Hypotonic Cerebral Palsy

Children with hypotonic cerebral palsy are those children who have very low muscle tone. They are also considered as floppy baby. In hypotonic cerebral palsy, the whole body is affected. Hypotonic Cerebral palsy is not so common form of cerebral palsy as Spastic. It is in general congenital in origin but a few cases have been reported post natal also. Generally the child has the following problems

  • Poor head control
  • Very poor trunk control and stability
  • Absence of protective reactions
  • Absence of balance reaction
  • Joints are excessively hyper mobile
  • Arms and legs are hanged down like a doll
  • Walking becomes very difficult
  • Some children have breathing and swallowing difficulties
  • Very difficult speech
  • Generally Normal intelligence

 
Etiology

Hypotonic cerebral palsy is associated with the cerebellum damage. Cerebellum is the part of the brain which control balance and coordination of the body.  

  • Associated Problems
  • Visual impairment
  • Hearing Impairment
  • Malnutrition
  • Feeding difficulties
  • Lax joints

Early recognition Diagnosis making
As these babies are very floppy, it is very easy to recognize the problem in early days.
Diagnosis making is very difficult as lot of neurological degenerative conditions mimic hypotonic cerebral palsy


Management Techniques
Standard management techniques to be started as soon as possible. As the child is very floppy, it is necessary to have neutral / normal tone to achieve basic physical abilities.
There is little chance to have contracture at the joints level as the tone is very low but due to laxity of the joints, the child gets problems with joint alignment.


TREATMENT

The management / treatment of children with Hypotonia are again a challenging job due to constant hypotonic muscles. Any activity which requires antigravity pull, the child gets problem. The child takes lot of time to gain antigravity postures and mobility. But with good and scientific intervention, mostly children with CP Hypotonia become independent in life.  

Standard Techniques
a. Handling, Transfer and Carrying Technique
The child should be handled with care till the child achieved head control. Spinal alignment should be observed while sitting and standing
Transfer and carrying should be modified according the milestones achieved

b. Use of Aids and Appliances
Postural Aids
Initially the child should be given corner chair to protect the spine and gain head control. As the child gets proper head control any arm chair with tray cut can be used. Few cases with hypotonic trunk can get help from a standing frame.
Orthotic Aids
Initially a SMO can be given for aligned weight bearing.
Mobility Aids
The FMS approach should be practiced for better outcome in mobility skills

c. Physiotherapy
Physiotherapy has a great role in the total management. Strength training program has a specific place in the physiotherapy program.

d. Developmental Therapy
The sequential milestones development approach is considered better for this group of children

e. Occupational Therapy
Occupation therapy session should be part of the total habilitation program to develop age appropriate hand function and independency in ADLs.

f. Special Education
Mostly children with hypotonia have good mental level so special education should be included to make the child integrated in the mainstream. A few cases may need special School set up to be functionally literate.

g. Speech Therapy
 A few cases with CP Hypotonia ay require the support of a speech therapist also. Due to hypotonia, the child may have excessive drooling and chewing disorders. These problems should be taken care by the speech therapist specifically.

h. Role of Oral Medicines
Although there is no specific medicine available to manage the generalized hypotonia but a few medicines have been tried by some experts.   

Experimental Therapies
A. Hyperbaric Oxygen Therapy (HBOT)
As HBOT is a generalized treatment for children with cerebral palsy, Children with Ataxic CP are also eligible for this treatment system. When HBOT is accompanied with good pediatric therapy, encouraging results have been observed. Isolated HBOT has no role in the total management of a child with Hypotonic CP.

B. Stem Cell Therapy (SCT)
Stem cells are considered repairing cell of the body. As the children with CP Ataxia have insulted brain, stem cell can play a role in the management. But there is no concrete data available for the same. Researches are going on, Hope for the best! 

Exploratory Therapies
A large number of parents have reported some results from these therapies so these can be associated in the total management program. Isolated use of these therapies has very little role. So whenever, you start any of therapies, please continue the standard therapies as usual.

  1. Hydrotherapy has been considered one of the best alternative therapies to encourage spinal / Truncal control and balance.
  2. Ayurveda
  3. Unani
  4. Acupuncture
  5. Acupressure
  6. Hippo-therapy
  7. Homeopathy
 
Prognosis
As the children with hypotonic cerebral palsy have good mental ability, if they are given chance, they do very well in academics. Mobility is always a concern. Early intervention can make them mobile in the form of supported walking and sometimes independent walking also. 



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