Clinical Characteristics of Hypotonia: A Survey of Pediatric Physical and Occupational Therapists

Martin, Kathy; Kaltenmark, Tiffany; Lewallen, Amanda; Smith, Catherine; Yoshida, Aika

doi:10.1097/pep.0b013e3180f62bb0

Cited by 29 publications

(31 citation statements)

References 23 publications

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“…With these populations in mind, the collective prevalence of atypical muscle tone can be estimated to affect about 5 to 8 per cent of the general population. This paper will focus on the intensity attribute of tone, which ranges between hypertonia (atypically high tone) and hypotonia (atypically low tone) . Persistent hypertonia is problematic because it can restrict movement and lead to secondary impairments such as contracture, pain, limited motor development, and restricted participation .…”

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confidence: 99%

“…Persistent hypertonia is problematic because it can restrict movement and lead to secondary impairments such as contracture, pain, limited motor development, and restricted participation . Persistent hypotonia produces other issues, such as poor joint stability, poor postural alignment, decreased activity tolerance, and delayed motor skill acquisition . Given such a large proportion of the population experiences difficulties with muscle tone, accurate assessment of muscle tone is essential for diagnostic, prognostic, and treatment planning purposes .…”

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confidence: 99%

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Muscle tone assessments for children aged 0 to 12 years: a systematic review

Goo

Tucker

Johnston

2018

Develop Med Child Neuro

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AIM The aim of this study was to identify and examine the psychometric properties of muscle tone assessments for children aged 0 to 12 years.METHOD Four electronic databases were searched to identify studies that included assessments of resting and/or active muscle tone. Methodological quality and overall psychometric evidence of studies were rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

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confidence: 99%

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confidence: 99%

Muscle tone assessments for children aged 0 to 12 years: a systematic review

Goo

Tucker

Johnston

2018

Develop Med Child Neuro

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“…(2013) introduced the term ‘hypotonia syndrome’, which they defined based on their two previous studies (Martin et al . 2005, 2007), and in their description have drawn on the gross motor milestones as an indicator of developmental norms. Harris (2008) also reiterated the use of developmental tests, and together these serve as examples of norms when assessing hypotonia.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical evaluation of hypotonia is one of the aspects of the diagnostic and therapeutic process that remains subjectively assessed and thus creates an accuracy predicament for practitioners (Martin et al . 2005, 2007). There are currently no standardised assessment tools for children (after infancy and during early childhood) with low muscle tone (Soucy et al .…”

Section: Introductionmentioning

confidence: 99%

‘Toning’ up hypotonia assessment: A proposal and critique

Govender

Joubert

2016

AJOD

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BackgroundClinical assessment of hypotonia is challenging due to the subjective nature of the initial clinical evaluation. This poses dilemmas for practitioners in gaining accuracy, given that the presentation of hypotonia can be either a non-threatening or malevolent sign. The research question posed was how clinical assessment can be improved, given the current contentions expressed in the scientific literature.ObjectivesThis paper describes the development and critique of a clinical algorithm to aid the assessment of hypotonia.MethodsAn initial exploratory sequential phase, consisting of a systematic review, a survey amongst clinicians and a Delphi process, assisted in the development of the algorithm, which is presented within the framework of the International Classification of Functioning, Disability and Health. The ensuing critique followed a qualitative emergent–systematic focus group design with a purposive sample of 59 clinicians. Data were analysed using semantical content analysis and are presented thematically with analytical considerations.ResultsThis study culminated in the development of an evidence-based clinical algorithm for practice. The qualitative critique of the algorithm considered aspects such as inadequacies, misconceptions and omissions; strengths; clinical use; resource implications; and recommendations.ConclusionsThe first prototype and critique of a clinical algorithm to assist the clinical assessment of hypotonia in children has been described. Barriers highlighted include aspects related to knowledge gaps of clinicians, issues around user-friendliness and formatting concerns. Strengths identified by the critique included aspects related to the evidence-based nature of the criteria within the algorithm, the suitability of the algorithm in being merged or extending current practice, the potential of the algorithm in aiding more accurate decision-making, the suitability of the algorithm across age groups and the logical flow. These findings provide a starting point towards ascertaining the clinical utility of the algorithm as an essential step towards evidence-based praxis.

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“…A challenge for clinicians however, remains in the accurate identification and quantification of muscle tone due to the subjective nature of the clinical evaluation process [ 3 ]. This continues to confuse clinicians, and the scientific community has yet to gain consensus on the operational definition, the diagnostic criteria used to determine hypotonia, and the clinical assessment techniques for evaluation [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Development of an Evidence-Based Clinical Algorithm for Practice in Hypotonia Assessment: A Proposal

Naidoo¹

2014

JMIR Res Protoc

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BackgroundAssessing muscle tone in children is essential during the neurological assessment and is often essential in ensuring a more accurate diagnosis for appropriate management. While there have been advances in child neurology, there remains much contention around the subjectivity of the clinical assessment of hypotonia, which is often the first step in the diagnostic process.ObjectiveIn response to this challenge, the objective of the study is to develop and validate a prototype of a decision making process in the form of a clinical algorithm that will guide clinicians during this assessment process.MethodsDesign research within a pragmatic stance will be employed in this study. Multi-phase stages of assessment, prototyping and evaluation will occur. These will include processes that include a systematic review, processes of reflection and action as well as validation methods. Given the mixed methods nature of this study, use of NVIVO or ATLAS-ti will be used in the analysis of qualitative data and SPSS for quantitative data.ResultsInitial results from the systematic review revealed a paucity of scientific literature that documented the objective assessment of hypotonia in children. The review identified the need for more studies with greater methodological rigor in order to determine best practice with respect to the methods used in the assessment of low muscle tone in the paediatric population.ConclusionsIt is envisaged that this proposal will contribute to a more accurate clinical diagnosis of children with low muscle tone in the absence of a gold standard. We anticipate that the use of this tool will ultimately assist clinicians towards moving to evidenced based practice whilst upholding best practice in the care of children with hypotonia.

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Clinical Characteristics of Hypotonia: A Survey of Pediatric Physical and Occupational Therapists

Cited by 29 publications

References 23 publications

Muscle tone assessments for children aged 0 to 12 years: a systematic review

Muscle tone assessments for children aged 0 to 12 years: a systematic review

‘Toning’ up hypotonia assessment: A proposal and critique

Development of an Evidence-Based Clinical Algorithm for Practice in Hypotonia Assessment: A Proposal

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