Physiotherapy

Low muscle tone seems to be the new buzz word – most people know somebody whose child has been diagnosed with this condition, but what does it mean?

A child with low muscle tone has difficulty contracting, and maintaining the contraction of certain muscles. As a result, the child uses other muscles to compensate, and begins to use incorrect movement strategies. Humans have a huge range of movements available to them to achieve the same outcome, but the low toned child may only be able to use one method due to his weak muscles. As the child grows and movement demands become more complex, this strategy may no longer work, and the child presents with problems from developmental delay, to difficulty in the classroom.

Low muscle tone seems to be on the increase. There is a greater awareness of this condition, and children who would previously have been labeled as ‘clumsy’ or ‘lazy’ are now being more accurately identified. Lifestyles are more pressurised and sedentary due to the advancement of technology, and premature babies who would not have survived in previous generations are now surviving due to advances in medical care.

How does low muscle tone present?

• Flat feet
• Rests weight on the inner borders of the feet
• Rounded shoulders/slouching
• Protruding tummy
• Lack of muscle definition and often has a tendency to be slightly overweight or heavy
• Some children with low muscle tone can also be ‘movers’ – they struggle to sit still, as their tone drops, and they are therefore of very slight build.

Signs related to play and activity

• Delayed milestones e.g. crawling or walking, or choosing alternative ways of moving such as bottom shuffling
• Lying or leaning when doing activities such as puzzles
• Inadequate height when jumping, and runs and jumps heavily
• Avoidance of climbing equipment
• Moves constantly and concentrates for brief periods
• Chooses more sedentary activities

Signs at school

• Poor posture at the desk (holding head in hand, slouching, hooking legs around the chair).
• Difficulty sitting still at the desk or during ring time
• Slow to complete work or rushes due to fatigue
• Poor concentration due to the effort required to sit up
• Poor pencil grip, complains of a sore arm and presses very heavily or too lightly when writing and drawing.

What can be done?

Low muscle tone cannot be prevented, as muscle tone is genetic, and the muscle tone one is born with remains for life.  However, muscle strength can be built up to help the child function well despite his low tone.

Intervention in the form of physiotherapy may be necessary to strengthen the weak muscles so that the child uses the correct movement strategies during all activities, and begins to maintain his strength on his own. Early intervention is key, and it is advisable to commence treatment before the child starts to struggle at school, and learning and concentration, as well as self-esteem are affected. If your child presents with a number of the signs mentioned above, particularly those related to school function, an assessment is recommended. It is important to note that physical extra-mural activities alone may not help to strengthen the weak muscles if the child is compensating.

Not all low toned children need intervention. if your child has low tone, but participates happily in physical activities, keeps up at school, and has no functional problems, then sport and physical activity will be sufficient to maintain his strength.

Here are some helpful tips to manage low tone:

• Encourage your infant to spend time playing on a blanket on the floor so that his muscles can work against gravity. Play gyms are useful, encouraging kicking of the legs while the infant is on his back, which strengthens the abdominal muscles, and tummy time which strengthens the back and shoulder muscles.

• Infants and toddlers should not be placed in walking rings or jolly jumpers, as they do not encourage the child to activate their muscles

• Before doing a desk activity such as homework, your child can do one of the following:

• jump on a trampoline,
• bounce on a ball,
• Star jumps,
• run up and down the passage or in the garden.

This increases muscle tone temporarily, and helps the child to activate their muscles with less effort. If you notice that your child is slouching during the activity, let them have a break and repeat the above activities to increase their tone once more.

• Encourage activities such as swimming, gymnastics, horseriding, ballet and karate, and as much outdoor and active play as possible. This will help to strengthen core muscles in a child who is not compensating during the activity.

• Give your child verbal feedback to help correct their posture so that they become more aware of how they should  sit or stand

Low muscle tone is a condition which is extremely manageable with correct identification and early intervention. This allows the child to reach his full potential, particularly at school, and enables him to participate in a wide range of activities.

• Neurodevelopmental Therapy

• Maes Therapy

• Aquatic Therapy