Starfish Therapies

January 14, 2013

What does High Tone mean?

Filed under: Developmental Milestones — Starfish Therapies @ 12:00 pm
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I wrote a post a while back describing low tone so I thought I would try to do the same with high tone.  Tone is the resting state of your muscles.   When someone has high tone it means that their muscles are getting more input than is necessary, even when they are at rest.  Where kids with low tone tend to melt into you, these kids tend to be on the ‘stiffer’ side.  One thing I often hear from parents is that their child likes to stand all the time (even before standing is a milestone they should be hitting) and they don’t like to sit. (PS- for these kids it is not better to put them in an exersaucer alot because it doesn’t help them learn how to use their muscles differently)  This is because it is easier for their muscles to work all together.  When they are standing they are able to use extension all together, they can keep all of their muscles turned on at the same time.  When they are sitting they are asking their muscles to do different things.  They need to keep their trunk muscles turned on without turning on their gluts (tush muscles) at the same time.

Many people think that kids with higher tone are stronger because they are able to keep their muscles turned on.  This is a common misconception and these kiddos often have the same amount of weakness as kids with low tone.  The just look strong when they are able to do a task like standing when all their muscles are on.  If you ask them to sit or go onto hands and knees they often have a more challenging time because they have to isolate their muscles to have them do different things.  When a child goes onto hands and knees they need to keep their head, neck and trunk extensor muscles turned on but they need to relax their gluts/hip extensor muscles so that they can bend at the hips and again at the knees.  Often they will hold this position for a short period of time before they turn their gluts back on and come up into high kneeling.  This is because its easier for them to maintain head, neck and trunk extension with hip extension then it is to have hip flexion with their head, neck and trunk being extended.  Just like in sitting they need to keep their trunk upright while keeping their legs bent at their hips and knees.

Its important to remember that these kids need to strengthen individual muscles so that they become more efficient at isolating out movement and don’t need to rely on using all their muscles doing the same thing at the same time.  The earlier they start developing isolated muscle strength the easier it will be as they progress through their milestones where they need to be able to use each  muscle differently.  In addition, as they grow or have growth spurts you may see some ‘stiffness’ return because their muscles have just been stretched and need to adapt to the new length.  Maintaining isolated strengthening will help your child to move through these growth spurts with increased ease.

I know this is a hard topic to explain so I hope I made it a little more understandable for you.  Please don’t hesitate to ask any questions that this may have raised and I will do my best to answer.

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17 Comments »

  1. Thanks for a great explaination that parents can understand.

    Comment by Barbara Stewart, MS, PT — January 14, 2013 @ 2:21 pm | Reply

  2. I LOVE your blog and think you have done an incredible job with a really difficult concept.

    Comment by Karen Miller, MSPT Physical Therapist Harrisonburg City Schools — January 14, 2013 @ 5:26 pm | Reply

  3. Fantastic article. So, my first child is low muscle tone and getting ot pt for it. From birth, I knew my now 7 month old is on the extreme other end. How do you teach a 7 month old to isolate/bend at knee, hip? We got the sit thing down, but how to get her to crawl? She’s been “standing” since 3 months due to the tone thing. The poor child is on tummy time like all the time. In a 24 hr period she gets maybe an hour at most on her back including diaper changes, and maybe 1.5-2 hrs sitting including playing, eating, car, and bathing time. No bouncies or swaddling ever, and we didn’t bwck to sleep much beyond the first two months due to sister’s history, and the fact that she was able to get her head up fully from birth. Sitting took a bit as you can imagine but as far as I can tell she has good rotation/bilateral limb control grasp, across midline etc etc. she rolls everywhere evenly on both sides and she is getting her knees under her once in a while, and her arms and abs I think are more or less ready. But she doesn’t like being in that knee down position again, as you can imagine. I’m trying to decide if the crawling will magically happen or if I need to get her to pt now given her sister’s history. She is ticklish, I do try to activate using that, but not much is happening. We do have the Lamaze spin thing, but she just rigids her legs in line with the torso. I’d love to try some things at home first. When she pulls up on things, the back just arches, the legs don’t flex at knee, hip stays extended… She is super early on all the milestones (communication, fine motor) and even the large motor for now, due to my incessant ball work and tummy time with her, but this one stumps me. I don’t let her stand for more than a few minutes a week and only recently at that, despite her liking it. I’d love 1-2 tips or ideas ( before I go and harass her sister’s pt or the ped, since we don’t see him until 9 months and as you know, that is sometimes not soon enough).

    Comment by Irene — January 15, 2013 @ 4:09 am | Reply

    • I’ll do my best. Try having her go into hands and knees but have her tush sitting all the way back on her heels. This will let her focus on just the head, neck and trunk while keeping arms extended. If she can hold that and maybe reach for a toy with one hand or the other without lifting up at the trunk so that her arms no longer touch the ground, then try to start slowly lifting her tush off her feet a little at a time and having her hold that position and ‘play’ in it (i.e. reach for toys). This should help build up the endurance of just using trunk muscles and not being able to call in all of her muscles. If she’s too ‘strong’ for just your hands you can sit on the ground and use your legs to help you stabilize her (not sure if that makes sense). Hopefully that’s one idea that can get you started.

      Comment by Starfish Therapies — January 15, 2013 @ 4:17 am | Reply

      • Maybe this will make your day a little happier. A big big thank you very much is in order. Less than 2 weeks and we are there. I still see kind of frog-like attempts with both legs, but the kiddo is on her hands and knees, crawling in reciprocal motion (when she remembers which limb to move next :-)) Thanks a million (and oh yes, she is mighty strong, took two people to get her to “assume the position” and play in it. Of course now she is insta-doing the two-rigid-little-legs-pushing-at-the-same-time pulling to stand, instead of one at a time. Now that I get it, we can improvise 🙂 and get some practice on using those little chunky legs individually. Woot woot.

        Comment by Irene — January 31, 2013 @ 3:46 am

      • I love it! That’s awesome and thanks for sharing! You completely made my day!

        Comment by Starfish Therapies — January 31, 2013 @ 3:58 am

  4. Fantastic, thank you!

    Comment by Irene — January 15, 2013 @ 5:13 am | Reply

  5. Hello! I love this blog post as you have described my daughter Taylor perfectly. She is about 7 months (6 months corrected age) and has CHARGE syndrome. She is starting to gain head control but it is still very very limited. She will not sit alone and only sometimes will she sit assisted. (we have learned she hates the Bumbo chair) She loves to lay! and like you described she likes to “stand” (with lots of help of course). She will do some tummy time and lift her head but because she cannot roll she gets very mad. Her arms are not very loose as she seems very tight or stiff (sorry not sure how to describe it) and she hates to be forced. Even the simplest thing like lifting her arm to take a temperature ticks her off. She is very small for her age weighing 12lbs 3oz. She had torticollis and we have been working at loosening this as well as side laying position at night to help with her flathead. She also likes very very firm pats. We have an Occupation Therapist but unfortunately she is not the most pro-active and attributes a lot of these things I am describing to her being a “drama queen”. Can you help me figure out if a SPIO suit is beneficial for her? I feel like the vest would be good as her core is where she has the least control however she may benefit from a long sleeve and pant suit as well?! Any help is greatly appreciated!

    Comment by Lana Cox — February 11, 2013 @ 6:26 pm | Reply

    • I’d love to try to help. It may be easier via email stacy at starfishtherapies dot com

      Comment by Starfish Therapies — February 11, 2013 @ 11:49 pm | Reply

  6. Glad to have found your blog. Thank you. Hello. my 4 month old girl is regularly stiff in the legs as you describe. She was frank breech and born vaginally, butt first.
    She sleeps great eats great and smiles a lot.
    Have an appointment on Monday w ped. I am assuming doc will refer me to PT. ?
    What should i look for in a therapist ? Program? What questions should I ask to find a good place for PT?
    What can i start doing in the meantime to help my daughter ? *
    I am in a web of emotions right now trying to wrap my mind around what this is and what it could mean.
    Thanks again. Please ! Any reply would help.

    Comment by Kelly — January 19, 2014 @ 1:19 pm | Reply

  7. Do you have lists of recommended exercises? I have a two year old with low tone core and high tone arms and legs. He can’t sit on his own yet but loves to walk with us holding onto his hands. This is the first I’ve heard about isolation exercises to work individual muscles. I’d love some ideas.

    Comment by Lee — April 17, 2015 @ 5:45 pm | Reply

  8. Hello my daughter was diagnosed with angelman syndrome. .and is high tone , walks on her toe almost all the time and Very rarely has her feet flat , she’s 15 now wears afo ‘ s that do help some , but just don’t want to keep her feet flat..any suggestions. .regards Joe

    Comment by Joe — May 16, 2015 @ 11:26 pm | Reply

    • Without seeing your daughter its hard to answer specifically, how is her hamstring length? What is her leg strength like? Does she walk with an assistive device or independenty? Is she currently receiving PT? Have they had any suggestions? I have a few things that I would maybe try but again, I haven’t seen her so its hard to be specific.

      Comment by Starfish Therapies — May 27, 2015 @ 3:12 pm | Reply

  9. they said my child only has it in his neck and his hands- no tone issues elsewhere- is this possible

    Comment by a — October 31, 2015 @ 5:05 pm | Reply

  10. Hello! Thank you for this great article. My daughter is 17 months and had a birth injury. She has some high tone on her right leg / ankle which is making it difficult for her to learn to walk. She has been pulling to stand and doing some side steps along furniture for several months but she sometimes tiptoes on her right side which makes it difficult for her to find her balance. Her left side is ok according to her pt. Do you have any tips to help her decrease her high tone and learn to walk by herself? Thank you very much!

    Comment by Joelle Guillet — August 10, 2016 @ 5:25 pm | Reply

    • You can try putting shoes on, that helps sometimes to decrease their tendency to go onto tip toes. I would say more strengthening so that she is able to choose which muscles she wants to activate rather then letting her tone take over. Practicing sit to stand and stand to sit, or picking toys up off the floor and returning to standing (all are similar to squats). Crawling up stairs. Lots of leg strengthening.

      Comment by Starfish Therapies — October 2, 2016 @ 3:08 pm | Reply

  11. […] a child has low muscle tone or high muscle tone there are other things to consider.  For a child with low muscle tone, they are working hard to […]

    Pingback by Growth Spurts | Starfish Therapies — January 29, 2017 @ 12:29 am | Reply


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