What is high muscle tone? Muscle tone is the basis for maintaining various postures of the body as well as normal movement, and is expressed in various forms. For example, when a person is at rest, the tension of the muscles in the body is called resting muscle tone. When the body is standing, although no significant muscle contraction, but the front and back of the body muscles also maintain a certain tension to maintain standing posture and body stability, known as postural muscle tone. The tension of the muscles during movement is called motor tone, which is an important factor to ensure continuous and smooth muscle movement (no tremors, jerks, spasms). In contrast, high muscle tone is manifested as: straightening of the lower limbs, inward crossed, scissor-like. How to judge the baby’s muscle tone How to judge high muscle tone: Before 3 months, put the baby on the bed, hands up to touch the bed, open outward also to touch the bed, hands crossed in front of the chest, to elbows touching each other. Put the baby’s feet outward to see how many degrees can be opened, within 90 degrees, high muscle tone is serious, below 120 degrees and above 90 degrees, high muscle tone is slight. Pinch the baby’s feet and lift them upward, the buttocks should not leave the bed, see how high the legs can be lifted (the legs are straight when lifted, not bent), 110 degrees or more normal. Hold the baby’s ankles, gently push the feet upward, so that the surface of the feet as close to the calf. After 3 months of age, in addition to the above, put the baby on the bed, squeeze the hands and pull the baby to sit up, if the head is still tilted back, it shows high muscle tone. 4 months old baby will jump when standing on the adult’s lap, high muscle tone baby will only stand straight and sink into the adult’s flesh with the toes. The infant is unable to lift his or her head when lying prone. If you determine that hypertonia is suspected, it is best to go to a hospital pediatrician or rehabilitation unit for a complete examination. If necessary (especially for babies born with brain hypoxia), have an MRI of the brain to see if the brain is abnormal. High muscle tone in babies is very harmful, as it can lead to uneven muscle growth in mild cases and abnormal walking posture in severe cases, such as inward facing or X-legged, or even pouting walking. Therefore, abnormal muscle tone should be detected and treated as early as possible. Usually, babies should be detected by physical examination at 3 months, and treatment within 4 months becomes early intervention, which is generally effective, improves rapidly and can be completely cured without affecting future motor development. At the latest should be corrective treatment before one and a half years old. Treatment: mainly massage and rehabilitation training, supplemented by swimming therapy, electrotherapy, etc. If the brain damage is obvious, acupuncture or brain activator injection should be used. Home care: daily adhere to the infant passive massage exercises, up, flat and chest crossed arms exercises, double leg rotation pedal wheel exercise, hand holding the ankle to turn the foot and leg foot surface against the calf exercises. Note that you should hold the strength, the action should be gentle, do not use excessive force to hurt the baby’s bones. You can play soothing soft music while practicing to help babies relax. The developmental process of muscle tone is often given to infants for bathing and swimming has a very strong expression as the flexor muscle tone increases during the neonatal period, and gradually decreases to normal as the months grow older. Therefore, in some less severe cases of spastic cerebral palsy, the increased muscle tone is not obvious within 6 months of age, which sometimes makes diagnosis difficult. However, some children with severe spastic cerebral palsy may still show increased muscle tone up to 6 months of age. Spastic cerebral palsy is characterized by increased muscle tone in the form of a “folding knife”, but it is important to note that the “folding knife” sensation gradually becomes less pronounced if the limb is repeatedly flexed and extended several times in succession during the examination. The tardive dyskinesia type is often absent within the first year of age, but increases with age and often appears as a “cogwheel” or “lead pipe”. The ankylosing type shows increased muscle tone in the form of a “lead pipe”. The ataxic type does not have increased muscle tone, while the hypotonic type has low muscle tone, increased range of motion in the joints, and active or hyperactive tendon reflexes. When examining muscle tone, it is important to note that some older children with a longer course of disease have limited joint movement due to joint contractures, which should not be mistaken for increased muscle tone. Postural abnormalities There are various abnormal postures in children with cerebral palsy, which are associated with abnormal muscle tone and delayed loss of primitive reflexes. 1. Prone position. Due to the delayed disappearance of the tense vagal reflex, the infant (after 3-4 months) shows a marked increase in flexor tone in the prone position, with flexion of the limbs and hips above the head; or he cannot raise his head, both upper limbs cannot support the trunk, the shoulders are on the bed and the hips are elevated; or the upper limbs are internally rotated and flexed, both hands are clenched in a fist, the lower limbs are straight, internally rotated, and the toes are facing inward; it can also show abnormalities on one side, with the elbow joint of one upper limb flexed and The wrist joint is flexed, and the figure shows that the left side is involved. 2. Supine position. Also affected by the tense vagal reflex, the head is tilted back, the lower limbs are straightened, and sometimes in a coracoid position. Due to the prolonged duration of asymmetric cervical tense reflex (disappears at 4-5 months of age in normal children), it is manifested as flexion of the upper and lower limbs on the occipital side when the head is turned to one side and straightening of the upper and lower limbs on the facial side. Sometimes the posture is Mom reflex-like. Sometimes the lower limbs are straightened. The limbs are hypotonic, and the wrist, elbow, shoulder, hip, knee, ankle and other joints can be flat on the bed at the same time in the supine position, in the frog supine position 3. Pull the child into a sitting position, the examiner holds the child’s hands, slowly pull the child from a supine position into a sitting position, observe the changes in posture during the pulling process. In normal children, the head no longer drops back significantly at 4-5 months of age, and the two upper limbs can be actively flexed. children with cerebral palsy after 3-4 months of age may exhibit a pulled up trunk with the head dropping back; one lower limb is straight and the foot is plantar flexed; both lower limbs are straight with the foot plantar flexed; one upper limb is normal, with elbow flexion, and the other side is straight; the traction becomes an upright position directly without the process of sitting; the head drops back extremely and the crest is dorsiflexed. 4.Upright position. When a normal 3- to 4-month-old child is held in an upright hovering position under the armpit, he or she exhibits flexion of both lower limbs, and when held in an upright position at 6 months, the lower limbs can support weight. When the child with cerebral palsy is in the upright suspended position, the two lower limbs are often internally rotated, straightened, and the toes droop, and the two lower limbs are crossed in a scissor shape due to increased tone of the adductor muscles. In the upright position, the head, crest and heel of the child with cerebral palsy often cannot be kept in a vertical line, and the hip and lumbar region is laterally bent; or the two thighs are internally rotated, the knees are semi-flexed, and the lower limbs are X-shaped with the toes on the ground. The tardive dyskinesia and ataxia types are different from the spastic type. In the first year, they often lie quietly with almost no voluntary movement, and their posture in supine position is the opposite of the spastic type, showing lower limb flexion, hip abduction and ankle dorsiflexion. When picked up in the upright position, the head can be controlled in the median position.