Hypotonia is a term that you may have heard a medical professional use before, but what really is it? This term refers to the “feel” of a specific muscle and the technical definition is abnormally low muscle tone. A child having hypotonia does not necessarily have weaker muscles, but these terms can go together.
Think of it this way: a typically developing child is sitting in a chair and gets up to stand. Now take a child with hypotonia and if they were to sit in the same chair and get up to stand, for them, it may feel like they started on the floor. This can be present across a multitude of different medical diagnoses.
With physiotherapy, we are not necessarily able to reverse the effects or change the actual cellular make-up of someone’s muscle; however, we can work towards strengthening which can help offset some of those difficulties that these kids may experience throughout their various activities. Typically, children with hypotonia will benefit from all types of therapy.
Autism is classified as being on a spectrum as each child presents very differently with their own unique strengths and abilities. Ultimately, each child will interact and engage with the environment very differently as they are processing information differently from each other.
Since there is a portion of this diagnosis where these children are processing information differently, they typically benefit the most from a standard and predictable routine to allow them the ability to transition between tasks or activities effectively.
Low muscle tone is commonly seen in children with autism. However, since ASD is a spectrum, their physical presentation can vary drastically from having increased tone which is causing the tip-toe walking, to decreased tone and walking either with flattened feet or compensating by going up onto their tiptoes to walk. As the presentations globally are different for each child, they may only need physiotherapy, occupational, or speech therapy, or all of the above.
At NAPA, our overarching goal is to focus on something called functional activities. Basically, these are activities that mimic movements and activities that children naturally do throughout their day.
For both diagnoses, we want to work on strengthening all the muscles that are weaker. Typically, balance is relatively difficult for children with either diagnosis. Hypotonia will affect how the muscles work, which will affect balance. Children with ASD are either walking on their tip toes or on flattened feet, which will impact their trunk leaning forward or backward (affecting their whole-body balance.)
Typically, for children with hypotonia, we focus on more of the “large” muscles like the thighs, bottom, and trunk. A few activities that are commonly worked on would be: squatting, kneeling, crawling, going up and down stairs, etc. As children with hypotonia already tend to be more flexible, we typically don’t want to work on stretching.
For children with ASD, typically we are working on general strengthening in activities that are more difficult for them, as well as addressing stretching, primarily of their calves. Even if tip toe walking is a compensation for their lower tone, it is important to not lose any muscle length so that they can still fully participate in a variety of activities. Additionally, for children with ASD, we will typically utilise a schedule to help with completing each task as well as potential sensory breaks to assist with their emotional regulation and participation in each task.
Kayla Darnbrough received her DPT from USC and is based at the NAPA Center in Los Angeles. She’s always had a heart for working with kids and loves figuring out the best way to motivate the little ones! When not at the clinic, she is either reading a book, snuggling with her cats, or trying a new cooking recipe with her boyfriend.
At NAPA Center, we offer intensive or weekly paediatric therapy to help children with hypotonia and autism among other diagnoses. We have several clinics located throughout the US and Australia and are continuing to expand to serve more families. We take an individualised approach to therapy because we understand that each child is unique with very specific needs. If your child needs our services, we will work closely with you to select the best therapies for them, creating a customised program specific to your child’s needs and your family’s goals. If you’re interested in learning more, contact us and our team will be in touch shortly!