Is there abnormal phasic tone postural tone or both

1. Phasic tone is the rapid contraction of a muscle. Examining deep tendon reflexes best tests this. Determine if reflexes are present or absent. If present, determine if they are symmetric, diminished, or brisk.

2. Postural tone is sustained or prolonged contraction against gravity. Examining child's traction response, horizontal suspension, and vertical suspension can assess postural tone. Traction response is elicited by pulling child to a sitting position from a supine position. Examiner should feel child resisting against the traction. Child should initiate lifting the head as body is raised and should attempt to keep the head erect when sitting. Significant head lag and failure to flex limbs in response to traction is indicative of hypotonia. In horizontal suspension, infant with normal tone should maintain head at midline; flex hips, knees, and elbows; and keep back straight. In vertical suspension with examiner's hands under the axilla, infant with normal tone should allow for suspension without compressing the thorax, given normal shoulder strength. In addition, infant should hold the head erect and flex at the knees, hips, and ankles.

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