Hypertonia - Iron Mountain,MI

Updated on June 29, 2010
S.D. asks from Iron Mountain, MI
4 answers

My 2 month old sees an OT for hypertonia but I'm having a hard time understanding hyptertonia, how he developed this, are there other medical issues going on that we haven't found yet, what this means for his future, how serious is it? We had a completely healthy and normal pregnancy and delivery - 5 days overdue, text book 3 hour labor with no meds of any kind, 2 pushes and he was out. He spiked a fever around 24hours after birth and his CRP (something reactive proteins) were elevated. They were suspicous of a neurological issue so he was transferred to a NICU and began 10 days of IV antibiotics and lots of testing. Spinal fluid and blood cultures were tested for 5 days and didn't grow anything. EEG was reported to be normal (athough I don't know if the neurologist reading the test specialized in infants/children at all). The CRP numbers came down quick and after he got over all the anesthetic from the Spinal Tap and PICC line and started eating normal he seemed perfectly fine. The pediatric PT saw him in the NICU and was going to get him thumb splints because his thumbs were turned inside his hands when fisting but they didn't come in for several days and his hands started looking better so that was cancelled too. So we left the NICU thinking he was completely normal until we mentioned to our pediatrician that he was stiff a lot and we have been working with Early On OT ever since.

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A.C.

answers from Cincinnati on

hi~
it is difficult to say how serious the muscle tone is because there are varying degrees of low tone and high tone ("mild, moderate, severe"). If your child has "severe hypertonia" then there are likely to be significant issues in the future. if it is just "mild" hypertonia then your child maybe 100% functional. I would talk to the therapists to see how significant the hypertonia is.

here is a great article that explains abotu muscle tone and muscle strength:

Tone versus Strength
By Diane E Gagnon, M.Ed., PT (Physiotherapist) Biddeford, Maine 04005, USA
Many people don't understand the difference between muscle tone and muscle strength.
True muscle tone is the inherent ability of the muscle to respond to a stretch. For example, if you quickly straighten the flexed elbow of an unsuspecting child with normal tone, the biceps will quickly contract in response (automatic protection against possible injury). When the perceived danger has passed, which the brain figures out really quickly once the stimulus is removed, the muscle then relaxes, and returns to its normal resting state.
The child with high tone or "spasticity" has over-reactive response to the same stimulus. When his arm is stretched, the biceps tightens at an even more rapid rate, and the rate of recovery is much slower, even after the stimulus is removed. Full relaxation is difficult to achieve, so the muscle stays taut for an extended period of time. If another stimulus is added before the muscle has a chance to recover (which happens often during normal movement in the everyday world), the muscle contracts again, becoming tighter. Because this child's muscles never truly rest unless he is asleep, the long term result is tighter, shorter muscles with reduced joint range. This is typically seen in the child with spastic CP.
The child with low tone has muscles that are slow to initiate a muscle contraction, contract very slowly in response to a stimulus, and can not maintain a contraction for as long as his "normal "peers.
Because these low-toned muscles do not fully contract before they again relax (muscle accommodates to the stimulus and so shuts down again), they remain loose and very stretchy, never realising their full potential of maintaining a muscle contraction over time.
These are the "floppy" children who have difficulty maintaining any posture without external support.
A child's unique neurological wiring determines whether he will be low, high, or normal toned. Most people have "Normal Tone". In those who do not, a number of factors are involved. Somewhere deep in the muscle are receptors responsible for detecting changes in muscle length. These receptors then tell the brain there is a stimulus, and the brain tells the muscle to contract in response. There are numerous feedback loops to tell the brain whether the muscle has responded appropriately, needs to contract again, relax or whatever... In addition, there are receptors that tell where each joint is located in relation to all the other body parts that help to determine position in space, etc. A delay in perception, decoding, or transmission anywhere along the neural pathways will result in a change from an optimal response, or "normal" tone.
People often refer to having a "toned" body when they are in "good physical condition" and exercise regularly. Their muscles are taut, and they look lean.
An out of shape person is referred to as having "poor tone", with fleshy muscles and an abundance of "fat". Neurologically these people actually have the same "tone", and the fat person is inherently capable of looking as "toned" as the other (with some allowances made for genetic make-up of course), and just needs to exercise regularly. Fitness experts and health clubs will tell you they are "improving muscle tone", when they are actually reducing the amount of fat to lean body mass ratio. You can improve your fat to lean body mass ratio, and you can become stronger too. These are under your voluntary control.
Muscle tone occurs at an involuntary level. We can effect changes in muscle responses with sensory integration treatment techniques that increase the "alert state of the muscle" by bombarding it with sensory stimuli and improve the brains ability to perceive changes in muscle length, preventing it from accommodating to stimuli.
With ongoing treatment and practice throughout the day, the more "normal" response elicited, the stronger and more efficient even low toned muscles become. "That" is the basis of our classroom program for children with low tone. Sensory bombardment can effect changes in perception that then lead to changes in efficiency along the neural pathways. But it goes way beyond a couple of hours a week in the gym.
© 1999 Diane E. Gagnon, M.Ed., PT Biddeford, Maine 04005, USA
For more helpful information about Hypotonia, visit: [1]
Retrieved from "http://www.holoprosencephaly.net/Tone_vs._Strength"

2 moms found this helpful
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S.B.

answers from Minneapolis on

Has he been tested for Cerebral Palsy yet? I am curious because I don't know that they could have tested him in NICU as he may have been too young to get an accurate result. I know with my daughter, we had to wait until she was a certain weight to be tested. I think at this point I would also ask your pediatrician for a referral to a neurologist . . . better to be safe than sorry. These types of motor issues (hypertonia, hypotonia, etc) can be something or nothing and if it IS something, early intervention (like the OT you are doing) can be so essential.

Good luck!

1 mom found this helpful
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A.C.

answers from Madison on

My daughter wasn't floppy as a child but wasn't very strong. I didn't think anything of it. When she was three I had her evaluated through the school district for speech because she had unitelligible conversation/couldn't talk. When she was four, they had her attend Early Childhood; halfway through the school year, we were asked for our permission to have her tested for possible OT/PT help. It was discovered that she has hypotonia. The summer before she entered Kindergarten, I quit working out of the house and opened my own editing business. We were aware something was different with our daughter from an early age. I managed to get her in to see a childhood psychologist (who is now a psychiatrist and still treats her), who confirmed my newly-awakening fears/insights: our daughter has Sensory Processing Disorder, on the high-functioning end of the Autism Spectrum. Not saying this is what your son has. However, for all intents and purposes, my daughter was born healthy. But from birth on, she suffered multiple ear infections and was on countless antibiotics and other pharma drugs, one after the other. She suffered every childhood illness known, had three ear tube placements, and her adenoids and tonsils out. She also had all of her childhood vaccinations. What caused her issues? We may never know. But it is something you might want to do some research on. And I agree with the poster who stated you should check into the side effects of vaccinations. They are not all lovey dovey, and my daughter will not be having any more. Ever.

Smallavatar-fefd015f3e6a23a79637b7ec8e9ddaa6

A.S.

answers from Boca Raton on

This may have NOTHING to do with it but I wondered if your child had the first dose of the HepB vaccine the day he was born (or soon thereafter)? The fever made me wonder.

If so, you may want to research the side effects to see if hypertonia is one of them.

Again - it may have nothing to do with your question.

Good luck to both of you!

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