High tone, tight muscles, hypertonicity… but what does that mean? When Tom was born we could not pull his arms above his head. The muscles were too tight and they just would not stretch. Tone is the resting state of your muscles and Tom’s muscles were hyper (over) active. You might hear someone say high tone (hypertonicity) when talking about your child but they usually don’t explain it.
Children with high muscle tone will benefit from physical and occupational therapy to stretch affected muscles and strengthen opposing muscles which then improves overall functioning.
Tom got a referral for an Early Intervention assessment almost immediately due to his blindness and had the assessment when he was about a month old. He began seeing a TVI (Teacher of the Visually Impaired) at about 6 weeks old. Tom is our first child so we did not notice his tense arms very much. There was so much focus on his eyes at that time because he has his first eye surgeries at two weeks old and another at two months old.
I can’t remember if it was our pediatrician or our Early Intervention team that recommended physical therapy. I was a little surprised because I thought that Tommy was just a crazy strong baby. He could hold his head up, practically from birth, though we always supported him. He was also pushing up at a very young age.
We started physical therapy when Tom was about 5 months old with a woman named Diane who worked with him until he turned three and aged out of EI. She was just what we needed, though we didn’t fully understand how much we needed her just then.
She worked to gently stretch his upper body and open up his chest. He tended to keep himself a bit hunched, or curled into himself. She stretched him backwards and opened up his arm and his chest. They worked with balance balls and did movement that strengthened opposing muscles.
Tom’s PT and OT consisted of real life movements and activities, or positioning that encouraged him to practice using his body in a proper way. The goal is to learn more normal movement patterns that will help the child function. They may position a child on all fours and then sound a toy and encourage the child to move to the toy or sound.
Tom did a lot of work stretching on balance balls and reaching for toys above his head. He still does a lot of reaching exercises at school by working with a peg board and having to put pegs in high on the board. He also works by putting those decorative window clings on windows. The gooey/sticky texture of the window clings gives tactile feedback that adds additional interest or challenge to the activity.
They also do massage and joint compression. I had no idea what joint compression was until his school physical therapist, Ms. Sue, demonstrated it on my own wrist. I came to realize that Tom had been trying to give me some joint compressions and I just didn’t understand! You just lightly squeeze or push on a joint. This sensory information can be very calming for children. All I know is that Tommy seems to enjoy it and benefit from it. In fact, I have to start doing more joint compressions. You can read a bit more about joint compressions and see a demo video at Sensory & More.
There’s a lot of information about hypotonicity (low tone) but very little about high tone. Pediastaff had a great overview – Understanding Hypertonic Cerebral Palsy. Don’t let cerebral palsy in the title make you think this article isn’t for you. Tom doesn’t have that diagnosis but he sure does have hypertone! It is a great read.