11. Jul, 2017

Why is muscle tone so important?

MUSCLE TONE

 

What is muscle tone?

Muscle tone can be defined as the degree of tension present in the muscles of the body, which enables one to assume different postures against gravity.  Sufficient muscle tone provides a base for accurate movements and is necessary for every motor action the body makes i.e. to crawl, to sit upright in a chair, to squat, to grasp a pencil etc.

 

Low muscle tone can affect kids to different extents. Low muscle tone is the term used for muscle tone which is at the lower end of the normal range of muscle tone. High muscle tone is known as spasticity, and very low muscle tone as flaccidity. However within the normal range there is a subtle difficulty which lies at the lower end of the normal range.  Low muscle tone therefore indicates that the tension present in the muscles of the body is not sufficient to assume and maintain a range of postures.

 

For some babies the symptoms of low muscle tone are obvious from birth, while for others the low tone might be invisible for the parent to see; your child seems perfectly good with their muscles - they are strong, they run around, but they have trouble doing certain motor activities.  Remember that a lack of muscle tone and a lack of muscle strength are not the same thing.  A muscle can be as strong as a bodybuilder's and still have low tone. The child needs sufficient tone in two kinds of body muscles: 

 

  • The muscles that enable the child to assume and maintain postures against gravity.  These muscles are usually deeper inside the body, close to the skeletal structures of the body – low tone in these muscles leads to insufficient stability of the body when assuming & maintaining postures.
  • The muscles that enable movement.  These are usually superficial muscles, further away from the skeletal structures of the body.

 

You have likely been given the standard explanation about your child’s muscles being floppy and you just cannot see it in your kid.  Your kid may seem to do everything just fine, but keep the same muscles working for any length of time and they will tire faster than another child’s muscles. Further due to the speed of the muscle response being slower, kids with low muscle tone have trouble keeping up with the speed and agility of similarly aged kids. For example, with jumping off steps, kids with low muscle tone will often land in the frog position, as their muscles cannot respond fast enough to keep them on two feet.

 

Low muscle tone might be one of the signs of other problems for example a problem in central vestibular processing.  The vestibular system takes in messages about balance and movement from the neck, eyes and body and sends the message to the central nervous system for processing; the brain then ‘tells’ the muscles exactly how much to contract so that you can resist gravity and move smoothly and efficiently.  

 

Warm-up activities can help increase muscle tone by activating the muscles. These activities however, will not lead to a permanent change in your child’s muscle tone. Encourage your child to do a warm-up activity before doing an everyday activity. For example, bouncing on a mini trampoline before sitting at a table to draw may help your child to sit up straight rather than slouch. Squeezing and rolling play dough before writing may help your child to maintain her hold on the pencil and write for a longer period of time.


Signs that your child might have lower muscle tone than expected.

 

  • The typical posture of these children is winging of the scapulae (shoulder blades), a protruding abdomen and increased lumbar curve, hyper extended knees, arms fixed at the waist, a wide standing base with hyper extended knees. Their ligaments can also be lax in their elbows, and joints of their fingers bending too far out.
  • May have a weak grasp on objects for example struggle to turn doorknobs or open lids.
  • Child might find it difficult to get into a new position or to maintain a position.
  • Child struggle to lift up their heads in a prone position and dislikes the prone position.
  • Child shows delayed motor development.
  • Child might slouches in sitting position or uses an m-sit position (sit in M way, with knees pointing forward and feet splayed to the side for added stability.).
  • Child usually wants to lean on you or any other object instead of standing and sitting independently.
  • Child leans with their head on their arm when sitting at a table.
  • They may handle objects loosely or with a very tight grasp in order to compensate for the underlying low muscle tone.
  • A child with low muscle tone may need to exert more effort when doing an activity to activate their muscles. As a result they may have difficulty maintaining a good posture when sitting or standing and may get tired easily due to the extra effort that is required
  • They may have problems with digestion; frequent constipation or have poor bladder control.
  • Child may also have low tone in their mouth area and could drool, tend to keep their mouth open or words may not be formed clearly.

 

Why is muscle tone important?

  • When you consider how muscles are tied to every physical endeavour we do, from eating, to talking, to facial gestures, to crawling, to just sitting still, you can then start to appreciate the significance this has to an individual with low muscle tone.
  • See above mentioned signs.
  • It plays an important role in body knowledge since it helps the brain to establish where the rest of the body parts are and therefore helps with controlled movements and later space perception.
  • The child is not always aware of the amount of pressure needed to perform an activity and would for example hold a pencil too loosely or to tight.
  • Helps child to assume new positions and to keep positions for the required time.
  • Important for the development of gross motor- and fine motor skills.
  • Child needs to adapt their posture for example sitting posture regularly and can’t keep the position for a long time and this influence the quality of their work as well as their attention levels.
  • Low muscle tone may cause poor development of bilateral movements (moving both arms and legs together in a well controlled manner), motor planning (important to plan and perform new activities) and protective reactions (slow protective movements e.g. stretching out hand or feet when loosing balance in order to regain their balance.)
  • Speech development might be delayed.

 

Exercises to improve muscle tone.

In general:

  • Expose the child to much playtime where they can exercise e.g. climbing on a jungle gym, obstacle courses where they can climb over objects or crawl under objects.
  • Always keep activities playful in order to keep your child motivated.
  • Improve your child’s muscle tone by doing exercises that have one or more of the following qualities:

Activity requirement

Some examples

Remember to always keep safety in mind

  • Activities that require the push, pull or carrying of objects and people.
  • Put in suitable added weight (e.g. telephone book) for their size and age for more resistance
 
  • Push/pull objects like boxes, blocks, play toys, wagons, carts, doll buggies, laundry basket etc.
  • Helping in the house and garden for example watering plants with watering can.
  • Help carry shopping bags/toys.
  • Carry a weighted ball/bean bag and place it in a raised basketball or a box on a chair.
  • Put a ball/balloon on a small blanket; you hold one side & he hold the other side – now try to bounce the ball on the blanket.

Activities that require muscle contraction

  • Let child lie on his back; hold both ankles in one hand and keep shoulders on floor with other hand; bent knees and move legs from side to side to give child feeling of body parts moving separately.
  • Reaching activities to improve the ability to stand on toes and raise arms above head. Use magnets placed up high on the refrigerator or reaching up to see what is on a high counter or table. Hold books up high and have your child point to pictures.
  • Obstacle course: encourage crawling over a mountain of cushions or pillows, crawling under tables and through tunnels or boxes, as well as stepping on or over objects.
  • Let child sit in box/laundry basket/on scooter board (almost like a skateboard) and pull him around and later lie on an open box and hold a rope while you pull him; later he can hold onto a hoola-hoop while you pull him around on the other side of the hoola-hoop. Start by moving slowly to make sure your child can use his trunk muscles to maintain balance. Then, move it quicker, starting and stopping, side to side and front to back.
  • Squat to pick up items and lift and carry. Put toys so that he is encouraged to squat and play. Children can help unpack groceries and place on countertop or a low shelf.
  • play wrestling,
  • games like tug of war (pulling on rope or toy),
  • Have a pillow fight; use small light pillows in the beginning; keep it playful.
  • Tape paper up on the wall just above eye level and provide crayons or markers. The goal is for the child to scribble with arm and hand above shoulder height.
  • Climbing onto appropriate furniture or ladders and jungle gyms at the playground

Endurance activities that require many repetitions of an exercise

  • Animal walks: Bear walk (on hands and feet with bottom in the air), duck walking in a squatting position, jump like a frog, hop like a rabbit, kick like a mule (hands on floor & kick feet up)
  • Lying on back riding a bicycle in the air; you might at first have to hold legs at ankles and do the movement for him till he can do it on his own.
  • Play games like row-your-boat, where you pull your child up and let him down in a rowing motion. Again, be careful and don't go too fast.
  • Sit-ups: Sit facing each other with legs straight in front (your legs will go past hers); both hold on to ball or small hoola-hoop; take turns to go lie down on back and sit-up.
  • Do activities while standing in upright kneeling position.
  • Riding a scooter/tricycle

Activities where the child makes bouncing movements in a fast, repetitive/arrhythmicmanner

  • Let child sit on you lap facing you (hold at hips) while doing a rhyme like: We going to the farm and we are on a sand road, sand road (bounce up & down); we are going to the farm and we are on a rocky road, rocky road (bounce quicker and more irregular) and there is a hole in the road (let him almost slip through your legs and lift up).
  • Let child sit on big therapy ball (± 40 cm ball) & hold at hips (giving nice pressure on hip joints) while bouncing up & down; You can also shift weight from one buttock to the other (side to side) while supporting, as this will teach child how to correct for imbalance.
  • Jumping on a mini-trampoline: first let him sit on your lap and gently bounce up & down, later hold his hips if scared and let him jump up & down; when he is fine with that you can hold both hands while he’s jumping till he can do it unsupported .

Activities that stimulate the vestibular / movement system

  • Hold him under the tummy and swing him around like a aeroplane , first only forward & later backwards.  Stop if he wants to stop.
  • Let him roll from one point to another.
  • Cocooning: Wrap the child tightly in a sheet, blanket or beach towel, and then hold tight like a caterpillar in a cocoon, now encourage child to roll (if on floor) or spin (if standing) out of cocoon.
  • Swings: Normal swing / frog swing / spandex-swings. (Available at Therapist Playroom, Tel.no: 0117825355, Cell.no: 0823226553, e-mail: lynpaula@iafrica.com ; Geppetto’s World www.geppettosworld.co.za ; Clever fish www.cleverfish.co.za )
  • Stop-and-go movements important: for example catch swing and talk to child/hug in swing and let go again – repeat.
  • One foot balance activities: lift one foot to step on bubbles blown low on the floor, kick a ball, step on and off steps, step over obstacles.

Activities in prone (lying on the tummy)

 

  • Do activities like building blocks while lying on tummy (start with short periods of time & gradually increase)
  • Mom lies on her back and pull up knees: let child lie on his tummy on your legs and move him forward & back & sideways.
  • Encourage child to roll a lot. Remember to do rolling action to both sides.
  • Lie on tummy in swing especially swings like spandex/lycra swing
  • Let child lie on their tummy over therapy ball (± 40 cm ball, start with smaller ball) & hold at hips (giving nice pressure on hip joints) while moving forwards/backwards & sideways. Let child reach for toy on ground when moving forward and hand it to you. Later put toys further and let child walk on hands to the toy or use bean bags and let child throw the bean bag at a big target.
  • Let the child stand in crawl position and push a ball with his head to you; later encourage him to crawl while pushing the ball.
  • Make a tunnel with spandex/lycra and let him crawl through it/ you can put toys inside as well and let him find the toys.  Make tunnel small enough that he can’t stand in it, but have to crawl through.

Do a warm-up activity before an everyday activity to temporarily increase muscle tone. This will help your child feel what it is like to do an activity with a better posture.

 

  • Bounce on ball,
  • Jump/bounce on mini-trampoline,
  • Jump up & down,
  • Jump like a frog,
  • Tug of war,
  • Ball games.

     

  • Arm and hand warm-up activities:
  • Playdough or theraputty – roll, pinch, squeeze, pound and make sausages or balls
  • Magazine scrunch – scrunch up piece of magazine into balls. Once a few balls have been made get your child to throw them into a bin or at a target.
  • Squeeze soft balls, sponges or face washers.
  • Pick up small toys or objects and place them in a container.
  • Pick up objects with a tong.
  • Put cloth pegs around a holder or face cloth.
  • Spray bottles – water plants or make pictures by spraying water paint on paper.
  • Carrying objects e.g. help carry small shopping bags.
  • Hammering activities.
  • When your child is seated at a table, be sure your child has adequate foot support . Feet should be flat on the floor. If the chair is too tall, use a phone book or small stool so that feet rest properly.

 

  • The older child will also benefit from participation in activities like horse riding, swimming, gymnastics, monkey-nastics, modern dancing, ballet etc.
  • Exercises to improve muscle tone must be done regularly

 

Tongue and mouth exercises

  • Sucking & blowing exercises when old enough.  For example blowing bubbles with a straw in water.
  • Make funny faces.
  • Stick out tongue as far as possible and move it from side to side and up & down.
  • Lick lollipops.
  • Lick off peanut butter or syrup that is painted around the lips
  • Suck sweets like life savers that have a hole in the middle.
  • Sucking of icicles.
  • Chewing crispy and crunchy foods that require chewing like biltong, jelly sweets or chappies (when old enough to spit out)

 

Muscle tone forms an important part of all motor development and later also influence perceptual and cognitive learning. Please do relevant exercises regularly and consult you Occupational Therapist if you are concerned about the progress or other developmental milestones.  Early intervention is always better than having problems later on.