Low Muscle Tone  
     
 

A product of our society? Or Genetic fact?

‘My child is just plain lazy’ – fact or genetic pre-disposition?

Playstation, TV and computers are they producing a generation of couch potatoes?

What exactly is muscle tone?

It refers to the constant underlying state of tension (stiffness) of our muscle.  Muscle tone helps us to hold our bodies upright, for example, when we are sitting and standing.  It also contributes to providing us with postural control, as well as the ability to control the speed and amount of movement a muscle needs to produce and control movement when executing a required task.  This state of tension in the muscle is a neurological brain based postural control mechanism.  Muscle tone should not be confused by how strong and ‘toned’ a muscle is from exercising.  The term low muscle tone refers to a decrease in the resting tension of a muscle thereby reducing it’s resistance to being stretched.  This results in poor endurance which in turn affects a whole host of postural, cognitive and physiological functions within the individual.

LMT can be caused by a number of factors related to the structure of muscle itself, as well as the function of the neural systems that activate and regulate the signals between the muscles, the spinal cord and the brain.  Its cause or origin can be genetic, developmental, neurological or acquired through injury, it is therefore not a disorder in itself but usually a symptom of a diagnosable medical condition.  Individuals with low muscle tone may need to put in more effort when doing an activity in order to stabilize, control or co-ordinate their muscles.  As a result they may have difficulty maintaining a good posture when sitting or standing and may get tired easily due to the extra effort they are required to put in.  Hypotonia affects every muscle in the body, so any activity that requires muscle activity is likely to be impaired to varying degrees.

In my 27 years of Occupational Therapy experience I have come to see individuals as all having their own ‘muscle personality’ and identifying hypotonic muscle as being generally ‘slow to warm up’.  People with low muscle tone are often misinterpreted as being lazy, with symptoms such as being overweight and day dreamy or even misdiagnosed as AD(H)D exhibiting increased restlessness.  Generally speaking the individual with LMT can either be ‘Hypoactive’ (under active) or ‘Hyperactive’.  It helps to understand low tone by comparing these muscles to that of a car where the timing is not set accurately resulting in inadequate, slow idling which requires extra fuel, effort and time to pull away.   This analogy usually hits home to especially the Dad’s who due to lack of understanding feel a mountain is being made out of a mole hill when their children are diagnosed as having low muscle tone.  Low muscle tone does not affect intellect or mental capacity in any way; however it does impair attentional ability.  Causing the person to perform less efficiently in either or both the motor and cognitive tasks. 

These individuals do present with a short attention span, distractibility, restlessness and very often day dreaming.  EEG results of individuals with low muscle tone usually also show clear disturbances which often do not correlate with a specific Neurological diagnosis.  Attention enhancing drugs, when indicated have been used successfully to improve the attention skills of individuals with low muscle tone.

Assessment:

Clinically muscle tone is assessed by passively moving the limb and feeling the resistance to the movement, as well as by palpating the muscle for firmness.  This assessment which must be done by an experienced professional, together with some very important observations made of the individual’s development and functioning will indicate the absence or presence of low muscle tone.  A detailed history together with observations indicating the following may be indicative of low muscle tone.  Absent or delayed motor development milestones, ‘floppiness’, joint hyper-mobility, poor gross and fine-motor-co-ordination, delayed speech development, muscle weakness and poor endurance, often wanting to be picked up or put in a trolley to avoid walking long distances, resistance to standing in a queue, clumsy (poor anticipatory postural responses), trouble sitting erect, slouched posture in standing or sitting, often lying down while watching TV, restless and fidgety, stretches a lot when sitting for long periods, starts yawning quickly when involved in a focused task, dislikes activities such as drawing and colouring and refers to them as boring, poor movement learning strategies, sensitivity to vestibular input (movement), reading problems, attention and concentration problems (not diagnosable as AD(H)D), day dreaming, neck tension or pain while working, digestive problems such as constipation, poor circulation, low blood pressure, obesity, depression and burnout disorders.

Treatment:

There is currently no known cure for most (or perhaps all) causes of hypotonia, and objective manifestations can be life long and may in some individuals have a severe impact on their functionality.  Early intervention with continuing Physical and or, Occupational therapy is essential to reduce the effects of Hypotonia to the greatest degree possible.  Participation in programs to help increase muscle strength and sensory stimulation programs is essential as a muscle’s stiffness can also be increased by active voluntary contraction.  This active control is learnt through intentional, persistent and repeated practice of movement skills thus giving the person a deep conscious awareness of how their muscles work.  The dietary requirements of an individual with low muscle tone should not be neglected. 

So, in conclusion, our society is not producing children with low muscle tone, much to the contrary, this Low Tone phenomenon does exist within the very intrinsic make up of the neurological and muscle personality of the individual.  We do however need to ensure that our children lead a balanced lifestyle thereby reducing sedentary activity time and increasing their participation in active leisure activities.  By creating awareness and educating our children we can empower them to accept an informed responsibility for their physical well being.

By:  Jenny Brandt                                                                             011-4322290

Occupational Therapist       
 
 
 
   
       
 

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