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Hypotonia: Is It a Clear Term and an Objective Diagnosis? An Exploratory Systematic Review
María Guadalupe De Santos-Moreno1, Antonio Pablo Velandrino-Nicolás2, Antonia Gómez-Conesa3
1International School of Doctoral Studies, University of Murcia, Murcia, Spain.
Insights
This systematic review identified 53 characteristics and diagnostic methods for hypotonia in children. Observation and the pull-to-sit test are most frequently used for assessing this developmental disorder.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Clinical Assessment
Background:
- Hypotonia is a key factor in developmental disorders, linked to various morbidities.
- A systematic review is crucial to identify characteristics and diagnostic methods for childhood hypotonia.
- Understanding hypotonia's associations aids in diagnosing and managing related developmental issues.
Approach:
- Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
- Comprehensive database search (PubMed, Cochrane, Web of Knowledge) in May 2021.
- Inclusion of studies on hypotonia characteristics and assessment tests, excluding peripheral hypotonia.
Key Points:
- Analyzed 45 studies out of 8778 identified, extracting 53 associated characteristics and diagnostic tests.
- Pull-to-sit and vertical suspension were the most frequently referenced methods.
- Muscle strength, hypermobility, and antigravity posture maintenance are debated characteristics.
Conclusions:
- Observation, pull-to-sit, and frog posture adoption are the most common diagnostic tests for hypotonia.
- A unified understanding of hypotonia terminology is needed to advance research.
- Further research is warranted to clarify hypotonia's characteristics and diagnostic approaches.
Background:
Hypotonia is considered a determinant factor in multiple developmental disorders and is associated with various characteristics and morbidities. It is necessary to perform a systematic review to know which characteristics are described as associated with hypotonia in children and which methods are used for its diagnosis.
Methods:
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to develop the systematic review protocol. A search of databases (Pubmed, Cochrane, Web of Knowledge, among others) was performed in May 2021 to identify relevant studies. Those describing characteristics or tests of hypotonia assessment were included, excluding those that exclusively addressed peripheral hypotonia. Two reviewers evaluated the articles and collected the data in a table, noting the authors, date of publication, type of study, and characteristics or tests described in relation to hypotonia. The quality of the studies was also assessed, and data were extracted.
Results:
A total of 8778 studies were identified and analyzed, of which 45 met the inclusion criteria. Fifty-three characteristics associated with hypotonia and tests used for its evaluation were located, with pull to sit and vertical suspension being the most frequently referenced.
Conclusions:
The characteristics associated with hypotonia, more highly debated by authors are muscle strength, hypermobility, or the maintenance of antigravity postures. The most used test in the diagnosis of hypotonia is observation, followed by the pull-to-sit test, and adoption of frog posture. A unanimous understanding of the term hypotonia would favor further research.
