Hypotonia or weakness of muscles and lack of muscle tone is a symptom of an underlying condition rather than a disease entity in itself.
Therapy involves treating the symptoms as well as the underlying conditions.
The therapy team is usually multidisciplinary. The team involves:
- a paediatrician
- orthopaedic surgeon
- chest specialist
- heart specialist
- physical and occupational therapist
- speech and language therapist
- sometimes genetic counsellors
Types of therapy for hypotonia
There are several types of therapy for hypotonia, these include physiotherapy, occupational therapy and so forth. (1-4)
Regular physiotherapy is important to improve muscle tone and prevent contractures.
Physiotherapy aims to improve posture, and co-ordination and strengthen the muscles around the joints of the limbs to provide more stability and support.
Regular exercises are prescribed for this purpose.
Occupational therapy helps patients in the activities of daily living.
For example, fine finger skills are focussed upon to improve feeding and dressing etc.
Speech and language therapy
Speech and language therapy is recommended for patients who have speech and swallowing problems due to hypotonia.
This therapy helps develop better control of the jaw and mouth muscles.
Patients with hypotonia often suffer from difficulty in breathing at night due to further loss of muscle tone.
These patients need assisted artificial breathing and ventilation through machines.
They are also at risk of repeated respiratory infections that need to be treated. Annual flu vaccination is necessary.
Orthopaedic review is important annually to check for spinal deformities, hip dislocation and joint weakness and slipping (subluxation).
Some patients may need braces and surgical procedures to improve movement and support of the limbs.
In babies and children with severe hypotonia and difficulty in feeding, interventions like tube feeding may be needed.
Ideal weight maintenance and adequate nutrition is important part of management.
Babies with myasthenia gravis need specific medication. These are drugs like Neostigmine, Physostigmine etc.
The treatment may often last a life time.
In myasthenia gravis the body’s immune system attacks certain receptors at the neuromuscular junction. Sometimes drugs that suppress the immunity like corticosteroids may be added to regular myasthenia gravis therapy to relieve symptoms of muscle weakness.
Hypotonia may be caused due to an infection, meningitis or encephalitis.
If antibiotics are administered to fight these infections, symptoms may be reduced.
Therapy for genetic disorders causing hypotonia
Genetic disorders like Down’s syndrome, Prader Willi syndrome, Marfan’s syndrome, Ehler-Danlos syndrome etc. do not always have specific therapy.
These conditions with hypotonia may be treated symptomatically with physical and occupational therapy.
Genetic counselling may be offered to parents regarding future pregnancies.
Therapies are not always needed
Premature babies who are born with hypotonia often recover by themselves as they grow. They may need vigilance against infections, sepsis and feeding difficulties.
Babies with no specific cause of hypotonia called Benign congenital hypotonia often need no therapy apart from physical and occupational therapy.