Muscle hypotonia is a decrease in muscle tone. Some people are born with hypotonia others can develop hypotonia due to health problems. How to treat it?
The body is made up of muscles which are like rubber bands, they contract and relax. Hypotonia occurs when these muscles are a little more “soft” or “relaxed” than normal. In this case, the muscles work less well. People with hypotonia may feeling weaker or having difficulty moving their arms, legs or other parts of their body or to perform certain tasks that require muscle strength. Sometimes it can also affect the way they talk or eat. Some people are born with hypotonia, which means they have had it since birth. Others may develop hypotonia due to health issues. What are the different types of hypotonia? What are the symptoms of hypotonia? And the causes?
Definition: what is hypotonia?
Hypotoniaunlike hypertension, designates decreased muscle tone, i.e. muscle strength. It is manifested by an absence of movement or a reduced resistance to passive movement of the joints. The origin is usually either nerve damage or muscle damage which can be isolated or part of more global pathologies. The affected muscles respond little or less to stimuli or solicitations.
What are the different types of hypotonia?
► Axial hypotonia concerns both the holding of the head, but also the sitting position, and the limbs. It can affect the infant and be the cause of developmental disorders, either temporarily, during an acute illness of any kind, or constantly.
► pyelic hypotonia refers to a decrease in muscle tone at the level of the pyelon, i.e. the renal pelvis. Pyelic hypotonia occurs when the renal pelvis, which is like a small reservoir in the kidney, becomes larger and distended than normal. This can happen if the place where urine passes from the renal pelvis to the ureter is blocked or narrowed. When this happens, urine has trouble flowing properly from the kidney to the bladder. This can cause problems like pain in the stomach or lower back, and urinary infections.
► Ocular hypotonia appears when the eyes have lower pressure than normal. When the eyes have too low pressure, it can cause some problems. For example, eyes may look soft or saggy, and vision may be affected. People with ocular hypotonia may have difficulty seeing clearly or to focus objects. They may also feel afeeling of discomfort or eyestrain.
► Perineal or perineal hypotonia. “It designates a tone [muscles] lower than normal perineum. The woman may have feelings of heaviness, urinary and/or gas leaks and decreased pleasure during sex“says Dr. Erwann Le Rumeur.
► Neonatal hypotonia. Hypotonia is often detected at birth or during infancy. An infant with hypotonia then presents with muscle relaxation which makes him unable to keep his knees or elbows partially bent. The child may later have difficulty eating and developing motor skills. Hypotonia can delay holding the head, then sitting, it can also predominate in the limbs… Hypotonia can be transient during an acute pathology, for example, or be permanent.
Hypotonia is manifested by a weakness or lack of muscle tone. This means that the muscles are not as strong or as active as they should be. Symptoms of hypotonia can vary from person to person, but here are some common signs:
- movement difficulties : They may have trouble standing, sitting, or walking steadily.
- lack of muscle strength : They may have trouble lifting heavy objects or performing tasks that require strength.
- balance difficulties : they may feel unstable or tend to fall off more easily.
- motor development delay in infants and children
- coordination difficulties (ataxia)
- urinary or anal incontinence, pain in the hypotonia of the perineum
What are the causes of hypotonia?
Hypotonia can be triggered by various causes including:
► An anomaly related to the nervous systemwith central hypotonia or peripheral hypotonia, or an abnormality related to the muscular system. For example, disorders such as muscular dystrophy, cerebral palsy, or motor neuron disease can affect muscle strength and cause hypotonia.
► Hypotonia can also be linked to an injury to the nervous system or eyes.
► Certain medicationssuch as those involved in anesthesia for example or neuroleptics, have the desired effect of muscle relaxation.
► Hypotonia can also be caused by a stroke especially if it only affects half of the body.
► In some cases, hypotonia may be due to genetic problems that affect muscle development. This means that the person was born with a predisposition to have weaker or less toned muscles. Genetic diseases like Down syndrome, Prader-Willi syndrome, Tay-Sachs disease and trisomy 13 may be involved.
► Prematurity : Babies born prematurely sometimes have less developed muscles, which can lead to hypotonia.
► At the level of the kidney, it is mainly linked to a ureteropelvic junction disease (where the ureter meets the renal pelvis), and at the ocular level with a trauma.
► “Hypotonia of the perineum often results from neurological diseases, certain treatments, a hormonal cause (menopause), surgeries, constipation chronic with repeated pushing efforts (tissue distension) or ink following a childbirth“explains Dr Le Rumeur.
► Hypotonia can be diagnosed from birth during the initial examination, or later after observation of symptoms. The doctor asks the mother about the progress of the pregnancy and childbirth, and about the child’s medical history. He performs a complete physical examination to assess the child’s abilities. Additional examinations (blood tests, imaging) can be useful to detect possible abnormalities and identify the causes of hypotonia.
► In adults, muscle hypotonia is observed duringa clinical and neurological examination. An EMG (electromyogram) may be useful as well as imaging tests such as a CT scan and/or an MRI. In case of ocular hypotonia, it is the measurement of the ocular pressure which confirms the diagnosis, in particular during a sudden drop in visual acuity or after a trauma.
► When the hypotonia concerns the kidney, it’s ultrasound which allows the diagnosis to be made.
► When the hypotonia concerns the perineum, “the examination consists of examining the tone of the muscle at rest by pressing on the central fibrous nucleus (area of the perineum between the vagina and the anus). If there is no resistance, we are in hypertonia“underlines our expert.
The management of hypotonia generally requires the use of a multidisciplinary team, and is essentially based on a treatment of symptoms. Treatment can also be specifically related to the cause of hypotonia. In the case of perineal hypotonia, for example, the re-education will be paramount. “Some exercises are interesting for contracting and strengthening the perineum, such as low-intensity but long-lasting contraction exercises. Treatments with radio frequency or lasers are also interesting when they play on the tone of non-contractile tissues by stimulating the production of collagen“continues Dr. Erwann Le Rumeur.
► occupational therapy aims to help patients regain their autonomy in the event of a disability. It can be useful for hypotonic children if the muscle weakness is too disabling to perform everyday actions correctly: walking, eating, talking, dressing, etc. The occupational therapist first assesses the difficulties and learns about his environment to recommend material and/or human aid.
► physiotherapy is indicated to restore motor skills. The use of this specialty can therefore be considered in the event of hypotonia. It helps to correct posture, coordination, and provides stability, through regular exercises and manipulations. Thermotherapy (hot), cryotherapy (cold) and hydrotherapy (water) are among the applications of physiotherapy. Physiotherapy is usually performed by physiotherapists.
► speech therapy is recommended for hypotonic patients whose lack of tone affects the mouth and jaw. Stimulation exercises of the oro-facial zone improve language and breathing.
► Children with illnesses such as myasthenia gravis undergo specific, long-term treatment. If hypotonia is associated with any of these conditions, it is managed as part of treatment. Antibiotics taken for meningitis may also help relieve symptoms of hypotonia. Surgical intervention may be necessary in case of renal hypotonia. In case of inflammatory ocular hypotonia, anti-inflammatory drugs are prescribed.
Is it possible to prevent hypotonia?
In many cases, it can be difficult to completely prevent hypotonia, especially if it is due to genetic or neurological conditions. But certain steps can be taken to help prevent or minimize the risk of hypotonia, depending on the underlying cause. Consult your doctor regularly, maintain a balanced diet to avoid deficiencies (especially in proteins to nourish the muscles) and exercise regularly are ways to help reduce the risk of hypotonia. “Concerning the hypotonia of the perineum, eat fiber, play sports, quickly take care of constipation especially if it is repeated reduce the risks” concludes the physiotherapist.
Thanks to Erwann Le Rumeur, physiotherapist.