Hypertonic and Hypotonic Cerebral Palsy

As the most common form of cerebral palsy (CP), hypertonic CP accounts for 80% of all cases in the United States. Hypertonic CP is considered spastic, marked by extremely stiff muscles. On the other hand, hypotonic CP, marked by extremely loose and floppy muscle tone, accounts for less than half of all CP cases.

Signs and Symptoms of Hypertonic Cerebral Palsy

Hypertonic CP is derived from hypertonia, meaning heightened muscle tension, rigidity, and stiffness. Although it can be months, and sometimes years before a physician can diagnose hypertonic CP, common signs and symptoms to look out for include:

  • Awkward, uncomfortable movements
  • Muscle resistance when attempting to move
  • Muscle spasms and spastic movements
  • Scissor-like movements in the legs
  • Poor balance
  • Random contractions in the muscles at any given time

Causes of Hypertonic Cerebral Palsy

As with most other types of CP, hypertonic CP is most often caused by brain damage before, during, or shortly after birth. Brain damage can occur from a variety of reasons, including asphyxia at birth, infant stroke and/or infections, maternal infections, mutations, and accidents causing traumatic head injuries.

Treatment Options for Hypertonic Cerebral Palsy

Medications used to relax stiff muscles are frequently prescribed for children with hypertonic CP. Common medications include baclofenac, dantrolene, and diazepam. Most doctors, however, recommend physical and occupational therapy before medication is prescribed. Some children will thrive with therapy and won’t need medication, while others may need it in addition to ongoing therapy. Although many of the symptoms are the same, each child’s case is different and treatment will depend upon the severity of the disease as well as how serious the pain is.

Prognosis for Hypertonic Cerebral Palsy

Prognosis will also greatly depend upon the severity of the disorder and how it’s affecting your child. For example, some children’s hypertonia will not worsen over time, and with the right treatment, the prognosis is favorable. However, other childrens’ conditions may grow worse with age, causing bone fractures, bed sores, infections, pneumonia, immobility, and joint contractures.

Signs and Symptoms of Hypotonic Cerebral Palsy

As mentioned earlier, children with hypotonic CP exhibit the opposite signs and symptoms of hypertonia, with the most common sign being floppy and loose muscles. Other common signs include:

  • Rag-doll appearance due to limp muscles
  • The head may fall backwards, forward, or to each side involuntarily
  • Respiratory problems
  • Difficulty maintaining proper posture
  • Difficulties in standing and walking without assistance
  • Abnormal truncal tone
  • Increased chance of autism

Causes of Hypotonic Cerebral Palsy

In most instances, hypotonic CP is caused by damage to the cerebellum, usually while the infant is still in the womb. Factors such as a maternal infection, blood incompatibility between infant and mother, and uterine ruptures can lead to hypotonic CP. During the labor and delivery process, deprivation of oxygen may also lead to hypotonic CP.

Treatment Options for Hypotonic Cerebral Palsy

Physical and occupational therapy is almost always recommended, and it’s recommended to start your child as soon as possible. Infants can benefit from therapy, but usually don’t start until around 18 months of age due to the delay in diagnosing the disorder. Before therapy begins, a full-scale diagnostic evaluation and assessment is usually conducted in order to determine how much and what kind of therapy activities would benefit your child the most.

Prognosis for Hypotonic Cerebral Palsy

Although CP in itself does not worsen over time, hypotonia may get more severe as the child gets older, depending on individual circumstances. Hypotonic CP never goes away; it’s a lifelong disability, but it can be managed with the correct treatment. In some instances, hypotonia will improve over time with regular physical and occupational therapy.