Category Archives: Associated Conditions

Hypotonia – Floppy Infant Syndrome

By The CP Family Network

Children who are born with or develop cerebral palsy may also manifest a condition known as hypotonia, or low muscle tone (the amount of tension or resistance to movement in a muscle). The condition is also known as “Floppy infant syndrome” or “infantile hypotonia”.

Individuals with this diagnosis are said to be “hypotonic” and demonstrate “hypo-tonicity”.  In children with cerebral palsy this condition is defined as Ataxic (weak tone) or Athetoid Cerebral Palsy (fluctuating tone).

The long-term effects of hypotonia depend on the severity of the condition and its cause, but early treatment is considered critical. Imagine, as a child, trying to learn to pull up, crawl, walk or talk without the ability or a greatly reduced ability to move muscles. Hypotonia can even affect autonomic functions such as swallowing and gastric emptying.  It’s no wonder children with hypotonia face many challenges with basic life skills

Causes of Hypotonia

Hypotonia can be found in many neurological disorders. Neurons in the brain and central nervous system are responsible for initiating impulses that trigger motor movement. Cerebral insult to these neurons, the connections between them, or damage to nerve pathways in the central nervous system or spinal cord can lead to decreased sensation and muscular tone.  Specifically, damage to the cerebellum portion of the brain can result in hypotonia, considering that the cerebellum facilitates the controlling and coordinating of muscles and helps with sustaining posture.

Signs and Symptoms

  • Children with hypotonia may exhibit poor head control and possibly fail to meet other developmental milestones such as sitting or crawling.
  • A child may exhibit floppy muscle tone, a lack of gross motor movements, and poor torso control.
  • A child may display difficulties with sucking, swallowing, and oral motor functions also known as dysphagia.
  • It can present issues involving a child’s ability to walk, sit, maintain torso control or use upper and lower extremities.
  • Depending on the nature, severity and location of the cerebral damage, hypotonia can affect the entire body or be limited to parts of the body.
  • Children with this disorder may or may not exhibit developmental disabilities, or mental retardation.
  • A child with brain injury resulting in hypotonia may or may not experience a seizure disorder or movement disorders

Complications of Hypotonia

  • Complications can include delayed gastric emptying (gastroparesis) and intestinal motility problems.
  • It also has the potential to impact cardiac function, and bladder control and may influence pulmonary function by inhibiting diaphragm and respiratory muscle tone.
  • Children with Ataxic (weak tone) or Athetoid Cerebral Palsy may be at increased risk of contractures and muscular atrophy due to restricted function
  • Lack of oral motor function puts a child at risk of reflux, GERD and aspiration.

Management and Treatments

Although there is no cure for the underlying neurological injury, children with hypotonia can benefit greatly from consistent, physical, occupational and speech therapy.  Therapy offers the venue to strengthen diminished or hypotonic muscle groups, and in some cases prevent muscular atrophy and contractures of the affected joints. In some cases therapy can help the brain establish new and different pathways to help facilitate and improve a specific motor function.

What Parents Need to Know about Hypotonia

  • Parents need to find a Neurologist, Developmental Pediatrician and/or Movement Disorder specialist to assist in the management of hypotonia and any accompanying movement disorders
  • Document challenges that your child may be experiencing to better customize therapy and intervention services to your child’s specific needs
  • Parents need be  assertive in acquiring all the supportive, adaptive and assistive  services and technology their child could benefit from.
  • Physical Therapy, Strength Training and Range of Motion are all vital components in the management and prevention of the neuromuscular consequences of Ataxic or Athetoid Cerebral Palsy
  • The prevention and management of hypotonia or any movement disorder requires a team approach.  Parents are the core of that team and communication and continuity are key. Put together a good team. Ideally medical professionals with special needs experience would be preferred but that’s not always possible.  Find providers you can communicate easily with, that respect your knowledge as the parent and that you can establish a rapport and continuity with.

Source

Human Anatomy and Physiology, Fifth Edition, Copyright 1978, 1981, 1984, 1987, 1990 by Wm. C. Brown

National Institute of Neurological Disorders and Stroke NINDS –
Hypotonia

Seizures and Cerebral Palsy

By Lee Vander Loop
CP Family Network Editor

As the parent of 4 grown children, one of whom has spastic quadrapalegia cerebral palsy, I feel like I’ve experienced my share of parental stress and fears of raising 4 children and dealing with the challenges of maintaining the best quality of life possible for my daughter with CP.

I’ve experienced the heart stopping moment of having my 3rd born not recognize me after a concussion and a multitude of other parental trials and worries, but nothing could prepare me for watching my daughter with cerebral palsy experience her first grand mal seizure also known as tonic-clonic seizures.

No training, literature, insight or experience can prepare you for the heart stopping, gut wrenching experience of watching your child suffer through a seizure. Whether it be the first seizure or 50th, they all feel like the first with the overwhelming sense of fear, helplessness and frustration that comes with the inability to stop your child’s suffering.

Continue reading

Scoliosis in Children with Cerebral Palsy

By John Lehman

Scoliosis is a spine disorder characterized by unusual changes in spine curvature. If the changes continue, the spine could become deformed, which could lead to severe health issues later in life.

Children with cerebral palsy are prone to developing scoliosis, as muscle weakness and balance issues are frequently associated with the disorder. Thankfully, scoliosis is very treatable if detected early on in the child’s development.

Characteristics of Scoliosis

Minor curves in the spine are commonplace and are usually not a cause for alarm. A curved spine is only diagnosed as scoliosis if the curve grows beyond 10 degrees. For children, scoliosis most often occurs between the ages of 10 and 18 years old, typically during a growth spurt. Roughly 20 percent of children who have cerebral palsy will develop scoliosis; the likelihood increases depending on how severe the cerebral palsy is. Girls are twice as likely as boys to develop scoliosis.

Children with cerebral palsy have a higher chance of continued changes in spine curvature and will likely start developing scoliosis earlier in life than children without CP. Children who have limited movement as a result of cerebral palsy also have an increased risk of developing scoliosis. It’s also important to note that scoliosis is hereditary, so a family history of scoliosis increases your child’s chance of developing it.

Detecting Scoliosis at an Early Age

Treatments for scoliosis are most effective when the condition is detected at an early age. For many children, the disorder will not cause much (if any) discomfort or pain in its early stages. Therefore, the best way to determine whether your child may have scoliosis is to look for visual clues, which can include:

  • Uneven shoulders
  • Prominent shoulder blade
  • Uneven waist
  • Elevated hips
  • Leaning to one side 

If you suspect your child may have scoliosis, set up an appointment with your child’s doctor as soon as possible. Doctors can diagnose scoliosis using a few simple physical tests. The most common physical test is the “forward-bending” test, where the doctor will ask the child to bend over and attempt to touch their toes. In this position, the doctor can look for curves or uneven ribs on your child’s body. Scoliosis can also be diagnosed through the use of x-rays.

Treatments for Scoliosis

When treating scoliosis, the goal is to prevent the spine from curving further out of shape. The type of treatment depends on the speed of the spine’s curvature and the degree of the curve. If the curve is less than 20 degrees, it is considered a mild case. Frequent checkups (quarterly or semi-annually) are typically all that is required in these situations. This ensures that the spine can be monitored for any changes as your child grows.

Moderate cases of scoliosis are marked by a fast progressing curve between 20 and 30 degrees. In these cases, your doctor may recommend the use of a brace. This is particularly true if your child is still at an age where their bones are growing. Although wearing a brace will not straighten your child’s spine, it should help keep the spine from getting worse as the bones strengthen.

If your child’s curve is progressing beyond 30 degrees, the case is considered severe and spinal fusion surgery or other forms of surgery may be necessary. Ideally, the surgery is performed once the child’s bones have stopped growing.  However, if the condition is rapidly deteriorating, your doctor may find that surgery is the best option. If the child’s bones are still developing and surgery is needed, metal rods can be installed in the spinal structure, which can be adjusted periodically as the child grows. 

Conclusion

Remember, cerebral palsy increases your child’s odds of developing scoliosis. It is important to check your child for signs of the disorder and to seek the opinion of a medical expert if you believe your child’s spine may be curving. The sooner a diagnosis is made, the sooner treatment can begin.

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Additional Resources:

Scoliosis Research Society

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