The fifth blog in this series is on hypertonia, which is a common condition found in children. This is in hopes of empowering YOU, the parents and caregivers. My mission in starting develoPT was to bring access to high-quality healthcare and education for ALL children and families. I want to bring more attention to these conditions and possibly help some of you prevent issues with your little one down the road.
If you missed the previous guides on torticollis, plagiocephaly, craniosynostosis, and hypotonia, you can find them HERE. Now, on to hypertonia!
Hypertonia is increased muscle tone. Increased muscle tone makes the arms and legs difficult to move. To completely understand hypertonia, let’s go over muscle tone in general. Muscle tone is the typical tension and stiffness present in your muscles, even when relaxed. This helps provide resistance to passive movement. People rely on muscle tone for posture and maintaining their position when sitting or standing. Muscle tone is controlled by signals from the brain to the nerves in the muscles. Severe hypertonia can lead to joint contractures, which is when a joint loses motion and function (freezes up).
With hypertonia, you also have to take spasticity and rigidity into consideration. These words are sometimes used to describe hypertonia in general, but they are very different. Spasticity is a type of hypertonia in which speed of movement affects the amount of stiffness in a muscle. Rigidity is also a type of hypertonia in which the muscles have the same stiffness throughout the motion, regardless of speed of movement.
Let’s use a rubber band for example to make understanding muscle tone a little bit easier. For example, the muscles in our bodies are like rubber bands; everyone’s bands are at different tensions, but there is an ‘optimal’ tension. The majority of us are pulled to around the ‘optimal’ tension, but each person varies upon a spectrum.
Children with HYPERtonia have more tension in their muscles, which leads to stiffness and difficulty moving. They have to use more energy to overcome the increased tone and work harder to perform voluntary movements. Because of effort required, development of motor, feeding, and speech skills can be delayed and very difficult for a child.
-Lack of flexibility
-Loss of function
-Difficulty reaching or lifting
-Uncontrolled scissoring (crossing) of legs
-Issues with posture and mobility
-Difficulty transitioning between positions
-Delayed developmental milestones
Hypertonia occurs when parts of the brain or spinal cord are damaged, and these signals are interrupted. The primary cause of hypertonia is injury to the brain or spinal cord before, during, or after birth. Common neurological conditions can cause this damage, including cerebral palsy, multiple sclerosis, and Parkinson’s disease. HYPERtonia occurs on a spectrum, just like HYPOtonia. Hypertonia is sometimes detected in infancy or shortly thereafter, but often takes months or years to notice issues.
Since hypertonia can be caused by different conditions, finding the root cause is very important. Discovering the type of hypertonia (spastic or rigid/dystonic) is also vital to the process. These findings can affect treatment pathways and outcomes.
Treatment often depends on the child’s age and health. Some of the interventions include muscle relaxants (medication), Botulism toxin (Botox) injections, physical therapy (postural management, stretching, strengthening, etc.), occupational therapy, and massage. Pediatric physical therapy helps your child increase flexibility, develop strength, improve balance, and build coordination. Pediatric PTs will also give you recommendations on how to help your child succeed and embrace their unique potential. PT for kiddos with hypertonia is extremely vital, because it will teach them functional skills and make their quality of life better.
So, the million dollar question....can you change muscle tone? I am going to answer this as no, but hear me out. Hypertonia itself typically does not change because it is a characteristic of a person’s nervous system. That being said, increased muscle tone can be overcome with targeted interventions to maintain motion and function. So in some ways, it will look like hypertonia improved, but in reality, you are improving ways to compensate for the high tone. It is a confusing relationship! Either way, a child with hypertonia CAN improve his/her skills with the right assistance, and that’s really all that matters!
-ALWAYS, always listen to your instincts! Most of the time, parents and caregivers are the first to notice an issue
-Seek out a medical and therapy consultation as soon as you have a concern
-Lots and lots of play!! (P.S. This is my recommendation for ALL children!)
-Pediatric occupational therapy
-Pediatric physical therapy
Knowledge empowers YOU to help your baby embrace their fullest potential! If you would like a helping hand to guide you along the way, and get a customized evaluation for your sweet babe, please reach out to me on my website, www.develoPTpeds.com.
In the meantime, I have put together a visual that summarizes the most important aspects of hypertonia and treatment. It is awesome to quickly refer to, even with a crying baby ;) You can access it HERE!