severe loss of muscle tone. The muscles feel soft and doughy.

Diagnosing the cause of hypotonia in a particular child is very difficult. Hypotonia is a symptom of many cerebral, spinal, genetic, or muscular diseases. Some of the diseases associated with hypotonia are Guillain-Barre syndrome, muscular dystrophy, myasthenia gravis, Werdnig-Hoffman disease, poliomyelitis, meningitis, and encephalitis. Injury or trauma can also cause hypotonia. Doctors use certain medical procedures to determine why the child has hypotonia. Computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalogram (EEG), a variety of blood tests, chromosome karyotyping, spinal taps, electromyography (muscle and never conduction tests), and muscle and nerve biopsy are a few of the tests which may be conducted to diagnose the cause of hypotonia.

Signs of hypotonia
Normally developing children tend to develop motor skills, posture control, and movement skills by certain ages.

Motor skills are divided into two parts. Gross motor skills include the ability of an infant to lift its head while lying on the stomach, to roll over from its back to its stomach. Normally, children develop the gross motor skills which enable them to get into a sitting position and remain seated without falling over, balance themselves, crawl, walk, run, and jump by certain ages.

Fine motor skills include the ability to grasp a toy or finger, transfer a toy or a bottle from one hand to another, point out an object, follow a toy or a person with the eyes, or to feed themselves.

Children who have too little muscle tone are unable to move independently. They have a hard time resisting gravity's pull on them. These children are slow to develop the skills to crawl, to sit, to pull on furniture or people to help them to stand, and to walk.

Children with hypotonia are sometimes labeled "floppy" because they have the look and feel of a rag doll. There is no clear definition of the muscles when the arms and legs are felt. They cannot maintain a hand grasp. These children are not able to maintain any position for very long, such as holding their head up or holding out their arm. When they sit, they are often slumped down on themselves and their head may rest on their shoulders because they cannot hold any position for too long.

Since the muscles that support the bone joints are so soft, there is a tendency for hip, jaw, and neck dislocation to occur. In addition, they are slow to develop a sense of balance.

There is a problem when feeding children with hypotonia. The children are unable to suck or chew adequately for long periods. They have a hypotonic gag reflex, their mouth is usually open and their tongue sticks out.

There are breathing and speech problems. Many times children with hypotonia breath very shallowly, making it difficult for them to sustain any activity, make noises, or talk for very long.

Once the cause for the child's hypotonia has been established, treatment programs can be created for the parent to help the child develop further. Treatment programs include the use of positioning techniques to teach the child how to move about horizontally, how to lie on his or her side, to sit, etc. Sensory programs to teach the child to respond to stimuli (sight, sound, taste, smell, touch) are also used. Other individualized programs and therapies can be developed once the initial diagnosis is determined.

Support Organizations
There are a number of support organizations. Here are just a few to consider contacting:

National Rehabilitation Information Center 4407 Eighth Street NE
Catholic University of America
Washington, DC 20017

Muscular Dystrophy Association, Inc.
810 Seventh Avenue
New York, NY 10019

American Coalition of Citizens with Disabilities 1012 14th NW Suite 901
Washington, DC 20036

National Multiple Sclerosis Society
205 East 42nd Street
New York, NY 10017

Checklist of Symptoms
1. Low tone, floppy, "rag doll"
2. Ability to extend a limb beyond its normal limit
3. Risk of dislocating jaw or hip or neck vertebrae
4. Delayed motor development
5. Tone remains the same regardless of body position
6. Muscles are soft and doughy
7. Shallow breathing, possible choking
8. Little sustained speech
9. Underactive gag reflex, open mouth, protruding tongue
10. Tone improves with increasing age, becomes more normal
11. Joint compression through spine and extremities
12. Insecure in most standing or sitting positions
13. Is unable to hold head up or arm out for very long
14. May be unable to suck or chew adequately for long periods

August 1997, The Benign Congenital Hypotonia Site,

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