Monday, January 21, 2019

Low Muscle Tone

Low Muscle Tone

Muscle tone can be defined as the tension present in the muscles of the trunk and limbs, which enables one to assume different postures against gravity, and forms the basis for all movement. Sufficient muscle tone provides a base for accurate movements and is necessary for every motor action the body makes.

The strength and tone of the muscles of the body develop from the body outward to the limb. E.g. the strength and tone of the muscles develop from the shoulders to the arms, to the wrists, to the fingers. Thus one cannot expect the finger muscles to be strong if the shoulder muscles are not strong.

Low muscle tone is a weakness of the muscles. A child with this condition is usually unable to perform normal everyday activities in a well-coordinated manner. Low muscle tone is a condition that in this computer and television age is unfortunately becoming more prevalent.

Children with low muscle tone are usually physically unfit; they tire easily, have poor posture, and are unwilling to participate in normal outdoor childhood games.

When parents are informed that their child has low muscle tone, they are often very surprised, as they experience their child as "stronger" than many other children. This phenomenon can be explained when considering the following:

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.
§ The muscles that enable movement. These are usually superficial muscles, further away from the skeletal structures of the body.

When a child experiences low tone of the muscles of his trunk and limbs, he will experience insufficient stability in his body when assuming and maintaining postures, as well as when performing activities which require movement. To compensate for this difficulty, his body will increase the size of the superficial muscles, trying to give him more support in general. For this reason, many children with low muscle tone appear to have quite an athletic build. The tone of the deeper muscle necessary to assume and maintain postures is still insufficient though, leading to typical symptoms of low muscle tone.

In the ‘Olden days’, before children were confined in town houses and fiats, they played outdoors. They ran, hopped, skipped and took part in games such as blind man’s bluff, catchers, hide and seek, ‘piggy’ and statues. They walked or rode bicycles to school. These activities helped children to develop the muscles of the body and to make friends while learning to play by the rules and to win and lose in a socially acceptable manner.

Many of today’s children are ferried to and from school in lift dubs. Many of today’s children spend hours in front of the television or computer. Their gross motor skills are not fully developed, their posture is poor they are not learning to communicate and their language and descriptive skills are often under developed.

A child who has low muscle tone may experience some of the problems listed below:

§ Low muscle tone indicates that the tension present in the muscles of the body is not sufficient to assume and maintain postures. To maintain postures against gravity, the muscles of the body will thus have to work much harder to compensate for the insufficient tone in their muscles. For this reason, the child with low muscle tone often experiences tiredness, dislikes motor activities like sport, and battles with gross and fine motor skills.

§ Physical problems: Often causes physical injury to due to clumsiness and poorly coordinated movements. May have problems in crossing the midline of his body-this often leads to learning problems. Is usually unfit and tires easily.

§ Emotional problems: Is afraid to venture into the unknown. Lacks confidence. Is afraid to explore and learn new things. Usually has poor self-esteem. Is seldom chosen for team games. Often becomes a ‘loner’ and does not make friends easily. Often lacks the ability to persevere and may give up in the middle of a task.

§ Posture: A child who has poor posture does not walk or sit up straight. He battles to maintain an upright sitting posture in his chair. He might slide down after sitting for a while. He does not sit still, and tends to fidget. The muscles of the neck get tired easily when sitting for a period of time. He might support his head with his hand while sitting at a table. This often causes concentration problems in school and back problems at a later stage. His shoulders are curved in a forward direction, his back is curved, and his stomach is pushed forward, his shoulder blades tend to make wings, the joints of his knees tend to over-extend and lock, when he walks he drags his feet.

§ Laterality: Does not have equal control over both sides of the body.

§ Dominance: Is usually late to establish a dominant side.

§ Poor fine motor skills: May have difficulty in cutting, writing, threading and doing jigsaw puzzles. Insufficient pencil grip or pencil control.

§ Language skills: May have poor communication skills.

§ Spatial skills: Because he has not had the opportunity to learn by exploring and investigating, his experience of space and distance will be limited. He will also find it difficult to judge length and height. He may struggle to set his work out neatly on paper and will possibly experience reversal problems when reading and writing letters and numbers. He will find sequencing activities such as reading and spelling difficult. Problems in the area of mathematics are very often related to poor spatial skills.

What is the result of poor muscle tone?

§ A general delay in development, especially in relation to gross and fine motor skills. The quality of his motor skills will be poor.

§ Poor performance in school in relation to activities like writing neatly, completing tasks in time, cutting with scissors, drawing skills, the ability to sit still and concentrate for a required period of time, etc.

§ Hyperactive behaviour: the child moves around a lot in the attempt to build up the tone of his muscles, which gives one the impression that he cannot sit still. This might distract his attention from his work, which can lead to concentration difficulties. If the child gets tired easily, it will make it difficult for him to concentrate well for long periods of time.

§ The child might appear tensed with frequent headaches and tiredness.

How to determine if the child experiences low muscle tone:

§ If the child experiences many of the symptoms mentioned, the possibility is very strong that he experiences low muscle tone.

§ When you palpate the muscles of his arms, you might notice that they feel "soft". When he straightens his elbows his elbow joints might overextend.

§ If motor skills in general are delayed, muscle tone is normally insufficient.

§ Let the child lie on his back Ask him to make a ball with his body. He must bend his knees and bring them up to his chest. His arms must be on his chest, not holding his legs. He must lift his head from the floor. Let the child try to maintain this position for as long as he can without rocking his body. If the child cannot assume or maintain this position for the time period indicated below, it could be a sign of low muscle tone:

The 4-year-old: can maintain this position for at least 14 seconds
The 5-year-old: can maintain this position for at least 14-20 seconds
The 6-year-old. can maintain this position for at least 20 seconds

§ Let the child lie on his stomach. Ask him to make an "airplane" with his body: Let him stretch out his arms and lift his head from the floor. He must also lift his legs from the floor; knees are straight and toes are pointed. His knees are not allowed to touch the ground. The child must try to maintain this position for as long as he can. If he cannot assume or maintain this position according to the norm for his age, it can be a sign of low muscle tone:

The 5-year-old: can maintain this position for at least 15 seconds. He does not have to be able to lift his knees from the floor, though
The 6-year-old: can maintain this position for at least 20 seconds

What can I do to improve muscle tone?

How often do you hear a parent say, "I hated sports at school!"? These parents often have children who dislike physical activities. Educationalists and therapists the world over agree that it is important to develop the whole child physically, intellectually, socially and emotionally.

Parents need to instil in their children a desire to be physically active. They need to create opportunities that enable their children to explore the potential of their own bodies and the world around them.

Agile athletic children usually have agile, athletic parents. These children are naturally active and enjoy games and physical activities. Other children have to be encouraged to participate in physical activities.

Participation in sport is essential. Examples of sports, which are excellent to improve muscle tone of the body, are: karate, judo, wrestling, gymnastics, swimming, ballet, and Catrobatkidz etc.

Expose the child to a lot of playtime where he can exercise his muscles, i.e. climbing on a Jungle Gym. Try to take him to places where he can climb and play on apparatus like these.

A child’s muscle tone can be improved by doing exercises, which have one or more of the following qualities:

§ Activities requiring the push or pull of objects or people. Examples are moving furniture, working in the garden or in the house.
§ Activities requiring muscle contraction, i.e. climbing on a Jungle Gym
§ Activities requiring endurance from the child, i.e. a lot of repetitions of an exercise. Riding a bicycle or tricycle will increase the child’s muscle tone as well as his physical endurance and balance.
§ Activities, which require a position where the head is lower than the heart: this position will cause the tone of the muscles of the body to increase, as it has a certain neurological effect on the nervous system. Examples of this position are: handstands, wheelbarrow-walking, hanging upside down from a swing, etc.
§ Activities where the child bears weight on his knees, hands, or hands and knees. Examples are crawling, handstands, wheelbarrow-walking, etc.
§ Activities where the child makes bouncing movements in a list repetitive way. Examples are: jumping on a trampoline, jumping with feet together like a rabbit or frog, etc.
§ Activities, which stimulate the vestibular system (movement), will also improve muscle tone.
§ Exercises that improve muscle tone must be done at least 3 to 4 times a week with the child. Muscle tone takes a long time to improve, the child will need to participate in sport and do exercises to improve his muscle tone for at least 6 months or longer to make a difference in his performance.


Level I

·       Play a game where the child must listen and then respond to a whistle being blown. E.g. when you blow the whistle once he must run fast, when you blow the whistle twice he must stand still until you blow the whistle again. A variation to this exercise: the child must run fast or slow, depending on how you blow the whistle.
·       Any activity where the child can run a lot
·       Have a pillow fight: The children can stand on their knees, sit on the floor or stand up straight when they have the pillow fight. Each has a pillow and they must hit one another with it. The child who falls over or loses his balance is the loser.
·       One child stands on all fours on the floor, while the other child tries to push him over to lose his balance. The children can take turns. One can let the child stand on his knees instead of on all fours, when his ability to contract his muscles during this kind of activity has improved.
·       Let the child run up and down a slope.
·       Let the child spend some time on the floor on his stomach while doing an activity or watching television: He must bear weight on his forearms and is not allowed to support his head with his hands. This position will encourage the strengthening of his the shoulder and neck muscles:
·       Put beanbags with different colours in front of a drum or big ball. The child can then lie on his stomach over the drum or ball, to enable him to grab hold of a specific coloured beanbag when you move him in a forward direction:
·       Tie a piece of rope or elastic to the legs of two chairs about 15 cm. above the floor. The child must then run and try to jump over the rope. Increase the height of the rope as the child’s skills improve. For the younger child, one can do the same activity where the child must run and then jump over a hose or rope lying on the grass.

Level 2

·       Crab-walking: Increase the distance the child must walk as his strength increases:
·       To improve the tone of the muscles of the mouth, choose activities where the child has to blow, suck or chew something. Examples of blowing are: blowing soap bubbles, blowing up balloons, blowing out a candle. Examples of sucking and chewing are: eating Peanut butter, a sucker, apples, popcorn, a Granola bar, carrots, raw vegetables, toast, dried fruits, licking syrup or condense milk from his lips, drinking a thick milk shake through a straw, etc.

Jumping exercises. Examples are:
·       Jumping with two feet together.
·       Let the child see how far he can jump with his two feet together: He must run up to a certain point and then jump; measure the distance.
·       Star-jumps: The child stands with his feet together, hands next to his body. Let him jump landing with his feet apart and his bands above his head. Then he must jump again, ending up with his feet together again and his hands next to his body. Repeat these two steps.
·       Playing Hopscotch: Draw big circles or other shapes on the floor, all connected to one another. The child can jump through the pattern in different ways and different sequences:
·       Jumping up and down stairs
·       Jumping on a trampoline in different ways: Examples are jumping with two feet together, making star-jumps, jumping on one leg, jumping in a certain sequence, etc.
·       Let two children "sit-lie" on the floor with their feet against one another, lifted from the floor. They must also keep their heads lifted from the floor during this exercise. Let them by to push one another away by pushing only with their feet:
·       Head-soccer: Let the children stand on all fours. They must then “head” the ball away in different directions instead of kicking it with their feet, playing soccer in this way.
·       Help the child to stand on his head for a few seconds at a time
·       Making handstands. In the beginning the child can try to stand on his hands momentarily. When he manages this well, you can ask him to stand on his hands for a longer period at a time.
·       Let the child lie on his stomach. He must lift his head, arms and legs up to make an "airplane" with his body. He must then try to make rocking movements, forwards and backwards in this position:
·       Running races
·       Let the child pretend to be a snake and sail across the floor from point A to point B
·       Let the child hit or kick a punching bag. One can make your own punching bag, by putting a big ball inside a material bag and suspend it from the roof or a branch of a tree.
·       Let two children hold the ends of a blanket, while standing up or standing on their knees. Put a ball in the blanket they are holding. The children must then try to throw the ball up and catch it again, using the blanket. See how many times they can do this.
·       Make heavy sandbags for the child to play with: Use scrap materials to make the bags with and fill them with sand, beans or rice.
·       Wrestling playfully
·       Tug-of-war: Divide the children into two groups. Let the two groups each stand in a row, the two groups must face one another. The two groups must now grab hold of the same thick rope On the count of three they must start pulling against one another trying to pull the other group over a certain point previously decided on. The group, which is the strongest and can pull the other group over the point, is the winner.

·       Let the child bend down and grab hold of his ankles or knees. He must now try to walk as fast as he can without falling over. Let him by to walk forwards, backwards as well as sideways.
·       Let the child pretend to be a duckling: He must go down on his haunches and put his hands on his knees. Let him walk in a forward direction without falling over. He can also by to stop and maintain the position for a while, while the "duckling" eats his food and drinks water.
·       Let two children stand on their knees, facing one another with their palms against one another. Let them see who can push his partner over by using only his hands to push with, other body parts are not allowed to touch.

Level 3

·       Push-ups, increase the amount of push-ups the child does as his skills improve
·       Sit-ups increase the amount of sit-ups as his skills improve. The child can do sit-ups with a friend too. Use a hoop or elastic band for them to hold onto to pull himself up with:
·       Let the child do pull-ups against a pole or a washing-line: Lift the child up in order to grab hold of the pole. Encourage him to lift himself up for his nose to touch the pole a few times. If necessary, hold his legs to help support his body weight while doing this activity.
·       Let two children stand back to back. They must then try to sit down and stand up again, maintaining back-to-back contact with one another.
·       Let two children sit back-to-back. They must then lift their feet up in order to try to touch one another’s toes while maintaining this position.
·       Jumping exercise Let the child start by standing with the left foot in the font hoop and the right foot in the back hoop Then he must jump m such a way that he will end up with his left foot at the back and the right foot forward. Let him do this repeatedly. You can let him do this exercise without using hoops:
·       Let the child lie on his back with you standing a distance away from him, facing him. He must lift his head to see when you throw a beach ball for him. Let him by to kick the ball back to you with both feet. He is not allowed to support his head with his arms in this position.
·       Skipping with a rope in different ways
·       Arm-wrestling: Two children sit at a table facing one another. They must put their elbows on the table and hold hands. The children must now each on the count of three push down with their hands trying to push his friends hand down to touch the table. The child who manages this first is the winner. Note that they are not allowed to use any other part of their bodies during this activity, only their arms.
·       Jumping exercise: Let the child stand on his hands and knees on the floor. Put two hoops by his feet. He must now support his body with his hands, while jumping with his feet back and forth between the two hoops:
·       Let two children stand facing one another while they both hold onto the same ball. Their hands are not allowed to touch one another. They must then by to take the ball from the other by only using their hands; they are not allowed to use any other body part to help during this game and no other body part is allowed to touch the ball.
·       Suspend a ladder horizontally. Let the child grab hold of the first bar of the ladder in such a way that he can hang in this position. He must then try moving forward by grabbing the bars. Hold him by his knees to help support his body weight in this position, if necessary.
·       Hang a rope from a branch of a tree for the child to swing on.
·       Let the child stand with both feet together: let him jump up in the air keeping his feet together while he tries to make a 180 deg. turn in the air. He must try to land with both feet together. He can also by to make a 360 deg. turn.
·       Let the children stand in a row, about 2 meters or more from one another. They must all bend forward a little, putting their hands on their knees. The last child in the row must then run and jump over each child in the row and then stand in the front of the row. Each child gets a turn.

Monday, January 7, 2019

W-sitting in Children

W-sitting in children: A habit worth breaking?

“W-sitting” or “W-sit” is a term used to describe a sitting position in which a child sits on the floor with their legs forming a “W” shape on the floor (knees bent, legs rotated and facing away from the body).
When is it ok?
Children often move into and out of this position during play or when transitioning from crawling to sitting. W-sitting is OK and perfectly normal if used in this way. It temporarily widens the base of support, giving the child a greater sense of stability and balance during play.
When is it NOT ok?
However, this position should not be encouraged for prolonged periods of time during play as it will lead to future orthopaedic and musculoskeletal issues, affecting muscles and joints of the back and lower limb. Long-term W-sitting is NOT encouraged as it will make the child become reliant on this position for added trunk/hip stability to allow for easier toy manipulation and play. Their trunk muscles will not be activated sufficiently for them to learn and practice weight shifts during rotation and lateral (side) movements of the body.
W-sitters are often children with:
·        Low muscle tone
·        Hypermobile joints
·        Difficulty with balance
Side effects of W-sitting:
·        May develop sway back posture
·        Walk and stand with feet turned inwards
·        Weak trunk and low back muscles
·        Tight hamstrings and low back muscles
Why do children choose to W-sit?
In W-sitting the legs are rotated outwards and spread wide apart. This means that there is a larger base of support and hence less work required by the trunk muscles to stabilise the body. The trunk muscles are important for maintaining an upright posture and reacting to shifts in balance. Possibly these children have not developed sufficient trunk rotation (twisting) or lateral flexion (bending to side) for weight shifts and so relies heavily on the wide base of support for maintaining stability during physical activity and play.

Correcting the Habit
Often W-sitting becomes a habit very quickly and it is important to address it promptly.
Encourage other ways of sitting:
·        Cross-legged
·        Side-sitting with both legs out to one side (make sure they alternate the side)
·        Sitting with legs straight out forward as able (hamstrings can be stretched at the same time)
·        Sitting on a low stool or a cushion

 Exercises and Activities
1. Strengthen the trunk muscles
a) Side to side rotation: Lying on the back with knees bent, slowly rotate legs from side to side but not letting knees touch the floor.
b) Side-sitting transfers: Start with side-sitting on one side. Without using their arms, the child moves from side-sitting onto their knees, then transfer to side-sitting position on the other side. Repeat in the other direction.
c) Seated marches on swiss ball: Sitting on a large swiss ball, ask the child to lift one foot off the ground and then the other, alternating side to side similar to marching.
d) Reaching on swiss ball: Sitting on a large swiss ball, hold objects at different distances and heights for the child to reach out for. This will train their trunk muscle control and strengthen the trunk muscles.
e) Bottom-walking: Sitting on the floor with legs straight out in front, the child bottom-shuffles by lifting one side of their bottom off the floor and moving forward, alternating side to side.

2. Back strengthening/Hip and shoulder stability
a) Superman arm/leg lifts: With the child on all 4′s, you can get them to do alternate arm lifts, leg lifts or combined arm-leg lifts (diagonal) – whilst maintaining stability and balance at all times.
b) Walking on all 4′s: You can get the child to walk on all 4′s (like a dinosaur), by lifting both arm and leg from one side forward, followed by the other side. This will encourage the training of stability in the shoulders and hips.
3. Hamstrings Stretching
The hamstrings muscle group runs down the back of the thigh and is usually tight in W-sitters, as they prefer to keep their knees in a flexed position. It is therefore important to stretch these muscles regularly to improve their flexibility.
Some exercises can become games for children eg. to stretch hamstrings you can ask the child to walk their fingers down the front of their legs as far as they can, aiming all the way to their toes, keeping the knees straight. Or if they are in long-sitting position, you can ask them to walk their fingers down their legs over the stretched out leg, as far as they can to their toes and hold the position, counting together 1 to 10.