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Treatment of the Child Who Has Hypotonia

70 minute DVD is designed to be a teaching tool for treating children that have low muscle tone. It includes treatment sessions on two children with different degrees of hypotonia. Both of the treatment sessions have been edited to highlight a variety of activities therapy can emphasize for each child. The entire videotape is scripted and professionally narrated so the viewer receives direct instruction about what the therapist is doing. The narration explains why each treatment technique is chosen as well. The videotape also includes an introductory section on major problems and pertinent treatment strategies for working with the floppy patient.

This DVD can be a valuable learning tool for beginning through advanced therapists. It may also be used to help parents of hypotonic children better understand their child and the need for ongoing therapy. New footage has been added to show the viewer what the first child looked like at an earlier and later age. Additional footage for the second child was not available but her parents’ report of her progress is noted. It is hoped this additional footage will further inform the viewer about how to treat children who present with these types of motor control.

Facilitating the Components of Gait Part I

This 92 min. DVD is designed to instruct the therapist on facilitating the components of control required for gait in children with cerebral palsy. The tape begins with an introduction that discusses essential components of normal gait, basic understanding of weight shifting, and basic differences between adult gait and gait of an early ambulator. There is also a discussion of the determinants of gait, and the therapist demonstrates some control required for normal walking. The tape then shows treatment sessions on two children who have cerebral palsy and are highly motivated to move. They are able to follow directions and cooperate with all activities presented.


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Facilitating the Components of Gait Part II

This 62 min. DVD emphasizes working toward independent gait in patients that have severe developmental delays secondary to syndromes and severe mental impairment. This tape emphasizes the need to integrate the sensory motor aspects of walking along with the gross motor control. The therapist encourages these patients to function outside of their fixed patterns of control and move higher against gravity. The tape includes therapy sessions on two different patients. One of the demonstrations is a co-therapy session with OT and PT. These videotapes can be valuable tools for all therapists working to facilitate the building blocks of control needed to achieve independent gait in their patients.


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Using the Therapy Ball to Treat the Pediatric Patient (a DVD)

This 55 minute DVD is designed to show a variety of patients being treated using the therapy ball. The five patients presented include children from ages 2-6 years with varying diagnoses and physical challenges.
Each patient is treated for part of a taped therapy session using the ball to accomplish case specific goals. Components of control such as range of motion, joint mobility, muscle strengthening, synergistic motor control, joint alignment , motor planning new movements, and enhancing reactions to weight shift are highlighted on the videotape with each of the patients.
The intent of this video is to provide a structure for using the ball as a therapy tool. For each patient, a diagnosis will be provided followed by showing and discussing a variety of ball techniques that can be used to address specific concerns.


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Treating the 30 month old who has Hypotoina Secondary to a Syndrome

This 75 minute long therapy demonstration has been narrated by the treating therapist. It has only been minimally edited to allow the observer to see components of the session in real time. In this session we see how a child's motor control can be adversely effected by the child's ability to tolerate and integrate sensory input. Although this child is low tone and has ligamentous laxity, we see how adaptive equipment can provide support and alignment. We also observe the therapist decrease her input and expectations once the child begins to be upset. This child is easily frustrated and responds quickly with a "panic" type cry which is a fight or flight sympathetic nervous system reaction. Therefore, the activity must be graded to the child's tolerance.
L was born at 40 weeks with complications secondary to an unknown genetic disorder. At birth she presented with Cushing's syndrome which caused her to be a large infant. She had chronic lung disease and required a G tube for all feeding. She was hospitalized for most of the first 9 months of life. She was evaluated by PT at 20 months and was receiving OT prior to that evaluation to increase her tolerance to any type of sensory input. At the time of this taping she is 30 months old.


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Treating a child who has Low Tone Secondary to Down Syndrome

This 73 minute long therapy demonstration has been narrated by the treating therapist. It has only been minimally edited to allow the observer to see components of the session in real time.
We see the following:
- how long it takes the child to activate new control
- how long the therapist sustains work in each position
- how the child becomes frustrated, then recovers without being rescued
- and how long the therapist actually WAITS to allow the child to integrate and activate new motor control.
It is intended that observing this tape will assist the therapist in how to treat a child who has low tone secondary to a diagnosis of Down Syndrome.


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Treating a Child who has Plagiocephaly and Asymmetric Head Turning

This 52 minute videotape will show one therapy session of a child who has plagiocephaly and asymmetric head turning.
He was referred to therapy for evaluation after his 8 week well baby check when his head shape and strong preferred head turning had not resolved.
He was fitted with a Dynamic Orthotic Cranioplasty Band (DOC Band) and began physical therapy 2 times weekly at 11 weeks.
At the time of this session he is 6 months old. Mother is very informed and understands home carryover activities as well as their importance.
When observing this session the viewer will be exposed to a variety of therapy techniques as well as the following:
-Parent therapist interaction for education about the child’s condition as well as home carryover suggestions.
-Different therapy approaches to stretching the neck musculature.
-Discussions on subtle other problems present as secondary conditions with these two problems.


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How to Make and use Shoe Boards and Moon Sandals

This 30 minute videotape will go through step by step directions on making a shoe board and a pair of moon sandals. These products can be used on a variety of patients by helping them master some or all of the following:

  • Standing independently
  • Moving from squat to stand without falling
  • Reaching in stance without taking steps
  • Performing a variety of motor skills without falling
  • Walking indpendently
  • Etc...

Following the detailed instructions on making the moon sandals and shoe boards, the videotape includes a variety of different children using these devices in therapy or during home carryover. The types of children shown using these devices include:

  • Pre-ambulatory child wih Down Syndrome diagnosis
  • 11 year old child with Ataxia diagnosis
  • 5 year old with Moebius Syndrome Diagnosis
  • A child who is an idiopathic toe walker
  • A 10 year old with Hemi-diplegic CP diagnosis

The shoe board and moon sandals can be a useful therapy tool for any therapist working with children mastering standing skills, walking control, gross motor skills and strengthening of legs and ankles.


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Treating The Birth To Three Client Who Presents With Hypotonia

This is a 90 min. DVD. Child #1 has a diagnosis of Down Syndrome. Although children who have this diagnosis often have low tone, they frequently are quite successful at moving. What they struggle with is sustaining antigravity activation and alignment.
Child #2 has a diagnosis of Cerebral Palsy-Fluctuaing Tone. These children often times are very low tone throughout their first year of life. As they begin to move, they use large amplitude “Bursts” of motor activation to overcome the pull of gravity.
Child #3 has a diagnosis of idiopathic congenital hypotonia of unknown etiology. She presents with severe hypotonia. As a result, she has difficulty activating any movement against gravity, holding postures and staying upright.
Child #4 has a diagnosis of mild hypotonia. He is mobile in a varieyt of positions but is having difficulty balancing and mastering more upright standing and walking. Although he can activate and sustain a variety of motor patterns, he needs assist to learn alightment and balance control.


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Treating a 1 year old Who Presents With Processing Challenges

This DVD wa taken at a course when a mother brought her 1 year old in for a consultation with the instructor. The child was diagnosed with hypotonia and mother, being a P.T., was working on home carryover to help her child gain strength in addition to taking her to therapy. The things that makes this presentation amazing are:

  1. The clarity ofmother's questions and the discussions that arise.
  2. The child's tolerance to handling even when therapist is answering mother's questions.
  3. The obvious motor control and tone that is present along with the persistent motor delays.

This is a classic example of a child that has a neurological challenge in integrating how the pieces of motor control fit together. Despite this, the numverous test that have been conducted on brain and muscles have shown no positive results that indicate injury or insult. For her parents, this lack of true diagnosis was very confusing and the results from theerapy were not adequately overcoming the simplistic idea that the child only had low tone.


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A 27 Mo. Old Who Presents With Motor Delays Secondary To Sensory Processing Deficits

This child was seen as a therapy demonstration during a course on treating children who have hypotonia. His diagnosis is hypotonia and developmental delay but as you watch this session it is hoped the viewer will clearly understand that the child's major challenge is his impaired ability to process and interpret the information he receives from his sensory systems. His way of dealing with the confusion is to shut down and avoid input, especially when someone else structures it. Here the challenge for the therapist is to communicate into the child's system and at the same time not overwhelm him triggering his fight or flight response.
From a session that begins with almost immediate crying and avoidance behavior this child is able to work for sixty minutes in therapy. Watching this session we see that even tough the child and therapist don't know each other, they are able to build a bond of trust and work together on the edge of new and established control.


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Coordinating Motor Control -
Treating a 21 Month Old

At the request of his therapist, this child’s parents volunteered to have him treated by the instructor at a course about treating children who have hypotonia.  This is the first and only time he was seen by this therapist and he is working in front of a group of strangers.  All of these facts are important to keep in mind since the child is working with a new person and is in an unfamiliar environment.  The treatment session was videotaped and the family agreed to make it available to the treating therapist to be used for educating therapists in how to treat children who present with similar challenges to their motor systems.  At the time of this taping he is 21 months.  He has been creeping on hands and knees since 15 months and has mastered pulling to stand as well as cruising but he is not standing or walking independently.  He has recently been fitted with SMO’s (supra malleolar orthotics) to support the architectural integrity of his ankles and feet and these are available at this session.  He receives PT/OT/Speech through birth to three and parents note that he can become very upset at times during his therapy sessions which they describe as willfulness when he is trying to avoid working or he is trying to get his way.
During this 60 minute session we witness this child starting with the following  patterns:
-strong ankle foot eversion to widen his base for increased stability
-fisting in his hands during creeping and weight bearing
-leaning strongly against a support causing poor postural alignment for standing
-stacking his head and neck with decreased sustained co-activation in his shoulders
-overuse of lumbar flexion as part of an extension thrust for weight bearing
-mouth open with drooling secondary to the stacked head posture
-significant scapular winging with decreased trunk co-activation
-collapsed and stacked postures to stay in weight bearing
-emotional collapse and avoidance of structure.
With therapeutic intervention he demonstrates the following changes to name a few:
-tolerating input to his body & integrating new motor control
-attending to verbal, visual and tactile cues and interacting with others
-practicing emerging independent standing control with good alignment
-pushing into standing without using an extension thrust
-catching himself when moving out of standing
-keeping hands open to interact with toys rather than avoid

This is a 90 minute DVD

Revisiting Motor Control -
A Second Look at Age 5

David, his parents and his private OT came to Milwaukee for a consultation when he was 5 years old. This therapist had met David and his parents when he was 21 months old and he participated in a continuing education seminar as the child who received treatment in order to demonstrate the techniques being discussed. That treatment session was recorded and developed into an educational DVD titled Coordinating Motor Control - Treating a 21 month old. When David's parents received their copy of the completed DVD, they contacted me and arranged to have this follow-up consultation. In exchange they agreed to allow the session to once again be filmed so the footage could be used to show the changes a child who has hypotonia has made over the past 3 years.
The time together lasted 3 hours and not all of the activities were recorded. In order to produce a ninety minute DVD, the footage was edited. Where it would be helpful, activities were shown over several repetitions to allow the viewer to observe David's success with following verbal, visual and tactile cues. The DVD shows that the activities also become more complex, requiring greater integration once David understands the general concept that is being practiced. Watching several repetitions allows the viewer to observe this integration and learning.
At the beginning of the session the parents shared some of the changes they saw and concerns they had over the past 3 years. When observed, David is physically stronger and more independent but his motor delays persist. While viewing his movement, it is apparent that the hypotonia is not the biggest obstacle to David's acquiring more complex motor skills. Instead, his processing is now the more obvious deficit.

This is a 90 minute DVD

Coordinating Motor Control
Volume I & Volume II

This 2 Volume DVD set provides the DVDs on treating the 21 month old and the follow up session at 5 years in one complet package.


These are both 90 minute DVDs

Through The Years
Volume I & Volume II

This 2 Volume DVD set provides video footage of treatment strategies and outcomes on a child who was followed from 31 months to 23 years. The movie is narrated to explain the strategies and provide pertinent historical context to her condition at the time of each recorded footage.
Due to the volume of information covered, this material is packaged as a 2 DVD set.


These are both 90 minute DVDs

Strategies For Treatment

This DVD was created to accompany the book called:
"Heads Up On Hypotonia"
Strategies are demonstrated on a variety of patients with differing diagnoses. Although some of the patients have been diagnosed with spasticity, they benefit from the treatment techniques where a focus on increased proximal stability and activation are emphasized. Case studies of several children are provided by presenting footage of their motor control over several years. This not only allows therapists to observe a variety of treatment techniques, it also provides some feedback about how individual children have responded to the treatment activities.

This is a 71 minute DVD

Facilitating Development & Sensorimotor Function -
Treatment With The Ball 


This book, written by Barbara Hypes, is designed to help therapists use a therapy ball in their treatment programs with clients of all ages; The book emphasizes techniques which lead to improvement in underlying components necessary for the development of skill; The treatment principles proposed are applicable to children and adults with neuromotor dysfunction; In addition to presenting treatment principles, the author includes over 250 illustrations to help clarify specific treatment techniques on the ball. Topics of interest include:
- Appropriate functional goals for ball treatment
- Muscle tone and ball therapy
- Balance reactions and ball therapy
- Definition of terminology
- Facilitation using the gymnastic ball in: prone, supine, side lying, sitting, kneeling and 1/2 kneeling, stance & gait
- Examples of actual treatment sessions.

HEADS UP ON HYPOTONIA
Understanding the Complexities of Hypotonia & Strategies for Treatment

This book, written by Barbara Hypes, is published by Clinician's View .

The chapters of the book include:
-Frequently Asked Questions
- What is Tone?
-What is Hypotonia?
-Problem List for Hypotonia
-Strategies List for Treating Hypotonia
-Therapy Tools
-Common Compensations & Secondary Complications Seen in Hypotonia

In addition to the text, the DVD on treatment strategies is included to further illustrate the concepts and an overview of the challenges of hypotonia is presented through observing a variety of patients in therapy sessions.


CALEB THROUGH THE YEARS Volumes I, II, III, IV
Booklets with included DVD's of therapy sessions and resulting motor control gains.

These products written, edited and narrated by Barbara Hypes cover the progress of one child named Caleb from 3 years to 11 years of age. Caleb is diagnosed with agenesis of the corpus collasum early in his development and receives therapy through a birth-to-three program. He begins working with the author around age 4. The approach taken in therapy includes a strong focus on supporting his sensory system development since it is apparent to the author that his motor deficits are stemming more from his lack of understanding and integration about how to move rather than from failures of his motor system to support his movement.

  • Each booklet is illustrated with images captured from the included DVD footage of Caleb's actual therapy sessions.
  • Reference materials including current research is documented and included in each of the four booklets.
  • Since many therapists inquire about paperwork, Volume three includes actual notes from daily therapy sessions, three month summaries and communication with Caleb's specialists.
  • Volume One is ages 3 years 1 month with home video provided by the family and progresses to 5 years 6 months.
  • Volume Two begins at 5 years 7 months and ends at 6 years one month.
  • Volume Three begins at 6 years 2 months and ends at 7 years 5 months.
  • Volume Four begins at 7 years 6 months and the video footage ends at 10 years 10 months when Caleb is filmed during his final clinic based therapy session. Discussion continues in the booklet and includes some comments shared by the family when Caleb is 11 years old.

 

BARBARA HYPES P.T.

RESOURCES AND INTERVENTION STRATEGIES