Hypertonia and Cerebral Palsy
Hypertonia in cerebral palsy is characterized by involuntary movements that are writhing, slow, and continuous. These involuntary muscle contractions tend to be less noticeable or stop altogether when the body is relaxed and more noticeable or even severe when attempting voluntary movements. Hypertonic cerebral palsy is one of several types of cerebral palsy.
What Is Hypertonic Cerebral Palsy?
Hypertonia is a movement disorder where muscles in the body become stiff or rigid and involuntarily contract, causing repetitive, writhing movements. People with hypertonic cerebral palsy may also have difficulties with posture, experience fluctuations in muscle tone, and suffer from immobility.
The basal ganglia area of the brain is responsible for controlling voluntary movements, but when this area of the brain becomes damaged, the nerve cells can’t communicate and uncontrollable involuntary movements result. It’s common for people with cerebral palsy to have damage in the basal ganglia area of the brain and therefore have a movement disorder like hypertonia.
Symptoms of Hypertonia in Cerebral Palsy
Hypertonia can affect one or many groups of muscles and causes tightness and rigidity, so the muscles become stiff and resistant to their full range of motion. Limbs affected by hypertonia tend to resist passive stretching and return to a fixed, involuntary position. Sometimes this fixed position is abnormal and can cause a person to have an awkward posture, loss of motor function, or difficulty walking. Other times, the hypertonia may be mild and have little effect on a person’s daily activities. Common symptoms often include:
- Uncontrollable muscle spasms
- Abnormal muscle tone
- Stiffening or straightening out of muscles
- Shock-like contractions of muscles
- Limited joint movement
- Inability to move quickly or stay balanced
- Exaggerated reflex responses
As with many medical conditions, not everyone has the same symptoms or the same degree of severity. Age can make a difference in what symptoms are present. Children often exhibit different associated conditions than adults do. These include:
- Hearing or vision problems
- Speech or swallowing problems
- Respiratory difficulties
- Joint contractures
- Constipation or bladder incontinence
- Learning or cognitive disabilities
Characteristics of Hypertonic Cerebral Palsy
Commonly affecting the hands, feet arms, or legs, some characteristics of hypertonic cerebral palsy include:
- Slow and “stormy” or writhing muscle movements
- Difficulty holding objects, like a fork or pen
- Restlessness and noticeable constant movement
- Unable to be still unless fully relaxed
- Inability to control lip, tongue, breathing, or vocal cord movements
- To some degree, speech is affected in all people with hypertonia
- Grimacing and drooling may be caused by muscles affected in the face and tongue
- There may be difficulties with eating and drinking
- Involuntary movements often stop completely when asleep
Hypertonia may sometimes be confused with dyskinesia, which is a broad diagnosis for involuntary muscle contractions and includes a wide range of movements. While hypertonia is also caused by involuntary muscle contractions, it is classified by a smaller range of specific movements and how it affects the body. Hypertonia specifically refers to rigid muscles with slow, continuous, and writhing movements. Hypotonia is the reverse of hypertonia, where the muscles are too loose instead of too rigid.
Treatment of Hypertonic Cerebral Palsy
There is currently no cure for hypertonic cerebral palsy. Medications, therapies, and surgery are treatments that may help with symptoms.
Medications may be prescribed for relief from stiff and rigid muscles, to get more sleep, and to help with other symptoms frequently related to hypertonia. Common medications include:
- Baclofen or other muscle relaxants
- Gastric reflux or constipation aids
- Sleep enhancers
- Respiratory medicines
A customized physical therapy program is often highly recommended for hypertonic cerebral palsy. A therapist can work with hypertonic patients to improve balance and coordination or increase muscle strength and length. Other types of therapy often recommended are occupational therapy to address specific functional issues or speech therapy to address vocal difficulties.
Surgery is a last resort when other treatments have been exhausted or the hypertonia is severe. Tendon lengthening surgical procedures may result in more mobility. Deep brain stimulation may help the basal ganglia area of the brain. Other surgical options may be available, depending on individualized needs.
Prognosis of Hypertonia in Cerebral Palsy
The long-term prognosis for children with hypertonic cerebral palsy depends greatly on the severity of the hypertonia and how well the child responds to treatments. With an individualized treatment plan that keeps the symptoms and pain under control, most mild cases of hypertonia respond well. Moderate cases may have an impact on health and safety. Severe cases may cause immobility and a greater number of health concerns.
If you think it’s possible that your child’s or loved one’s cerebral palsy is the result of medical malpractice, you may have a case and be eligible for compensation. With our years of experience, combined with our legal and medical expertise, the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC have helped over 30,000 families with their cases across the country. Contact us today and let us help you and your family.
Claire Surles, RN
Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO