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Flaccid Cerebral Palsy: How to Manage Low Muscle Tone

understanding flaccid cerebral palsy symptom

Low or flaccid muscle tone (hypotonia) is a rare symptom of cerebral palsy.

In fact, most people with cerebral palsy have the opposite condition, which is high muscle tone (hypertonia).

This article will provide understanding for what to expect if your child has flaccid muscle tone as well as the most effective ways to manage it.

Types of Cerebral Palsy with Flaccid Muscle Tone 

Cerebral palsy is a motor disability that affects a person’s movements.

Our muscles create movement by contracting and relaxing. Individuals with flaccid muscle tone lack muscle tension at rest, which increases their risk of injury and makes it difficult to coordinate movements.

There are 4 main types of cerebral palsy:

  1. Spastic CP  is the most common type of cerebral palsy, making up approximately 80% of all CP cases. It’s caused by damage to the motor cortex and is primarily characterized by high muscle tone. Individuals with spastic CP may experience flaccid tone in their trunk or neck alongside spasticity in their limbs.
  2. Dyskinetic CP is characterized by uncontrollable movements and is caused by damage to the basal ganglia. Individuals with this type of cerebral palsy experience involuntary fluctuations between spastic and flaccid muscle tone. 
  3. Ataxic CP will affect one’s balance and coordination. It’s caused by damage to the cerebellum. Individuals with this type of cerebral palsy often have flaccid muscle tone.
  4. Mixed CP is caused by damage to multiple areas of the brain. Therefore, individuals with this type of cerebral palsy will demonstrate symptoms of 2 or all of the types listed above.

Most children with flaccid muscle tone due to cerebral palsy will be diagnosed by the time they’re 6 months old. 

However, milder forms of hypotonia may go unnoticed until the child is older.

Signs of Flaccid Cerebral Palsy

flaccid cerebral palsy muscle tone


Every case of cerebral palsy is unique. Even individuals with the same type of CP may have completely different symptoms.

Symptoms of flaccid cerebral palsy include:

  • Limp or flaccid limbs
  • Minimal or no neck control (head tilting to the side while sitting or inability to raise head when lying on stomach)
  • Developmental delays
  • Frequent falls and clumsiness
  • Extreme flexibility
  • Slow movements and reflexes
  • Soft or weak voice
  • Feeding difficulties
  • Wide-based stance when walking, sitting, or standing
  • Fatigue

Cerebral palsy is caused by damage to the brain at birth or early childhood. While the brain damage may not worsen over time, symptoms can progress which makes proper management essential.

Management of Flaccid Cerebral Palsy 

physical therapy for children with cerebral palsy and low muscle tone

© Antonio_Diaz

Early management of cerebral palsy symptoms is crucial to maximizing your child’s mobility. 

Management for flaccid muscle tone can consist of:

Physical Therapy

Physical therapy for children with hypotonia will consist of exercises to build muscle strength and improve coordination. 

Muscle tone refers to the amount of tension a muscle has at rest. In contrast, muscle strength helps you perform movements when the muscles aren’t at rest.

By exercising to build strength, individuals with flaccid muscle tone may improve the speed and coordination of their movements.

Occupational Therapy

Occupational therapy for flaccid muscle tone will focus on practicing everyday activities such as eating, grooming and dressing.

Working on functional tasks teaches children how to be independent at home and promotes active movement.

Depending on the severity of your child’s hypotonia, an occupational therapist may also teach your child how to use adaptive equipment.

Speech Therapy

Flaccid muscle tone may affect any muscles in the body, including those around the mouth.

To manage speaking or feeding difficulties, individuals with hypotonia may benefit from treatments from a speech-language pathologist.

During speech therapy, children may practice activities focused on strengthening the oral motor muscles so that they can communicate more effectively.

Children with severe cerebral palsy who are non-verbal may learn to use alternative forms of communication such as tablets or voice generators.

Orthotic Devices

Because children are constantly growing, poor posture may affect the way the body develops. 

Wearing orthotic devices such as braces or casts promotes proper body alignment and form.

For example, a trunk brace will prevent slouching due to weak core muscles and promote upright sitting balance. 

While orthotic devices won’t change flaccid muscle tone, they may provide the support necessary to reduce injuries and promote proper musculoskeletal alignment.

Caring for a Child with Flaccid Cerebral Palsy

cerebral palsy flaccid tone management

Now that you understand what flaccid muscle tone is and how to manage it, here are some tips to consider when caring for a child with hypotonia:

1. Before lifting your child, always make sure that one hand is supporting the back of their head to prevent neck injury.

2. Avoid lifting your child by their arms or legs because children with low muscle tone are more likely to dislocate a joint.

3. Select clothes that are comfortable, easy to put on, don’t restrict movement, and won’t get caught on nearby objects. 

4. Encourage your child to perform activities of daily living independently and only assist them when they ask for it to promote active movement and body awareness.

5. Be patient. Because children with flaccid muscle tone struggle to coordinate their movements, they’ll likely need more time to carry out tasks and activities.

With the right care and enough practice, individuals with hypotonia can improve their mobility. Good luck!

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You’re on a Roll: Discover a home exercise program for CP that’s actually fun to do!

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Music is a motivator for him. He has been using it on his arm and we will try the leg exercises soon.”

FitMi works by motivating high repetition of therapeutic exercises while playing an engaging game. This gamification has been particularly great for motivating individuals with cerebral palsy to recover.

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