Muscular tonus disorders in children: hypotension, hypertonus, dystonia - Causes, symptoms and treatment. MF.

Tonus is the muscle tension that is necessary to maintain the body's posture and ensure its movements. The right balance of the tone of the various muscles is the condition for correct economical movement.

Muscular tone of the newborn

Developing in the abdomen of the mother, the baby is in the embryo's posture: the legs are bent at the knees, slightly dilated and pressed to the stomach, the arms are bent at the elbow joints, pressed to the chest, the fingers are clenched into the fists, the thumbs are pressed to the palm,head is located on the middle line, the position of the right and left sides are symmetrical. The muscles of the child are strained at the same time. After a birth within a month the child continues to support this pose. However, in normal muscle should not be too strained - you can unbend limbs, unclench the cams. Up to one year of life, the increase in muscle tone is physiological, that is, the norm variant, and the tone is higher in the flexor muscles, and in the extensors below and

the tone is necessarily symmetrical .With age, by about 6 months, the tone gradually gradually decreases. Define the muscle tone as a resistance to passive movements. A normal newborn, held horizontally on the abdomen( on the physician's arm), the head, torso and legs extend( Landau's reflex).

If the toes and legs of the baby are strongly pressed to the body, it is difficult to unbend them, while the baby cries, throws back the head, reacts irritably to light and sound - this muscle hypertonus - excessive muscular tension .Hypertonus can be common, in hemitipu - the same hand, leg, only hands, only legs.

Symptoms of hypertension in a child

If the child is sluggish, the arms and legs lie sluggishly along the body, the baby moves little, does not try to take the toy, turn over to restrain his head - this is hypotension - reduced muscular tension .

Asymmetry of the muscular tone a - on one half of the body the tone is greater than on the other. In this case, the head and pelvis of the child are turned toward tense muscles, the trunk is bent by an arch, the child falls over on its side.

Dystonia - uneven tone - a combination of hypertonia and hypotension. Asymmetry of tonus and dystonia at any age is NOT a variant of .

Causes of muscle tone disorder

Muscle tone disorders are always a problem in the central nervous system - the brain or spinal cord. The change in muscle tone - muscular dystonia - is not a disease, but a symptom. The cause of the violations may appear before or at the time of birth. These are, for example, maternal illnesses during pregnancy, diabetes mellitus, alcohol and drug use, smoking, taking medications, stress, multiple pregnancy, rapid delivery, birth and hypoxia( oxygen deficiency), asphyxia( asphyxiation).Violation of muscle tone in newborns and children of the first year of life is most often due to hypoxic-ischemic encephalopathy. This brain damage is a consequence of two reasons: hypoxia and ischemia( a violation of blood supply to tissues, which in turn leads to hypoxia).

Diseases that may be accompanied by a disruption of the tonus

Muscle tone decreases with neuromuscular diseases such as spinal muscular atrophy, poliomyelitis, neonatal myotonic dystrophy, congenital myopathies, Guillain-Bares syndrome, myasthenia gravis, botulism. Toxic disorders of neuromuscular transmission can cause hypotension in newborns. For example, if mothers used magnesium sulfate for the therapy of pre-eclampsia, then hypermagnesia can cause hypotension. The use of aminoglycosides can also cause neuromuscular abnormalities.

Increases muscle tone in diseases of the brain - infection, trauma, vascular disease, brain underdevelopment - cerebral palsy.

Dystonia - pathological postures arising from simultaneous contraction of muscles - twisting or kinking of the body along the axis, speech disturbance - dysarthria. Depending on the number of muscle groups involved, dystonia may be generalized( torsion dystonia) or focal( blepharospasm, spasmodic torticollis, scabies spasm).

Dystonia

Detection of muscle tone disorders requires observation, comparison with the presence of other developmental developmental symptoms. You should consult a neurologist who examines the child, assesses his condition, if necessary, appoints additional methods of examination and conducts differential diagnosis with listed and very serious diseases. Use ultrasound methods of research - echo-electroencephalography, neurosonography;computer diagnostics - magnetic resonance imaging;examination of muscles and nerves - electroneurography. If you suspect a myasthenia gravis, you will have to examine the thymus gland. In a number of diseases, molecular genetic methods can be used.

If the cause of the violation of the tone is not established, talk about PEP( perinatal encephalopathy).

Treatment of tonus disorders in a child

With the exclusion of serious illnesses, the early onset of treatment results in complete recovery. Therefore, you should not postpone the visit to a pediatric neurologist. In the absence of treatment, tonus disorders will lead to deformations of the skeleton, joints, impaired movement and general development.

Treatment should be an integrated, prescribed pediatrician, orthopedist and neurologist:

1. kinesitherapy - motion treatment;
2. aqua gymnastics;
3. drug therapy.

Kinesitherapy can be passive - various types of massage and passive gymnastics and active - corrective therapeutic exercises and swimming. You can use a gym ball - fitball.

For the removal of hypertonia a gentle massage is performed - relaxing and soothing. Use stroking and rubbing with your fingers and whole brush, acupressure. Massage should not lead to child crying and hypothermia. This will increase muscle tension. There are many techniques for relaxing the muscles - embryo posture, shaking on Phelps, playing on the ball, massage on Semenova( effective even in cerebral palsy), rapprochement of muscle attachment sites, massage of biologically active points.

In warm water, muscle tone decreases - you can use warm baths - coniferous, valerian, swimming in a circle, playing moments in the bath. Such baths and exercises in the water well soothe the child before day and night sleep.

Exercises for hypertension of the limbs that parents can spend with their child every day at home are different, depending on which muscles are toned, but the principle is one.1. The child lies on his back, the adult strokes his hands and / or legs( with an increased tone), respectively, from the shoulder to the fingers, from the hip to the fingers.2. Unbending spasmodic limbs and fingers gently, stroking movements from the palm to the fingertips, from the heel to the fingers. Circular motion with a brush or foot clockwise, counter-clockwise.3. Shaking the limbs, holding the baby gently by the fingers. The alternation with the next exercise is 4. The embryo posture, the pens and legs are pressed to the abdomen.5. Exercise on the ball, helping to form a support on the foot - the child puts his feet on the rough surface, puts his belly on the ball( not very large), the adult shakes the ball back and forth, left-right. Such exercises are recommended to be performed with the child on a daily basis, always following the sequence. They greatly accelerate the process of recovery.

The doctor can be prescribed paraffin wraps( moisten the gauze in the heated paraffin, curl it in 3 layers, shift the cellophane and another triple layer of gauze with hypertension) - make sure that it is not hot, wrap and fix the limb in the maximally unfolded state, the duration of the course is not less than 10days for 20 minutes a day), babies - electrophoresis.

With a lowered tone of , massage is done more intensively, stroking deeper with the brush pressing on the massaged muscle areas, rubbing the second phalanges of the fingers with a fist clenched, flicking, tingling, tapping( with the tips of the relaxed fingers and the side of the hand), stimulating stimulating acupressurebiologically active points.

Drug treatment is prescribed by a neurologist, it is used, as a rule, for hypertension, dystonia, asymmetry( up to a year only with dystonia and asymmetry).It is possible to use neuroprotectors, antioxidants, muscle relaxants. You can use in the treatment of children Cerebrolysin, pantokaltsin, Semax, solcoseryl, midokalm, baclofen, B vitamins.

What you need is your child will choose a professional.

Prophylaxis of muscular tonus disorders

Prevention of dystonia is primarily a healthy mother, exclusion of bad habits, monitoring the course of pregnancy and fetal development, training with the newborn, carrying out with him a healing massage and exercises, developing child care, comprehensive medical examinations for timely diagnosis and taking the necessary measures of help.

Consultation of a doctor on the topic of muscle tonus disorder in a child

Question: How early can you start a massage?

Answer: Massage in the form of stroking and rubbing starts from the first two weeks, later more intense massage is done and special exercises of charging are added.

Question: what massage can mom do herself?

Answer: the massage begins with the toes of the foot, with the little fingers - press, stroke, stroke, twist and pull. We pass to the foot - we press under the fingers - the fingers are compressed, we press on the heel - the fingers - are unclenched. Draw the eight on the baby's foot. We make a notch on each foot in its direction. We spend from the heel to each finger. We wind the foot on the finger of the masseur. We take the legs in hand and simulate running - we stamp on the table, draw a five-figure figure. We stroke the legs from the foot up to the joints. We do kneading, light movements, circular movements around the knee and hip joint. We do the hip joint diligence, fixing the knees with the hands - exercise "little book".We pass to the tummy and do stroking movements clockwise, press the fingers around the navel and twist - "bell" to strengthen the muscles of the abdominal wall. We take fingers of the hand - we stroke them, then stroke them upwards, around the shoulder.

Interior surfaces are not massaged. We stimulate a grasping reflex, raise the child. We turn on the tummy and stroke the muscles of the back, along the spine, pinch and knead the ass. With increased tone, tapping and patting can not be done. We take the baby in his arms and press the back to his back and simulate the simulator - we tilt the child forward - he tries to hold his back. With the older ones you can even play - pick up the toy from the table.

Mom can learn such a general massage and spend it at home. But, depending on the sperm tone, special movements and techniques can be added. In order not to harm the child, you first need to show it to the doctor, visit a professional masseur, and at home to repeat the necessary movements.

Question: can massage damage?

Answer: can. If the massage is not carried out correctly, you can further increase the tone of the spasms and relax the muscles so that they can not move in the joints.

Question: what is the symptom of a "sluggish child"?

Answer: the term "sluggish child syndrome" combines the cases of muscle hypotension in children of the first year of life - a violation of fixation of the head( the head hangs down), the "frog" posture in the supine position. Muscular hypotension can be caused by damage to the central and peripheral nervous system, including the brain and spinal cord, peripheral nerves, neuromuscular synapse, muscle pathology and systemic diseases - hypothyroidism, Down's syndrome. Most often - an atonic type of infantile cerebral palsy. The "sluggish child" syndrome may be a manifestation of degenerative diseases, for example, Tay-Sachs disease, Crabbe's disease, leukodystrophy. With a transverse presentation of the fetus, a transverse lesion of the spinal cord may occur. The newborn will first have hypotension and weakness below the level of the lesion, and in the course of time will pass into the spastic tension. Another terrible option is poliomyelitis, a viral infection that affects the motoneurons of the spinal cord. Diagnosis of the disease - a child's neurologist. Prevention - compliance with the vaccination calendar! Do self-diagnosis and self-treatment is unacceptable.

Hypotone due to poliomyelitis

Neurologist doctor Kobzeva S.V.