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Review
. 2024 Feb 18;12(4):493.
doi: 10.3390/healthcare12040493.

Identifying and Evaluating Young Children with Developmental Central Hypotonia: An Overview of Systematic Reviews and Tools

Álvaro Hidalgo Robles  1 , Ginny S Paleg  2 , Roslyn W Livingstone  3
Affiliations
Review

Identifying and Evaluating Young Children with Developmental Central Hypotonia: An Overview of Systematic Reviews and Tools

Álvaro Hidalgo Robles et al. Healthcare (Basel). .

Abstract

Children with developmental central hypotonia have reduced muscle tone secondary to non-progressive damage to the brain or brainstem. Children may have transient delays, mild or global functional impairments, and the lack of a clear understanding of this diagnosis makes evaluating appropriate interventions challenging. This overview aimed to systematically describe the best available evidence for tools to identify and evaluate children with developmental central hypotonia aged 2 months to 6 years. A systematic review of systematic reviews or syntheses was conducted with electronic searches in PubMed, Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, Google Scholar, and PEDro and supplemented with hand-searching. Methodological quality and risk-of-bias were evaluated, and included reviews and tools were compared and contrasted. Three systematic reviews, an evidence-based clinical assessment algorithm, three measurement protocols, and two additional measurement tools were identified. For children aged 2 months to 2 years, the Hammersmith Infant Neurological Examination has the strongest measurement properties and contains a subset of items that may be useful for quantifying the severity of hypotonia. For children aged 2-6 years, a clinical algorithm and individual tools provide guidance. Further research is required to develop and validate all evaluative tools for children with developmental central hypotonia.

Keywords: classification; diagnosis; down syndrome; evaluation; hypotonic cerebral palsy; low tone; measurement; reliability; validity.

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Conflict of interest statement

Á.H.R. and R.W.L. have no conflicts of interest to declare. GSP has worked as an educational consultant for Prime Engineering, a manufacturer of supported standing and stepping devices. This relationship had to influence on this unfunded study.

Figures

Figure 1
Figure 1
Prisma 2020 flow diagram of the search process.
Figure 2
Figure 2
ROBIS risk-of-bias ratings for the three systematic reviews [15,41,42].
Figure 3
Figure 3
AGREE II rating comparing consensus of published expert review [44] and consensus of this review.
See this image and copyright information in PMC

References

    1. Van Der Meché F., Van Gijn J. Hypotonia: An erroneous clinical concept? Brain. 1986;109:1169–1178. doi: 10.1093/brain/109.6.1169. - DOI - PubMed
    1. Shortland A.P. Muscle tone is not a well-defined term. Dev. Med. Child Neurol. 2018;60:637. doi: 10.1111/dmcn.13707. - DOI - PubMed
    1. Ganguly J., Kulshreshtha D., Almotiri M., Jog M. Muscle tone physiology and abnormalities. Toxins. 2021;13:282. doi: 10.3390/toxins13040282. - DOI - PMC - PubMed
    1. Peredo D.E., Hannibal M.C. The Floppy Infant: Evaluation of Hypotonia. Pediatr. Rev. 2009;30:e66–e76. doi: 10.1542/pir.30.9.e66. - DOI - PubMed
    1. Bodensteiner J.B. The Evaluation of the Hypotonic Infant. Semin. Pediatr. Neurol. 2008;15:10–20. doi: 10.1016/j.spen.2008.01.003. - DOI - PubMed

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