Sunday, September 15, 2013

Muscle Tone vs Muscle Strength

So What Is The Big Difference?

The Difference Between Muscle Tone and Muscle Strength Explained By Diane E Gagnon, M.Ed., PT (Physiotherapist) Biddeford, Maine

Many people don't understand the difference between muscle tone and muscle strength. True muscle tone is the inherent ability of the muscle to respond to a stretch. For example, if you quickly straighten the flexed elbow of an unsuspecting child with normal tone, the biceps will quickly contract in response (automatic protection against possible injury). When the perceived danger has passed, which the brain figures out really quickly once the stimulus is removed, the muscle then relaxes, and returns to its normal resting state.

The child with high tone or "spasticity" has over-reactive response to the same stimulus. When his arm is stretched, the biceps tightens at an even more rapid rate, and the rate of recovery is much slower, even after the stimulus is removed. Full relaxation is difficult to achieve, so the muscle stays taut for an extended period of time. If another stimulus is added before the muscle has a chance to recover (which happens often during normal movement in the everyday world), the muscle contracts again, becoming tighter. Because this child's muscles never truly rest unless he is asleep, the long term result is tighter, shorter muscles with reduced joint range. This is typically seen in the child with spastic CP.

The child with low tone has muscles that are slow to initiate a muscle contraction, contract very slowly in response to a stimulus, and cannot maintain a contraction for as long as his "normal "peers. Because these low-toned muscles do not fully contract before they again relax (muscle accommodates to the stimulus and so shuts down again), they remain loose and very stretchy, never realizing their full potential of maintaining a muscle contraction over time. These are the "floppy" children who have difficulty maintaining any posture without external support. A child's unique neurological wiring determines whether he will be low, high, or normal toned.

Most people have "Normal Tone". In those who do not, a number of factors are involved. Somewhere deep in the muscle are receptors responsible for detecting changes in muscle length. These receptors then tell the brain there is a stimulus, and the brain tells the muscle to contract in response. There are numerous feedback loops to tell the brain whether the muscle has responded appropriately, needs to contract again, relax or whatever... In addition, there are receptors that tell where each joint is located in relation to all the other body parts that help to determine position in space, etc. A delay in perception, decoding, or transmission anywhere along the neural pathways will result in a change from an optimal response, or "normal" tone.

People often refer to having a "toned" body when they are in "good physical condition" and exercise regularly. Their muscles are taut, and they look lean. An out of shape person is referred to as having "poor tone", with fleshy muscles and an abundance of "fat".  Neurologically these people actually have the same "tone", and the fat person is inherently capable of looking as "toned" as the other (with some allowances made for genetic make-up of course), and just needs to exercise regularly. Fitness experts and health clubs will tell you they are "improving muscle tone", when they are actually reducing the amount of fat to lean body mass ratio.

You can improve your fat to lean body mass ratio, and you can become stronger too. These are under your voluntary control. Muscle tone occurs at an involuntary level. We can effect changes in muscle responses with sensory integration treatment techniques that increase the "alert state of the muscle" by bombarding it with sensory stimuli and improve the brains ability to perceive changes in muscle length, preventing it from accommodating to stimuli.

With ongoing treatment and practice throughout the day, the more "normal" response elicited, the stronger and more efficient even low toned muscles become. "That" is the basis of our classroom program for children with low tone. Sensory bombardment can effect changes in perception that then lead to changes in efficiency along the neural pathways. But it goes way beyond a couple of hours a week in the gym.

© 1999 Diane E. Gagnon, M.Ed., PT Biddeford, Maine 04005, USA

My little Emmalin and a fine example of low tone.  So hard to believe this was comfortable.


Tone by Loren Shlaes-Pediatric Occupational Therapist

As a therapist, I sometimes forget that civilians don't understand all of the professional jargon that my colleagues and I use to communicate with each other. I try, when I write an evaluation of a child, to explain what each thing I assess means, and most important, how it affects the way the child functions. But when I hand over a 12 page report to a parent, I have to remember that not everything is sinking in all at once, and that the information I'm conveying has to be absorbed, bit by bit, as the parent can integrate it.

"Low tone" is something we occupational therapists talk about quite often. But parents complain to me that they have no idea what that means. Sometimes it's quite obvious -- the mother of one of the children that I treat just had a baby, and she called me to tell me that the baby is so weak and floppy that it can't tighten its fist around an index finger placed in its palm. Other times it's not nearly as apparent, and a child can appear to be quite athletic and still be plagued by all kinds of problems associated with low tone.

Tone is the amount of electricity that courses through the muscles and allows them to do the jobs of extending the body against gravity, contract themselves around joints for balance and stability, and work for long periods of time without undue fatigue. An example of someone with plenty of tone is a professional athlete or dancer. I'll never forget the time I met my favorite baseball player, Dennis Eckersley. He practically crackled, he had so much juice and electricity flowing through his body! As far as I know, there is no one definitive reason for low tone.

Some people believe that it is a nutritional issue, and that for some reason the body is not delivering, {perhaps because of dietary issues or metabolic difficulties} or the muscles are not utilizing, the raw materials needed for maintenance and sustained use. The child's muscles don't develop well, and so they tire easily.

An under responsive vestibular system can be a possible reason for low tone. The vestibular nerve is responsible for many things. It tells us, along with our eyes and muscles, where we are in space. It also responds to how much and what kind of movement we get, and communicates directly with the muscles that extend us against gravity and allow us to be upright. It also talks to the part of the brain that is responsible for alertness, attention, and arousal. If the vestibular nerve is not picking up and processing this information correctly, the result will be insufficient muscle tone and chronic low arousal.

Another issue that interferes with the child's ability to function is delays in the maturation of spinal reflexes. When a child is born, its nervous system is immature, unlike a horse's -- a pony can get up and walk shortly after birth. Humans start out instead with nervous systems that respond by increasing or decreasing muscle tone in response to certain stimulation, and then go on to refine themselves through movement and play until voluntary control is established. Then the reflexes disappear. If they don't disappear and are dominating the nervous system, the child will have difficulty working his body against gravity.

If your child tires easily, complains that he doesn't have any energy, can't sit up while he's writing, is a chronic slumper, or has a hard time sitting still or sitting on the floor, chances are his tone is low, even if he appears to be athletic. I've seen plenty of boys who could pitch a ball like Roger Clemens -- but their core strength was so weak that they couldn't do a single sit up or lift their chests and thighs up off the floor when lying on their bellies. Children with low muscle tone have an especially difficult time of it in school, because their bodies don't have the effortless uprightness against gravity that allows them to sit still. If they are struggling to stay upright, they're using the mental and physical energy to sit that they should be applying towards attending to the lesson.

I once went to school to observe a little boy who acted out a lot, especially during circle time, when all the children had to sit cross legged on the floor. The day I saw him, during circle time, he sat with his legs straight in front of him and his hands behind his back on the floor, using his arms to brace himself. He simply was not able to sit in the traditional "criss cross applesauce" position, and needed the additional support from his arms, and wide base from his extended legs, just to stay upright. I saw immediately that he was so uncomfortable sitting this way, and that it was so much effort, that he couldn't sit on the floor and attend to what was going on at the same time. He didn't have enough sophistication in his language to tell anyone what the problem was. His only recourse was to refuse to stay there for very long, and this was viewed as disruptive behavior. I suggested to his teacher that he either be allowed to sit in a chair or that he be assigned a place against the wall so that he could sit with his back supported. He was much happier after that, and he was much more able to attend. Low tone affects many aspects of function, which I will address in future posts.  Meanwhile, if your child has low tone, no amount of yelling at him to sit up straight will help. Try incorporating activities to strengthen the trunk, like sitting on a therapy ball while doing homework or watching TV, doing sit ups and pushups, wheelbarrow walking, wrestling matches, and playing with whistles, bubbles, and blow toys to your child's daily routine. Spinning is good for vestibular activation, if your child likes to spin. Or take your child outside and play tag or ball, or organize a game of statues or red rover with other children in the neighborhood.

So Now What?


Your child’s doctor will run a series of tests to determine the extent of the condition. He may use x-rays and other tests to check muscle and nerve function. He will also assess your child’s balance, coordination, and motor skills. Whenever possible, your child’s underlying medical condition will be treated.


Hypotonia may sometimes gradually improve with treatment. A physical therapist might use a sensory stimulation program, which involves facilitating muscle contractions by stretching and tapping the muscles. Physical therapy may help improve fine motor control. Your child will also likely be treated by an occupational therapist. The occupational therapist will also work to improve fine motor control.

Speech Therapy

Low tone does not stop with physical and occupational therapy.  Low tone in fact plays are large role with our kids speech.  Children with hypotonia often have trouble breathing and vocalizing. Hypotonia can affect the ability to move oral structures like the jaw, lips, and tongue. It can also affect the quality and rate of speech, often resulting in slurred or slowed speech. A speech-language pathologist (SLP) can help your child improve his swallowing and feeding abilities, as well as address his speech delays. She may help him improve his oral motor skills, which means that he will have better control over his mouth muscles. 

See more at:

Emmalin started hippotherapy to help with the low tone.  The horse will be a great addition to our therapy program.

Tuesday, September 10, 2013

Methylation and MTHFR

What is Methylation

Simply put, methylation is a chemical reaction that occurs in every cell and tissue in our body.  Chemically speaking, methylation is the process of adding methyl groups to a molecule.  (A methyl group is a chemical structure made of one carbon and three hydrogen atoms.)  Since methyl groups are chemically inert, adding them to a protein (the process of methylation) changes how that protein reacts to other substances in the body, thus affecting how that protein behaves.  Enzymes, hormones and even genes are proteins and the process of methylation affects them all.

In some way, methylation of proteins helps the body detoxify.  For example, the methylation process helps convert the toxic amino acid (homocysteine) into a beneficial amino acid (methionine).  If your body cannot methylate properly, toxins build up in your bloodstream and will eventually cause disease. 

Another role of methylation is to help the enzymes in our bodies work efficiently.  Enzymes are proteins that act like switches for chemical reactions-they initiate very important processes in every cell and tissue.  In a similar way, methylation affects our genes, which are also made up of proteins.  In fact, methylation can turn genes on and off, which can be good or bad for our health, depending on the gene.

Some nutrients affect the process of methylation quite dramatically-methyl donors (nutrients like folate and choline) actually donate methyl groups to proteins and methylating factors (nutrients like vitamin B12 and zinc) helps this process along by monitoring specific methylation reactions.  how well your body "can methylate" is important to your overall health.

What is MTHFR and How is it Related to Methylation

MTHFR (methylenetetrahydrofolate reductase) is an enzyme that converts folic acid into usable form that our bodies need.  It is a key enzyme in an important detoxification reaction in the body-one that converts homocysteine (toxic) to methionine (benign).  If this enzyme is impaired, this detoxification reaction is impaired, leading to high homocysteine blood levels.  homocysteine is abrasive to blood vessels, essentially scratching them, leaving damage that causes heart attacks, stroke, dementia and a host of other problems.

Additionally, when the enzyme MTHFR is impaired, other methylation reactions are compromised.  Some of these methylation reactions affect neurotransmitters, which is why impaired MTHFR activity is linked with depression.  Inefficiency of the MTHFR enzyme is also linked to migraines, autism, fertility, cancer and birth defects, all of which depend on proper methylation.

High levels of homocysteine can be attributed to many conditions such as: 
*  The condition can lead to high rates of dementia /Alzheimer`s due to a decrease in vitamin B-12. 
*  High homocysteinemia can lead to coronary artery disease, common carotid atherosclerosis other Vascular Diseases.
*  Complications in Pregnancy Due To Neural Tube Defects. 
*  Atherosclerosis
*  Rheumatoid Arthritis
*  Downs Syndrome
*  Alcoholism
*  Osteoporosis
*  Neuropsychiatric Disorders
*  Non Insulin Dependant Diabetes
*  Early Pregnancy Loss
*  Spontaneous Abortion (Viable Fetus)
*  Placental Abruption, Low Birth Weight

What is the MTHFR?

There is a gene called the MTHFR gene that basically controls how well this enzyme works.  A simple blood test can tell you if you have variant copies of this gene.

There are over 50 known MTHFR variants, but the two prime variants are called 677 and 1298, the numbers refer to their location on the gene.  The routine lab test for MTHFR variant only reports on 677 and 1298 as these are the most studied.

The 677 variant is associated  with early heart disease and stroke and the 1298 variant with a variety chronic illnesses.  The MTHFR is reported out as heterozygous or homozygous.  If you are heterozygous you have one affected gene and one normal gene (could have come from either parent).    The MTHFR enzyme will run at about 55% to 70% efficiency compared to a normal MTHFR enzyme.  If you are homozygous then enzyme efficiency drops down to 7% to 10% of normal, which of course makes a huge difference."  Emmalin is homozygous as am I.  She got one copy from her father and one copy from me, just as I received one from each of my parents.

"The worst combination is 677/1298 in which you are heterozygous to both anomalies.  Many chronic illnesses are linked to this anomaly.  98% of autistic children have an MTHFR anomaly.  Fibromyalgia, irritable bowel syndrome, migraines, are all conditions associated with MTHFR anomaly." 
"MTHFR can make you susceptible to illness because the pathway is the primary source of glutathione production in the body.  Glutathione is the body's primary antioxidant and detoxifier.  People with MTHFR anomalies usually have low glutathione, which makes them more susceptible to stress and less tolerant to toxins."  
"As we age MTHFR problems get much worse due to the accumulation of toxins and the cumulative effect of oxidative stress, which ages our bodies."

What kind of symptoms are associated with the MTHFR gene defects?

There are many different symptoms someone with one or both gene mutations might encounter.  Not everyone has the same set of symptoms because there are many other genetic and environmental differences that complicate health.  But if you boil it down, there is a key systemic problem that comes from low methylation and it causes three different symptom areas. 

Systemic problem:  Homocysteine levels are too high due to the fact that not enough Methylfolate is available to convert the Homocysteine into Methionine, SAMe and Glutathione.  Think of Methylfolate (L-MTHF or 5-MTHF) as the wizard changing the bad guy (Homocysteine) into good guys (SAMe and Glutathione).

Three symptom areas:

    1.  Central Nervous System disorders - some of these come from Homocysteine not getting converted into SAMe.  SAMe is responsible for creating Serotonin, Dopamine, and Norepinephrine (neurotransmitters responsible for mood, motivation, and to some degree energy levels - if these are low, then Depression is often the result, but even aggression and alcoholism are symptoms sometimes found in men).  Pregnant women may encounter extreme Post-partum depression.  Also, things like Fibromyalgia, Chronic Fatigue Syndrome, Migraines, IBS (Irritable Bowel Syndrome), Memory loss with Alzheimer's and Dementia and other psychiatric problems can be tied to this issue (OCD, Bipolar, Schizophrenia, and more).  These challenges are typically more related to the 1298 gene mutation.  A very recent clinical trial (not even published yet) was done by Dr. Fava (July, 2011) showed that giving L-Methylfolate (Metafolin) found in the prescription 'medical food', Deplin, was as effective as the top anti-depressant drugs available today (and without all the side effects).

   2.  Cardiovascular problems often occur when Homocysteine levels in the body are too high.  Heart attack, Stroke, Blood clots, Peripheral neuropathy, Anemia even Miscarriages and Congenital birth defects can be related to this issue among others.  These problems are typically more related to the 677 gene mutation, but the worst is for a person who has one 677 variant and one 1298 variant.

    3.  Environmental poisoning can increase when not enough Homocysteine gets converted into Glutathione.  Glutathione is responsible for detoxifying the body of the heavy metals we encounter in the environment - it is our body's most powerful antioxidant.  When a body gets too burdened by heavy metals and toxins, a lot of unexpected health problems emerge.  Some symptoms of this can be: nausea, diarrhea, abdominal pain, liver and kidney dysfunction, hypertension, tachycardia, pulmonary fibrosis, asthma, immune problems, hair loss, rashes and more.

Sometimes diseases/disorders fall under a 'two-pronged' cause, meaning the causes of it stem from both genetic and environmental problems).  Autism is a big one that falls into this 'two-pronged' cause category [American Journal of Biochemistry and Biotechnology, 2008] along with Fibromyalgia, Chronic Fatigue Syndrome and more.  MTHFR is at the top of a list of 16 genetic defects for autism.  Another study showed 98% of children with autism had one or both of the MTHFR gene defects (677 and/or 1298).  A recent clinical study indicated that mothers with MTHFR who didn't take folate during pregnancy were 7 times more likely to have an autistic child than mothers without the MTHFR gene defect [Epidemiology, July 2011, Vol. 22, Issue 4, pgs 476-485].  Colon and gastric cancers also have key links to the MTHFR gene defects, just do an internet search on 'MTHFR and colon cancer' or 'MTHFR and gastric cancer' and you will find many clinical studies and articles on the subject.

 If I Have Variant Copies of the MTHFR Gene, What Can I Do?

If the MTHFR enzyme is inefficient, you can compensate for your body's inability to methylate efficiently since this biological process is dependent on several B vitamins.  You may simply need more B vitamins than someone without a variant copy of this gene, such as vitamin B6, B12 (methylcobalamin) and the active form of folate (5-methyl tetrahydrofolate).  Other methyl donors such as SAMe and trimethylglycine may also provide benefits.  If you have a defective copy of the MTHFT gene, it is important for you to monitor your homocysteine level as well.  Fortunately, lowering homocysteine can often be done with the nutrient supplements listed above.

Determining what copies of the MTHFR you have gives you the ability to compensate accordingly.  The old paradigm that we are simply a the mercy of our genes is now challenged.  Genetic testing empowers you to take control, launching you into a new age of truly individualized healthcare.

I knew the more I researched the more I would discover.  The deeper I looked I realized how hard Emmalin's little body really has to work.  As scared as some of this makes me, I thank God I know what to do to help my child be her best.  Now most of the stuff I was already doing with Emmalin so I only have to change up a few things.  I now know what multi-vitamins she can handle and which ones are toxic to her and me.  I have always been heavy on the B Vitamins but I did need to change her B12 vitamin based on this new information.
Why MTHFR Is Only A Part of Methylation
Here is the B Vitamin that we use currently.
And here is the vitamin we are switching too:
Please watch for my next post when I go into details about the lifestyle and dietary changes I have made for Emmalin and our family, now that we know each of us is affected by the MTHFR gene.