What does low tone mean?
The best explanation is by means of analogy. Imagine purchasing a mechanical arm that could wash dishes. The arm would need to be attached near the sink. Would you attach it to the curtain/drapes? Not likely. The arm might end up swinging the dishes through the window. No. The arm would need to be attached to the very sturdy wall. This is true for all movement. Arms and legs need a stable background of attachment where movement forces can be generated. Precise and coordinated movement need to come from a strong central support. Low tone implies that postural muscles are somewhat too floppy for good support, resulting in uncoordinated limb movement. This could affect writing and fine motor activities in school, as well as sports participation and social skills. The origins of low tone based postural instability often have to do with a lack of healthy and varied movement opportunities as a baby.
How do I know if my child has low muscle tone?
The low tone child has a very real struggle to remain upright in various positions. They adopt compensatory strategies early on. Children with inadequate muscle tone display poor postural control. In other words, they slouch.
Low tone children may present with some of these characteristics:
– They fatigue easily or lose concentration
– Poor perseverance in gross motor activities
– Improper body awareness feedback
– Avoid or struggle with chewy foods
– Poor posture in sitting and standing
– Impaired balance
– Lacking in confidence or assertiveness
– A preference for indoor activities
A child with low muscle tone may use compensations such as the following to sit perfectly upright:
– Hand support on the surface with locked elbow(s)
– Hooking feet around chair legs for support
– ‘Fixing’ shoulders by shrugging them up for fine motor tasks such as cutting or writing
– ‘Locking’ the pelvis into an anterior tilt by arching the low back
– Leaning to one side – bearing weight only on one buttock
– Pushing the chin forward so the head ‘locks’ into compressed position on the neck, sometimes with mouth open
– Creating a wide base: Sitting with legs bent to one side or in reverse w-position.
– Folding themselves into a chair. Low tone children may appear very bendy.
Why is this important to know? How would my child be affected if she had low muscle tone?
Low tone children struggle in school. Poor central trunk and head control has many implications.
Good head-on-neck control is necessary for:
– Efficient speech
– Directing the gaze, eye contact, reading skills
– Hand-eye coordination, drawing and writing skills
– Direction and redirection of attention
– Concentrating on tasks
A raised fixed shoulder girdle interferes with normal breathing. Diaphragmatic breathing is impaired in this position, affecting breath control during speech. Impaired diaphragm movement also affects core muscle activation – causing the low tone and core instability situation to perpetuate itself.
Muscle imbalance creates malalignment of spine and joints. Malalignment leads to strain and pain.
If a child has trouble maintaining postural muscle control, the head is not properly aligned for good eye tracking movements on a page. Reading gets harder to do.
Proximal stability (good shoulder control) is needed for coordinated and effective distal movement (hand grip and movements). Writing takes more effort.
The ability to sit still is an active process of maintaining reciprocal balance between muscle groups. It is compromised in low tone kids. Paying attention becomes more difficult.
Social interaction is affected by attention and eye contact.
Sports participation is affected by balance, posture and coordination.
Having to work at maintaining an upright position leads to fatigue and impaired concentration. Postural control and balance should be automatic and ingrained long before school age, allowing kids to deal with the tasks at hand.
Low tone with poor postural control create anxiety and feelings of inadequacy in children who fail to perform to their academic, social and sports ability as a result. The social and school pressures on children are very real.
Why would a weighted vest help?
Deep pressure is very calming. Wearing the vest is like being enveloped in one long continuous hug. Kids love it. A weighted vest has a snug fit with pockets designed to house little weights. It creates a downwards pressure on the joints of the spine, which stimulates extension responses.
Deep pressure is useful for down-regulation of heightened sensory states. Wearing a weighted vest enhances proprioceptive and sensory feedback. This increases body awareness, tactile integration with improved posture and balance. Automatic balance reactions develop with sufficient postural control.
Wearing a weighted vest should be part of a sensory diet as prescribed by an occupational therapist. Always have a paediatric physiotherapy or occupational therapy assessment for any suspected developmental challenge.
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What an excellent article! I wish I had know about the existence of this when my cousin’s kids were small and suffered from low tone problems. Keep writing and educating!
Hélène Serfontein says
Thank you! Good to hear.