Low muscle tone, also called Hypotonia, is a term used to describe the resting length of a muscle before it is activated for purposeful movement. If a muscle’s resting length is greater than average, a child may present with hyperextenion of the joints. In addition, hypotonia refers to the speed of a muscle contraction, difficulty in maintaining a static pose and difficulty in completing dynamic movements. This is not to mean that a child has no muscle tone, but rather that a lower muscle tone makes it more strenuous to complete age-appropriate tasks.
Hypotonia is often identified at birth or during infancy. You may see low tone as a child ages as well. A common indicator of hypotonia is delayed motor skills. It can be associated with certain medical diagnoses, including Down syndrome or Prader-Willi syndrome, or can be independent diagnoses.
Other common signs of Hypotonia
- Open mouth posture
- Difficulty in initiating a suck or swallow reflex
- Breathing difficulty (could be shallow or labored)
- Slow reaction times to stimuli, including pain, surprise or humor
- Difficulty in flexing arms and legs in infancy
- Delayed motor skills
- Difficulty in maintaining a seated posture
- Inability to lift or carry body weight
- Low foot arches
Hypotonia cannot be cured, however, with consistent physical or occupational therapy, low muscle tone can be managed and treated. A therapist will complete standardized testing and clinical observations to determine how a child is performing certain tasks and what aspects of the task are proving difficult. Therapy will focus on providing multisensory and motor experiences to improve muscle tone, responses to sensory input and body awareness.
NSPT offers physical or occupational therapy services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!
Pediatric physical therapists and physicians often rely on the help of orthotists and prosthetists to help with patients’ mobility needs. Sometimes, children come to physical therapists with gait and postural deviations (toe-walking, in-toeing, scoliosis, etc) and other conditions where exercises and muscle retraining simply are not enough. In those cases, we often ask for the help of an orthotics and prosthetics (O&P) specialist. Braces and artificial limbs are important to facilitate movement and promote independence.
When we refer children to an orthotist, it means we think that some aspect of their movement and growth could be helped out by an external medical device. An orthotist is a critical part of the rehabilitation and therapy process. Orthotics help correct alignment and improve function of childrens’ neuromuscular or musculoskeletal system. Orthotists evaluate what a child’s functional needs are and will design and construct the orthotic devices as needed. An orthotist is a certified healthcare professional who is knowledgeable in human anatomy and physiology, biomechanics, and engineering. As movement specialists, physical therapist rely heavily on the help of orthotists to achieve the mobility goals for our clients.
Some conditions that may require help of an orthotist:
- Hip Dysplagia
- Cerebral Palsy
- Spinal Bifida
- Muscular Atrophy and Muscular Dystrophy
- Spinal cord injury
- Brain injury
- many other post-surgical and rehabilitation needs
Not sure if your child will have orthotic needs? Come see a physical therapist and we can point you to the right medical professional depending on your needs.
Physical Therapy Posts
North Shore Pediatric Therapy recently hosted our first IEP bootcamp, where our school advocate explained how to get the most out of your child’s IEP and school services. Similarly, children can receive physical therapy services at school. Here is a breakdown of how a child would qualify for physical therapy services in a school system and the differences between physical therapy services in a school and physical therapy services in a private setting.
How is Physical Therapy Included in School Services?
Through the Individuals with Disabilities Education Act (IDEA), public education must be accessible to all children aged 3-21 years old[i]. Physical therapy is a related service used to help implement IDEA. School-based physical therapy must be aimed towards allowing the child to access his educational environment. Some of the things a school-based physical therapist might assess include travel from one area of the school to another, getting onto and off of the bus, safely navigating the bathroom and cafeteria, getting into and out of classroom chairs, and participation in all classes. They will assess independence, safety, and timeliness of the above areas in determining need for physical therapy services.
The Role of the IEP:
If parents, teachers, or students determine a need in the student accessing the school environment, an IEP referral is made. This begins the process for school-based services. A physical therapist employed by the school district or contracted through an outside agency will evaluate the child and determine eligibility. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. However, physical therapy services must be provided at no cost to the family when deemed necessary.
Clinic-Based vs. School-Based Physical Therapy:
Clinic-based physical therapy is aimed at improving quality of movement, return to function, and achieving gross motor milestones in an age-appropriate time frame. Many children who would benefit from physical therapy services, but don’t qualify for school-based services due to the restrictions, attend private clinics for physical therapy services. In these settings, a physical therapist determines need based on standardized assessments, functional assessments, strength and range of motion testing, and compares these scores to age-appropriate norms. Some things that may qualify a child for outpatient physical therapy but not school-based physical therapy include gait abnormalities (including toe-walking and in-toeing), developmental coordination disorder, decreased endurance and overall weakness, hypotonia, foot pain, sports injuries, burns, etc. In Illinois, the physical therapist is required to obtain a prescription for physical therapy from the child’s physician prior to treatment. Physical therapy services in an outpatient setting must be covered through insurance or private pay.
Dependent on your child’s needs, physical therapy services may be required in a school setting, in an outpatient setting, or both. If you have any concerns about your child’s gross motor development or access to services in their school district, please contact the professionals at NSPT.
NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!
Autism Spectrum Disorders (ASD) is a diagnosis that describes kids with significant social, communicative, and behavioral challenges. While the diagnosis is mostly associated with difficulty with communication, there are also common physical issues experienced by children with ASD.
Some children with autism are not diagnosed until they are older, though retrospective studies have shown gross motor discrepancies in babies and toddlers who were later diagnosed to be on the spectrum. With so much treatment emphasis placed on their social and language impairments, physical limitations only become more amplified in these children as they age. Children with ASD can have trouble with a number of large postural tasks, such as sitting, walking, running, jumping, and balance. Studies have shown the prevalence of low muscle tone (hypotonia), toe-walking, ankle stiffness, motor apraxia, and increased motor stereotypes in children with autism. Hypotonia is the most common motor symptom, affecting up to 51% of these children.
How can physical therapists help children on the autism spectrum?
- Collaboration: Having a child on the autism spectrum (click here to view our autism infographic) can be challenging for parents. Limited social, behavioral, speech, and motor skills can lead to difficulties both at home and at school. With balance, coordination, and poor motor control at play, it is important for physical therapists to collaborate with other professionals involved in a child’s care. It is also important for physical therapists to contribute to the conversations involving parents and therapists. Physical therapists can address a child’s balance and postural control to encourage improved endurance and attention with school time activities. Knowing a child’s sensory processing needs and behavioral tendencies helps physical therapists make effective goals to make the most gains for a child with ASD associated gross motor delay.
- Education/Resources: Parents may not understand the link between physical performance and behavioral responses. A child with gait changes due to sensory-seeking behaviors or a child with poor balance due to decreased motor control will have a hard time participating in play and social skills. As some children are diagnosed years after gait deviations or musculoskeletal compensations are in place, parents also rely on physical therapists to provide information and resources for their child’s orthopedic or developmental needs. Physical therapists can direct parents to orthotists, equipment, or community sports programs specialized for their child with ASD.
- Therapeutic Play/Socialization: A huge focus of therapeutic exercises for children with ASD is to encourage large quality movements and age-appropriate play. For example, a child who walks on his toes will need exercises to increase ankle mobility and calf flexibility. A child who has a hard time holding his trunk upright during school will need exercises for postural control. Some children may have a hard time coordinating their limbs to participate in age-appropriate skills, such as hopping on one foot or skipping. Physical therapists help these kids gain more confidence in the skills they need in the future to navigate different environments and perform challenging tasks in the community as adults. Pediatric physical therapists often design treatment sessions where movements that hinder social participation are reduced and movements that lead to independence are encouraged.
New research on toddlers and preschoolers with autism found that children with better motor skills are more proficient at socialization and communication than those who have physical deficits. In addition, autism spectrum disorder has a wide range of presentations and physical involvements, with impairments varying from mild to severe. Physical therapists are becoming much more involved in the lives of children with ASD, in order to help these kids improve their day to day functioning from early childhood well into adulthood.
Oregon State University. Autistic children with better motor skills more adept at socializing. Available at: http://oregonstate.edu/ua/ncs/archives/2013/sep/autistic-children-better-motor-skills-more-adept-socializing. Accessed on July 7th, 2014.
Bullen, D. More than just playtime. Advance: Physical Therapy and Rehab Medicine. Vol.24 No.21. Available at http://physical-therapy.advanceweb.com/Features/Articles/More-than-Just-Playtime.aspx. Accessed on July 7th, 2014.
Ming, Xue, Michael Brimacombe, and George C. Wagner. “Prevalence of motor impairment in autism spectrum disorders.” Brain and Development 29.9 (2007): 565-570.