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5 Physical Therapy Exercises for Low Muscle Tone (Hypotonia)

Mar 27th, 2020 | by Cait Parr, PT, DPT

Cait Parr, PT, DPT

March 27th, 2020

What is Hypotonia or Floppy Baby Syndrome? 

Hypotonia, or hypotonicity, is the medical term for abnormally low muscle tone, sometimes also referred to as floppy baby syndrome. Normally, even relaxed muscles have a very small amount of contraction that gives them a springy feel and provides some resistance to passive movement. Hypotonia is not the same as muscle weakness, although hypotonia and weakness can often go hand in hand. Muscle tone is regulated by signals that travel from the brain to the nerves and tell the muscles to contract. Hypotonia does not affect intelligence. Pediatric therapy helps children overcome hypotonia; the primary treatment for most children with congenital hypotonia is occupational and physical therapy

What Causes Hypotonia?

Hypotonia can be seen in children with Down syndrome, cerebral palsy, autism spectrum disorder, muscular dystrophy, Marfan’s syndrome, and sensory processing disorder (not an official DSM diagnosis), among other diagnoses. Sometimes, the cause of hypotonia remains a mystery, with no clear diagnosis. Hypotonia can happen from damage to the brain, spinal cord, nerves, or muscles. The damage can be from trauma, environmental factors, or genetic, muscle, or central nervous system disorders. 

Hypotonia Symptoms: Signs of Low Muscle Tone in Babies and Toddlers

Hypotonia in infants is usually noticeable by 6 months of age, by which time the low muscle tone in babies typically becomes apparent. Babies with hypotonia have a floppy quality because their arms and legs hang, and they tend to have little or no head control. Children or toddlers with hypotonia may have difficulty transitioning in and out of positions and be slow to attain motor milestones, resulting in global developmental delay. Hypotonia in toddlers may cause movements with clumsy or inefficient patterns, difficulty with hand-eye coordination, and a preference to sit and watch rather than move and groove with other kids. Other symptoms of hypotonia include problems with mobility and posture (such as difficulty sitting upright without significant leaning or support), breathing and speech difficulties, ligament and joint laxity, poor reflexes, and getting easily frustrated with physical challenges. 

Exercises That Can Help Treat Hypotonia/Low Muscle Tone in Babies, Toddlers, and Children:

1. Crawling Across Different Surfaces

  • Easy: Army crawl on carpet (increased resistance compared to tile or linoleum) 
  • Medium: Couch cushions (more pliable surfaces present a dynamic challenge) 
  • Hard: Crawling up ramps or steps (with close supervision for safety) 

2. Pulling to Stand

  • Easiest: from sitting on parent’s legs (motivation: hugs, kisses, and snuggles!) 
  • from sitting on low bench or couch cushion (motivation: whatever is cool on the couch or low table – games, toys, food) 
  • from kneeling through half kneel (more advanced, might need help to keep one leg kneeling instead of going over toes) 
  • at vertical surface (try introducing cool fridge magnet toys at the refrigerator) 
  • Hardest: push to stand using low bench or cushion for hands 

3. Squatting and Returning to Stand

  • Squat and return to stand with trunk/arms/hands on couch or low table for support (trunk being most support, hands provide least support) 
  • place motivating toy or game with pieces on floor to encourage your child to squat and pick one up and then stand up and place toy in a container on supporting surface

4. Tall Kneeling

Tall kneeling challenges glute and core stability.

  • Easy: holding tall kneel position at a supporting surface such as a low bench/table – the cube chair works great for this! 
  • Medium: heel sit to tall kneel to bring puzzle pieces from floor to puzzle on couch or low table 
  • Hard: blow bubbles or hold a ball or balloon up just beyond their reach, encouraging them to come up into a tall kneel position. Can they hold this position and play here for a few seconds?

5. Other

  • Bilateral play – promotes use of both sides of body and movements that cross midline  
  • Sports skills – requires hand eye coordination, reaching, squatting, balance 
  • Navigating obstacles – play tunnels build strength, endurance, and motor planning 
  • Climbing up and down – targets both concentric and eccentric muscle activation 

For Further Reading: 

Find Additional Resources in the NAPA Blog:

About the Author 

Cait Parr is a pediatric physical therapist at NAPA Center. Her favorite animal is snails, because they remind her to slow down and enjoy the beautiful details about life. She loves desserts almost as much as she loves long walks with her husband on the beach at sunset.

Hypotonia Treatment at NAPA Center

At NAPA Center, we offer hypotonia treatment in an intensive or weekly pediatric physical therapy setting to help children experiencing low muscle tone. We have several clinics located throughout the US and Australia and are continuing to expand to serve more families. We welcome families from around the world to participate in our renowned 3-week intensive pediatric therapy sessions. We take an individualized 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 customized program specific to your child’s needs and your family’s goals. If you’re interested in learning more, send us a contact form and our team will be in touch shortly!

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