Some children are born with developmental delays related to any number of things, most significantly from disease or genetic disorders. One difficult thing to assess in infants is if the cause of hypotonia is neurological, or some other indirect ailment.
If the nerves can’t send impulses to the muscles to tense, it’s a neurological disorder. Examples of possible neurological issues are a myelin (nerve insulation; determines speed at which signals are passed through) production deficiency, or a mitochondria (involved in utilizing nutrients to perform tasks) function impairment. Sometimes an infant’s neurological function is normal, but the individual has a muscular function disorder, such as Muscular Dystrophy.
These are of course just a number of challenges in assessing and incorporating a strengthening regimen for these individuals. Below, I’ve outlined these challenges and addressed them with researched protocols:
1. Low muscle-tone, low strength
Oftentimes, if an infant displays low muscle-tone and low strength, it’s a sign of a neurological disorder. Not surprisingly, the muscles follow the nerves, and if the nerves aren’t functioning properly, the muscles can’t develop.
Signs that a child has low muscle-tone and low strength can be seen by their response to stimulus. Muscles don’t build strength when they can’t contract fully, and low muscle-tone is an indicator of delayed or sub-optimal contraction.
Infants, children, or young-adults facing these strength issues need assistance from a trained professional. When I say assistance, I mean manual manipulation; the PT (physical therapist) will help the infant raise his head, roll on the floor, move his ankles and hands, play with his fingers, or any number of other assisted exercises. The child needs the muscles to work to help develop potential nervous system activation.
Young adults should have been exposed to this manipulation and built some form of strength or control by the time “play” is an active strength builder.
My suggestion: Involve the developing child/young-adult in low-impact, interest-stimulating exercises that require them to move. Legos are pretty great at developing fine motor-control in the fingers, and building things are a great way to keep them interested. To incorporate strength building into this fun, have the Legos spaced out across the room and at different heights. Give them excuses to sit at different heights on stools and high chairs and reach low and high; sitting-to-standing is a great way to build strength and functionality. When it’s all said and done, clean-up can also be an interactive time to move and stretch. Have certain bins go in low-lying cubbies, and some go on high-standing shelves. Nothing heavy of course, but something they can really get on their toes to place. Perhaps include exercise balls of varying sizes on the floor with them to drape themselves over while piecing things together. This will incorporate core control, balance, and leaves their hands close to the ground in the event of a tumble.
2. Low muscle-tone, normal strength
Normal strength but low muscle-tone means there is perhaps adequate neurological signaling, but the muscles themselves aren’t operating efficiently. There are any number of muscular degenerative diseases where a child may have proper function, but can lose strength over time given their respective disorder. Given that this child has low muscle-tone, we can assume he has hyper-flexibility. This can give way to potential structural damage with negligent strength-building, so be wary with the below information.
My suggestion: Playgrounds. Be attentive and active in his activities and he should be safe. Climbing, rolling, jumping, and swinging are great ways to indirectly build strength. Plus, playing together is always fun!
3. Core weakness and poor balance
It’s now understood that a child with hypotonia can develop strength over time. It’s an active growth and delayed, but can be an eventuality. One issue with this delay is a lack of core strength and lower-body strength. Building these strength groups is extremely important, as it’s much more likely to develop strength in the most commonly used areas of your body (arms and hands) and not necessarily in your trunk. Take, for example, your average older-fella; he sits and stands real slow and doesn’t walk very fast, but I’ll bet you $20 he can twist open any jar you hand him!
My suggestion: Bring those exercise balls back into play. Have the child lay on their back and place the ball in between their feet, getting them to squeeze the ball. Then tickle them. I’d wager they’ll curl up and at least raise their knees close to their midriff. You can even do this while they lay on their sides (preferably playing with Legos!). You can use very light-weight resistance bands around their ankles and have them try pulling their feet apart in all directions. If you have stairs in the house (with hand-railings), find reasons for them to go up and down the stairs; their favorite movies are upstairs and the T.V. is downstairs; their sports balls (footballs, basketballs) are upstairs and the courts are outside, etc.
My takeaway from all this is that it’s extremely difficult as a parent to help strengthen a child displaying developmental delays. I’m not sure I could do it, and I respect each of you for your valiant efforts. I applaud the doctors and therapists who are actively trying to streamline the strengthening process (and education process!). One of the more important things I’ve learned about all of this is that it takes a physically active approach to strengthening; you as the parent (or professional) need to be hands-on at all times. Most infants will start very underdeveloped and will need frequent manipulation. Hopefully with sound progress can they begin having some independence to move themselves into different positions. Eventually, the play can become more “fun” than only clinical in scope. I’m not sure if this is a reality for some people, but I know one thing; children are children. Play is play. Children need to play to help build so many minute (sometimes simple) things that adults take for granted. A developmentally delayed child is no different.
Below, I’ve also compiled my sources I referenced in developing this. If any of my readers have suggestions or comments, or want to educate me, feel free. I’m not a medical professional or a specialist therapist; I’m a humble personal trainer that’s willing to learn. If you happen to be a medical professional that’s reading this (and have made it this far!) I would love your advice on how to build strength in these children with weight-training equipment of any kind.
Thank you to my friend Zan for asking me to research and develop my own ideas about such a difficult topic. I know you’ll have more sage advice to share. I appreciate the opportunity, and I hope those reading enjoyed it!