Treating Children with Hypotonia with Physical and Occupational Therapy

Depending on the cause and severity of hypotonia, treatment may vary. However, early and skilled treatment (physical, occupational and speech therapy) will minimize long-term impairments due to hypotonia and provide the best outcomes.

When treating hypotonia with physical and occupational therapy, the primary objective is to improve posture and core stability to provide a foundation for upper and lower extremity movement and function. Another common treatment goal is to strengthen muscle around joints for support and stability to compensate for decreased tone and hyperflexibility. While strengthening, an emphasis is made on promoting proper alignment and biomechanical positioning and on improving body awareness through proprioceptive input.

There are many techniques used to increase core stability and strength. For infants, a majority of strengthening is based on the facilitation of developmental milestones with an emphasis on the developmental progression, moving through transverse/ rotational planes, pushing through the surface with arms and feet, weight shifting and symmetry. Often times a therapy ball will be used to provide appropriate challenges on a dynamic surface, increase vestibular input and weight shifting and to foster success. To better achieve outcomes, parents are trained in these techniques to be done at home.

Treatment changes as children age

As children age, strengthening is accomplished through both specific localized efforts and generalized through function or developmental milestones. Performing activities on pliable or dynamic surfaces are used to promote increased postural control. Large postural muscle groups (shoulder and pelvic girdle) are strengthened using closed chain large movements such as climbing up and down surfaces to target both concentric and eccentric muscle activation. A strong emphasis is on motor planning and control, bimanual skills or crossing midline activities and improving speed and quality of movement. Functional electrical stimulation can be used to support strengthening efforts and to improve motor control.

For some children, support is needed for proper alignment and improved biomechanics. Poor alignment is often due to muscle imbalance. There are many tools therapists use to help support these imbalances. Thera is a supportive garment designed to allow therapists to facilitate specific muscle activation is often used. Kineseo taping is also used in this way. Orthotics may be recommended to improve the position of the foot on the floor. Developmentally appropriate biomechanical alignment helps to facilitate the use of the correct muscles needed during movement and prevents compensatory movement patterns.  

Sensory-based techniques during therapeutic activities can help to support strengthening of children with hypotonia. Techniques to provide joint compression and tactile input promote co-activation of muscles for joint support and improved body awareness. Vestibular activities (swings) are also frequently used to improve arousal level and to support increased muscle tone.

Every child is different, and what one child benefits from another may not. With a thorough evaluation and collaboration with you, your therapist will be able to develop a treatment plan and goals that will best meet your child’s needs. To learn more, talk to a pediatric therapist, call us at Dynamic Solutions or email me at

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