In this post, we will address low muscle-tone (Hypotonia), motor clumsiness, and some strategies to improve particular skills for Aspergers (high functioning autistic) children...
Hypotonia is a state of low muscle-tone (i.e., the amount of tension or resistance to movement in a muscle), frequently including decreased muscle strength. Hypotonia isn't a particular medical condition, but a potential outward manifestation of several different diseases and disorders that affect motor nerve control by the brain or muscle strength.
Identifying hypotonia is usually relatively simple, but figuring out the actual cause can be challenging. The long-term results of hypotonia on a kid's development rely primarily on the seriousness of the muscle weakness as well as the cause. Some problems have a particular remedy; however, the primary remedy for most hypotonia of neurologic cause is physical therapy and/or occupational therapy to assist the individual in compensating for the neuromuscular impairment.
The affected muscles may be trained, but not via regular weight training. Proper training to address hypotonia comes from some very specific therapy and may not be 100% effective. In young kids, the difficulties of low muscle tone may decrease in severity as they age (up to about age 10); nevertheless, children with Aspergers will probably continue to adjust and compensate for the remainder of their lives.
Low muscle tone is usually referred to as "floppiness". This is because the muscles are meant to help support the skeletal system and are designed to prevent certain kinds of motion. Because the muscles are not especially tight, individuals with low muscle tone frequently experience "hypermobility" (i.e., the ability to move limbs into awkward positions). Children with Aspergers often find that they're able to very easily carry out feats that require flexibility, but not strength or balance (e.g., splits, back-bending, shoulder rotation, etc.). They might display uncommon flexibility in other joints (e.g., fingers).
This kind of flexibility comes with a price. Aspergers children are generally very uncoordinated and awkward. In running, this plays a role in the so-called "unusual gait". A myth is that muscle tone just impacts the large muscles, but this is not the case. Muscle tone impacts all activities requiring muscles including speech, pencil grip and writing.
Fine motor skills are hard to learn if you have Aspergers. These fine skills are essential for drawing or coloring, grasping objects, riding a bike without training wheels, zipping-up jeans, and tying shoelaces. However, when muscle tone is low, these skills are much harder to perform properly.
When an Aspergers child isn't proficient at something (e.g., riding a bike), but all his friends can do it, this deficiency can create a sense of isolation in the Aspergers child. Imagine watching all the other children in your neighborhood doing various activities very easily while you don’t appear to have the same abilities. Consequently, Aspergers children can start thinking they're ‘dumb’ or ‘stupid’. This is definitely not the case. Intelligence has nothing to do with it!
Aspergers children often slump a great deal when seated or standing for long stretches. Occasionally, they'll stand with their legs crossed in what seems to be an uncomfortable manner. Even though this appears uncomfortable, this is really an extremely comfortable position for Aspergers kids. Additionally, they frequently sit with their head and shoulders rolled forward and will often lean on walls, furniture, door frames and desks. Moms and dads of Aspergers kids will probably be very familiar with being "leaned on".
Low muscle tone doesn't prevent Aspergers kids from enjoying themselves. They are able to run and have fun with other kids without feeling any harmful effects. The issue is that they are a little slower and they tire easier. Consequently team sports (e.g., soccer, basketball, football) are often not suitable to these children.
While the slumping and leaning habits are not necessarily good posture, they are not particularly harmful to the Aspergers child unless of course the position is adopted for very long intervals without proper breaks.
It is important to remember that “low muscle tone” isn't a diagnosis. Usually, kids are believed to have low muscle tone because they have poor postural stability and poor performance on movement tasks. The presumption is made that these issues result from low muscle tone - but this isn't always the case. Aspergers children might have problems with understanding movement skills and obtaining basic strength needed for action for a combination of reasons: joint hypermobility, a fearful temperament, difficulties with the thinking skills needed for learning, such as predicting what happens next and the ability to learn from watching other people and from their own experience.
Therefore the real question is not what you can do for an Aspergers child with low muscle tone, but instead what you can do to improve overall performance on age-appropriate movement tasks? And that depends on the underlying reasons for the child’s problems, which may or may not have anything to do with low muscle tone.
Children with Aspergers can have a comprehensive assessment by a physiotherapist and/or occupational therapist to determine the nature and degree of the problem. Listed here are a few of the areas where motor clumsiness is evident, and some ways of improve specific skills:
Locomotion-
When the Aspergers child walks or runs, the movements may seem ungainly or "puppet" like, and many kids walk with no associated arm swing. There might be deficiencies in upper and lower limb control. This particular feature can be very noticeable and other kids may mock the Aspergers child, resulting in his/her desire not to take part in running sports and physical education in school.
A physiotherapist or occupational therapist can develop a remedial plan to ensure the child’s movements are coordinated. Therapy might include the use of a large wall mirror, video recording, modeling, and imitating more "fluid" movements using music and dance. An intriguing fact is that the ability to swim seems least affected, and this exercise can be encouraged to allow Aspergers kids to experience genuine proficiency with movement.
Basic skills-
Catching and throwing precision seems to be especially affected in Aspergers children. When catching a ball with two hands, the arm movements of the child are often badly coordinated and affected by problems with timing (i.e., the hands close in the correct position, but a fraction of a second too late). One study noted that Aspergers children would frequently not look in the direction of the target prior to throwing. Clinical observation additionally indicates that Aspergers children have poor coordination in their ability to kick a ball.
One consequence of not being proficient at ball games is the exclusion of the Aspergers child from some of the most well-liked games on the playground (i.e., kick ball). Aspergers children might avoid such games simply because they understand they lack proficiency, or are intentionally excluded since they're a liability to the team. As a result, they're much less able to improve ball skills with practice.
From an early age, mothers and fathers should help their Aspergers child practice ball skills in order to guarantee that he/she has fundamental proficiency to be included in the games. A number of kids might be enrolled in a junior soccer or basketball team to enhance coordination and to learn to play specific games. It's also vital that you have your child’s eyesight examined to determine whether wearing glasses enhances hand-eye coordination.
Balance-
In Aspergers children, there can be an issue with balance, as tested by analyzing the ability to stand on one leg with eyes closed. A number of Aspergers youngsters are not able to balance when placing one foot in front of the other (i.e., tandem walking, which is the task of walking a straight line as though it were a tightrope). This may affect the child's ability to use some adventure playground equipment and activities in the gym. The child may need practice and encouragement with activities that require balancing.
Manual Dexterity-
This area of movement skills involves the ability to use both of your hands (e.g., learning to dress, tie shoelaces, eat with utensils, etc.). This might also extend to the coordination of feet and legs (e.g., learning to ride a bike). If the Aspergers child has problems with manual dexterity, a good technique to help is "hands on hands" training (i.e., a parent or teacher physically patterns the child's hands or limbs through the required movements, gradually fading out physical support).
Handwriting-
A teacher may invest a lot of time interpreting and correcting the Aspergers youngster’s illegible chicken scratches. This child may also be aware of the poor quality of his handwriting and may be hesitant to take part in activities which involve extensive writing. Regrettably, for many kids, high school instructors and potential employers consider the neatness of handwriting a way of measuring intelligence and character. As a result, the individual with Aspergers may get embarrassed or upset at their own inability to write neatly and consistently. The child might need an assessment by an occupational therapist and remedial exercises, but today's technology might help reduce this issue.
Kids with Aspergers are often very competent at using computers and keyboards, and the youngster might prefer typing over writing homework and exams. In this case, the presentation of their work is then similar to the other kids. A parent or guardian or instructor could also act as the youngsters scribe to guarantee the legibility of his/her written answers or homework. The ability to write longhand may become a lot less important in the future (to the great relief of thousands of children with Aspergers).
Rapid movements-
Research conducted recently noted that, while engaged in activities that require motor coordination (e.g., cutting out shapes with a pair of scissors), a significant percentage of kids with Aspergers were known to hurry through the task. They seemed to be impulsive, unable to take a slow and calculated approach. With such haste, errors occur. This is often infuriating for the Aspergers child and the teacher. The child may require guidance and reassurance to work at a suitable pace, having time to correct mistakes. Occasionally the youngster can be asked to slow down by having to count between actions and using a metronome to indicate a suitable pace.
Lax joints/Immature grasp-
One of the features analyzed during a diagnostic evaluation of Aspergers children is the existence of lax joints. We don't know if this is a structural problem or due to low muscle tone, but the autobiography of David Miedzianik (1986) explains how:
At infant school I can seem to remember playing a lot of games and them teaching us to write. They used to tell me off a lot for holding my pen wrong at infant and primary school. I still don't hold my pen very good to this day, so my handwriting has never been good. I think a lot of the reason why I hold my pen badly is that the joints of my finger tips are double jointed and I can bend my fingers right back. (p. 4)
The Aspergers youngster could be referred to an occupational therapist or physiotherapist for evaluation and remedial activities whenever difficulties occur from lax joints or immature grasp. This ought to be a priority with an Aspergers youngster, because a lot of school work demands the use of a pen or pencil.
Exercises for babies and young children with hypotonia to develop fine motor skills—
• Create tape recordings of your child's own sounds, the sounds of your family, and appropriate music. Play these tapes often, and dance your child around rhythmically in your arms during music or sounds. Again, this helps your child to become aware of her own body.
• Draw feet up to the baby's mouth, circling the mouth with each big toe. Repeat with hands and fingertips in order to increase awareness of extremities and oral motor control.
• Expose the baby to as many different pleasant stimuli as you can think of. This includes mobiles, wind chimes, patterned cloth for crib sheets and bumpers, and musical or noise toys in bright, primary colors. Primary colors are bright red, blue and yellow. Babies see high-contrast things the best, and love these colors. An effective tactic that some parents have used is to cut out suitable pictures from magazines and placing on baby's walls, which allows the frequent change-out of pictures needed to give stimulation without breaking the bank.
• Give a newborn a lot of smiles, hugs and cuddles. This both increases emotional bonding and stimulates baby's senses.
• Help the child with hypotonia to do occasional rounds of heel walking, where all of his weight is balanced on his heel and his toes stick in the air.
• Hold bright or desirable small objects out, encourage reaching for it and praise any attempt or success to do so.
• Lightly brush from the heel to the toe on each foot and from the base up to the fingertips on each hand with light massage strokes or a soft, 1 inch paintbrush.
• Make a safe place for your child in every room of your house, and bring baby along as you go about your normal routine. The frequent changes in environment and constant contact with you will help stimulate your child's mind and awareness.
• Place child-safe mirrors on crib walls or down near the floor where your baby can see himself often. This helps increase your child's self-image and self-reflection.
• Place toys or objects at the midline of the body and encourage drawing the limbs in to pick these objects up successfully.
• Play patty cake and patty foot to bring hands and feet into the center of the body.
• Resist any thrust of your baby's legs while you're holding him, and hold him often in a standing position while supporting him well in the torso.
• Rub the hands and feet together, first left hand to left foot, then right hand to right food, then across the body.
• Talk to the baby often. Tell your child what you're doing, especially when bathing, grooming, dressing or changing her. Verbally repeat each step in the process often. Play mimic games with your baby, repeating the sounds he will naturally make. Encourage your baby to make sounds by making faces, singing, and talking nonsense syllables.
• Use a backpack with books or toys in it for weight training.
• Use deep pressure massage on the hands and feet, focusing on the pad of the big toe and each of the fingertips.
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