hyptonic-cerebral-palsy

Learning that your child has Cerebral Palsy is a tough moment for any parent. It is a lifelong condition that significantly impairs movement and communication, and your child may even require special care all their life. The good news, however, is that early intervention and treatment can equip your child with the skills they need to learn, play, make friends, and enjoy their life. It is thus critical to know about the different subtypes of Cerebral Palsy and how they present. Here, we take a closer look at Hypotonic Cerebral Palsy.

Understanding Hypotonic Cerebral Palsy

Cerebral Palsy refers to a group of non-progressive neurological disorders that affect movement, muscle tone, coordination, and gait. It occurs due to damage to the brain on account of an injury or infection before, during, or shortly after birth. Children with Cerebral Palsy experience various movement-related symptoms depending on the subtype of Cerebral Palsy they are diagnosed with. Tailored treatment programs can significantly improve mobility, communication, and functionality for the patient.

Hypotonic Cerebral Palsy is a rare variant and accounts for about 2.6% of all Cerebral Palsy cases. It is also known as Atonic Cerebral Palsy. Children with this subtype have low muscle tone, which manifests in the form of floppy limbs. Parents may observe their child missing key developmental milestones like rolling over, crawling, or walking. There may also be neurological impairments involved. 

Many people confuse Hypotonic Cerebral Palsy with Hypertonic Cerebral Palsy. While the words do sound similar, they actually mean the opposite. Hypertonia refers to exaggerated muscle tone, which leads to stiff muscles and often painful contractures. Hypotonia, on the other hand, refers to unusually low muscle tone, which causes loosened muscles.

Symptoms of Hypotonic Cerebral Palsy

The main characteristic of Hypotonic Cerebral Palsy is hypotonia, or low muscle tone, which leads to floppy muscles. It is important to note that the muscles do not lack strength, but stability. Simply put, it means that the muscles are too relaxed to work properly.

Parents may start noticing Hypotonic Cerebral Palsy symptoms when the child is anywhere between a few months to a few years old, depending on symptom severity. Key signs to watch out for include:

  • Delays in hitting developmental milestones like rolling over, sitting up, or crawling
  • Excess muscle flexibility
  • Clumsiness
  • Exhaustion
  • Poor head control
  • Loose muscles
  • Slow reflexes
  • Unusually flexible joints and ligaments
  • Poor trunk stability
  • Wide gait with feet abnormally far apart
  • Balance or stability problems
  • Problems with chewing or swallowing
  • Seizures
  • Vision impairment such as slow eye movements
  • Making breathy, grunting sounds
  • Learning disabilities
  • Speech impediments
  • Cognitive dysfunction
  • Breathing difficulties
  • Difficulty with fine motor activities like buttoning clothes or writing

Causes of Hypotonic Cerebral Palsy

Like all forms of Cerebral Palsy, Hypotonic Cerebral Palsy occurs due to damage to the developing brain. Specifically, when the cerebellum is affected, messages from the brain and spinal cord related to movement control cannot be relayed properly to the rest of the body. This leads to problems with muscle tone and motor skills. Some of the factors that could cause damage to the cerebellum include:

  • Lack of oxygen to the fetus
  • Damage to the placenta
  • Maternal high blood pressure (causing fetal stroke)
  • Certain types of maternal infections, especially during the first five months of pregnancy
  • Umbilical cord complications
  • Problems during delivery, often from improper use of forceps by the doctor
  • Pulling excessively on the newborn’s head, neck, or shoulders

Treatment for Hypotonic Cerebral Palsy

If your child has Hypotonic Cerebral Palsy, a healthcare team will carefully assess their symptoms and design a custom treatment plan to maximize their functionality and consequently, independence. The objective is to train the brain to relearn and improve through highly specific and repetitive tasks. Typically, a treatment plan for Hypotonic Cerebral Palsy will include the following:

  • Physiotherapy: A physiotherapist will work with your child and teach them special exercises to target underused muscles and build greater stability.
  • Occupational Therapy: Occupational therapists will teach your child how to build the necessary fine motor skills to eat, dress, bathe, and groom themselves independently. They could also recommend adaptive equipment for specific tasks to improve the child’s ability to participate in school activities.
  • Speech and Language Therapy: Quite often, children with Hypotonic Cerebral Palsy have poor mouth and jaw control. Speech therapists can guide them through exercises that strengthen their oral muscles and help them chew, swallow, and speak more effectively. The therapist may also teach them how to use communication devices to supplement their verbal skills.
  • Mobility aids: These are ideal for helping children with Hypotonic Cerebral Palsy move about with greater ease and with a reduced risk of falling. Braces, for instance, can elongate and support the leg muscles to counteract stability problems. When used early, braces can significantly improve musculoskeletal stability and help children stand and walk with minimal support. For more advanced cases of Hypotonic Cerebral Palsy, a wheelchair can be ideal for getting around.
  • Cognitive Therapy: Cognitive impairments occur frequently in cases of Hypotonic Cerebral Palsy. Cognitive rehabilitation therapists can guide the child through exercises that improve memory, learning, attention span, and decision-making abilities. 
  • Stem Cell Therapy: This is a revolutionary form of treatment that uses the patient’s own healthy stem cells to replace the damaged ones in the brain. It has shown considerable success in reducing the symptoms of Cerebral Palsy, and may even potentially reverse the damage.
  • Medication/surgery: Medication can alleviate specific symptoms like seizures, while surgery can correct bone or joint deformities so that physiotherapy can be more effective.

Over time, and as the child responds to continued treatment, the healthcare team may modify elements of this plan or introduce new exercises to meet emerging needs. In addition, parents should take their child for regular health check-ups and ensure that they eat a nutritious diet, just as they would for any child.

FAQs

  • What causes hypertonia in Cerebral Palsy?

Hypertonia in Cerebral Palsy occurs due to brain damage, which is most often the result of birth injuries like trauma to the head or lack of oxygen to the fetus while being born.

  • What are the 4 types of Cerebral Palsy?

The four main types of Cerebral Palsy are Spastic, Ataxic, Dyskinetic (which includes Dystonic, Athetoid, and Choroathetoid), and Mixed.

  • Is Cerebral Palsy hypertonic?

Hypertonic or Spastic Cerebral Palsy is the most common type of Cerebral Palsy. It involves tightened muscle contracture that leads to difficulties with walking and coordination.

  • What type of Cerebral Palsy has hypotonia?

Hypotonic Cerebral Palsy, or Atonic Cerebral Palsy, is a rare subtype of Cerebral Palsy that affects multiple muscle groups and leads to floppy muscles.

  • What are 3 early signs of Cerebral Palsy?

In general, three early signs of cerebral palsy are developmental delays, abnormal muscle tone, and abnormal posture.

  • How is hypotonic Cerebral Palsydiagnosed?

A Hypotonic Cerebral Palsy diagnosis requires a thorough examination by the child’s doctor, including an assessment of their movements and coordination, an MRI/CT scan to detect brain damage, and often an appointment with a bone and joint specialist to detect floppy movements.

  • Can babies with Cerebral Palsy roll over?

Rolling over either too early or too late could be an indicator of neurological disorders like Cerebral Palsy. For instance, babies with Hypotonic Cerebral Palsy often roll over much later than normal.

  • At what age can you tell if a baby has Cerebral Palsy?

Most Cerebral Palsy cases are diagnosed when the child is around two years of age, and some might be evident at even a few months. 

  • Can a baby with Cerebral Palsy do tummy time?

Tummy time is a simple and useful exercise for children with Cerebral Palsy, as it helps develop head control, provides a good stretch to the whole body, and promotes balance.

  • Can you fix Cerebral Palsy?

Cerebral Palsy has no cure. However, tailored treatment options can significantly reduce the child’s symptoms and improve their long-term outcome.

  • Can Cerebral Palsy affect the eyes?

One of the most common symptoms of Cerebral Palsy is vision impairment. Cataracts, refractive issues, and strabismus (turned eye) are all frequently observed.

  • Does Cerebral Palsy affect IQ?

About 30-50% of Cerebral Palsy cases also present with some form of cognitive impairment. This is typically an outcome of the same brain damage that caused the Cerebral Palsy in the first place.

In short, a Hypotonic Cerebral Palsy diagnosis is never easy to receive, but there are several treatment options to ensure your child the best future possible. As a parent, it is advisable to reach out to support groups for education and assistance so that you can be the best caregiver while prioritizing your own mental health. Above all, remember that your child’s symptoms can and will improve with regular treatment and that they can enjoy their life just like any other child.

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.