PPP Symptoms : Muscular Hypotonia

What is a muscular hypotonia?

There are various names for a pathologically low muscle tone: hypotonia, muscular hypotonia, and floppy infant syndrome. Muscle tension and muscle tone describes the state of stress or the residual stress of a muscle or muscle group at rest, in motion, or during exertion.

In the case of a hypotension, muscle tension at rest is very low.This is a frequent  symptom in many genetic disorders.


What are the effects of  muscular hypotension?

With muscle tension contributing to almost all important processes within the human body,  muscular hypotension has an impact on most areas within it.  Here are some of the effects:

In general :

  • Delayed or impaired motor development

Infant Stage:

  •  Limited neck and head control

  • Unstable in parents‘ arms

  • Easily fatigued and sleeps often

  • Cannot easily reach their legs or bring their feet to their mouth Delayed rolling over and crawling

  • Delayed sitting


During Childhood:

  • Requires great effort to control the body or stay in a single position

  • Later, when child is able to sit with minimal support, they might  require to put their head down on their hands or the table

  • Late development of walking abilities mostly driven by by the weakened trunk control

  • Partially jerkyand unbalanced movements

  • Sometimes the children compensate for their lack of voltage by the increase tensing of certain muscle groups; this looks like a surge (hyperkinesis).

  • Walking often looks like stomping with small steps and a broad base

  • Might experience frequent stumbling and falling

  • Transitioning to standing or sitting might lead to additional falls as it is difficult to aquire the necessary muscle tension to hold against the force of gravity

  • The kids start to cool down faster than other kids

  • These challengesmay be increased due to the additional impairment of proprioception


Difficulties in the proprioceptive perception (deep sensitivity) :

Proprioceptors are nerve cells that report the position of the tendons and joints in space to the brain, and back.  Hypotonia often affects the proprioceptive perception because the proprioceptors are located in the muscle fibers and joints.

  • It is difficult while sitting at the table (is a-based position in which the child can feel that him to build of the necessary tension is relieved )

  • The children like to have a close limits, in order to feel strong stimuli.

  • Clear, firm, close touches at the joint are best felt.

  • Children may like to lie on a hard surface because you can feel better throughout the body.

  • Children often appear rough, restless, aggressive and clumsy


Instability of the joints and the skeleton

The skeleton is held in place by the tension of muscles and ligaments. If the muscular tension is missing or is weakened, the joints are offset. These joints are called: Hyper-mobile joints. Development of poor posture include:

  • Fallen arches (ankles bend to the inside, low-profile arch of the foot)

  • Scoliosis due to weak back and abdominal muscles

  • Difficulties in Grasping and Holding objects


Difficulty speaking:

Learning to talk requires complex motor and cognitive skills. Since children affected by Jordan’s Syndrome often have poor face, mouth and tongue motor skills which affects the acquisition of language. This reveals itself in a few ways:

  • Children might smile late

  • Children might have limited facial expressions

  • Sounds to shapes is more difficult

  • Weak mouth muscles may lead to difficulty closing the mouth and impaired ability to speak clearly

  • Children know what they want to say and will try, but their body can't perform the required action.


Difficulties in food intake:

Due to the decreased muscle tension in the orofacial tract, the following are strongly affected:

  • Difficulties in breast-feedingDifficulty swallowing might lead to frequent aspiration and potential lung inflammation

  • Difficulty opening and closing the mouth leads to open mouth posture and breathing through the mouth. This may lead to more frequent respiratory infections. Frequent drooling

  • Trouble with coughing  because of the weekened diaphragm muscles Frequent respiratory infections that might take longer to heal


Problems with digestion and elimination:

Hypotention plays an important role in the digestive system and its impact on the internal muscles.

  • Gastro-oesophageal Reflux occurs because the muscle that closes the stomach is too loose. The very acidic stomach content can flow due to  small changes (change from sitting to lying or vice versa, or pressure on the abdomen...) which flows into the esophagus. This might cause coughing, pain, frequent vomiting, etc. The reflux can be medically diagonosed and treated through medicatio

  • Because of  the difficulty in food intake, the body lacks important dietary fiber (vegetables, fruits, cereals) for the digestion process.

  •  Children may need help with bowel movements otherwise it might cause severe pain

  •  Some children might deal with alternating diarrhoea and constipation.

Experiences, tips and advice from parents:

Below are some exercises to help strengthen your child’s core and upper body. Be sure to provide the right amount of support and encouragement through the exercises as it‘s important to create an enjoyable experience for you and your child.


These home exercises can supplement physiotherapy - but they do not replace a physiotherapy treatment. Before performing the exercises, it is important to assess the child’s vision and hearing. This way, stimuli can be found that motivate the child.
For example, you can use toys in light-colored or black-and-white toys with contrasting strains if the visual sense is impaired. Doing the exercises bare foot can provide additional stimulation to the child. For lying on the stomach you can also use the following tools: rolled towel, nursing pillow, thighs, as long as they are not too soft to provide enoughstability.  Eye contact with your childcan help you recognize immediately if they do not feel well or are in pain.


Head lifts while lying on their stomach

Place your child on his/her stomach on the floor or your thigh.

Support your child’s head with your hand and gently nudge upwards to encourage them to lift it.  You can also tickle them which may produce a lift reflex. Be sure to provide lots of vocal and visual cues. Alternately, you can also lie down in front of your child and engage with them by singing, talking, playing with toys etc. For more support, place a rolled up blanket or cushion under their chest.

Head lifts while lying on a physiotherapy ball

  1. Lay your child on his/her belly on top of a physiotherapy ball.

  2. Gently rock the ball, swaying from side to side to get your child accustomed to it. It is important to create an enjoyable experience for your child. Talk, sing, laugh with your child to get them engaged.

  3. Begin rocking the ball back and forth to get them to raise their head. Provide encouragement by tickling them and with vocal and visual stimuli. As your child gets stronger, she will be able to raise their head more.

  4. Roll the child on the ball from side to side and with the slope of the ball encourage them to turn over and later move to the seating position

Crossing midline while lying on their back

In order to raise your child’s awareness of their midline, take their left leg and right hand and touch them together. Repeat with their right leg and left hand. ting position

Knees to head

Gently push your child’s knees to their head while simultaneously lifting their head. Do not push more than is naturally possible and provide as much support as needed for the head.

Lying on the side

  1. Place your child on their side and encourage them to roll onto their stomach and back by moving a toy or tickling them. 

  2. Have them also spend some time on their sides as well in order to raise awareness of their shoulder movement. Place their legs in a position similar to the picture below.

Lean forward

Place your child on your lap and encourage them to lean forward towards you to help strengthen their necks and shoulders. 

Core Strengthening Handbook

One of our families highly recommends the core exercises in the Core Strengthening Handbook, which is available in PDF from the link below for $12.99. Payment through card or Paypal is accepted.

Link to book purchase


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