The Low Down on Low Tone: From an OT


Low muscle tone is also known as hypotonia. A medical professional will diagnosis the condition. I feel like the term is over-utilized and also not always used correctly. Hypotonia is sometimes seen in children with Down Syndrome, Muscular dystrophy, Cerebral palsy, or Prader-Willi syndrome. As an occupational therapist, in the school-based setting, I work with a lot of students who have low tone and muscle weakness. Here are some of my favorite products and activities to target low tone!

Some Signs of Hypotonia:

  • Difficulty meeting motor milestones such as rolling over, holding head up, sitting up independently, and walking 
  • Difficulty with feeding: swallowing, sucking, chewing 
  • Easily tired 
  • Increase flexibility in joints  

Children with low tone often benefit from accommodations and modifications to increase their success. 

When thinking about the best accommodations and modifications think about the task and how to adapt it so the child is as independent as possible. I like to ‘build up’ or ‘bulk up’ the utensil/tool. When the tool is larger, it doesn’t require the muscles to have to work as hard to grasp and maintain grasp. Children with hypotonia can easily fatigue. 

Some of my Favorite Products to Address Low Tone:

Egg Grip

These pencil grips I only utilize for certain students. The grip is designed to bulk up a pencil, therefore the goal isn’t to utilize a precise grasp pattern it’s all about function.

I had a lot of success using this grip with a student that had a medical diagnosis of Cerebral Palsy. He was able to hold the pencil independently to make his paper without increase difficulty.

I have also used this pencil grip to build up zippers on Jackets, backpacks, and AT carrying cases. They really helped a few of my students increase their independence and success! Love these!!


Foam tubing is an easy and quick way to build multiple items up! From silverware to pencils/markers, and paintbrushes. Stephanie, from the Simply Special Ed team, also recommends putting it on a joystick! 

Table Top Scissors:

I have used these scissors for multiple students! Using adaptive loop scissors requires strength and coordination of the intrinsic muscles. Cutting is a very difficult task for students with low tone. These scissors just need a bit of force to decompress and then they spring up. I have my students decompress them with the hard part of their palm vs fingers. Put some dycem under the scissor base so they don’t slide.


Built-up Silverware 

Built-up silverware can be quite expensive. Ask your school’s OT or SLP if they have silverware recommendations or extra for you to trial. Sometimes tubing will work on silverware when budgets are tight. The thing to look out for with built-up silverware, is you don’t want the item to be weighted. If it is weighted it could make it very difficult for someone with low tone to coordinate the movement of the silverware from the plate to the mouth. 


I have used this product for multiple students in the past! I have had to try a few different brands because some of them are designed for smaller hands. The idea is it acts almost like a cuff. The student just has to slide their hand through and be able to lift! I have put them on different supplies like markers and pencils! You do not want the cuff tight around the hand. The student should be able to slide their hand out 

Check out Stephanie’s blog article on other adaptive tools!

Activities to Address Low Tone

Vertical play!!

Vertical Play is my favorite recommendation. It is easy and very beneficial! The idea is proximal stability before distal mobility. This is a fancy therapy term that means the big muscles in the back/shoulders need to develop before the smaller muscles of the hand. 

Here are some of my favorite vertical play ideas:


I love these lakeshore magnetic gears! I really like the quality, the plastic is sturdy. My daughter has been enjoying them!  

child placing magnets on a vertical magnetic surface

Letter Magnets

Magnets are always fun! Whether they are fun letter magnets to practice CVC words or playing I Spy for letter recognition! I found these cute letter magnets in the Target Dollar Bin! 

Window Clings

It is always fun decorating the windows or doors for holidays and seasons! They are a great and cheap way to work on muscle coordination that is fun!

Child spraying windows with a small spray bottle

Spraying Widows 

I don’t know why young children love spray bottles so much but I do know that it keeps my daughter entertained for a while! For children with low tone, find a spray bottle that doesn’t need a lot of pressure to decompress! 

This particular ramp is pricey but you could make one!


Do you have a student that loves cars? An easy vertical play idea is using the wall as a race track. 

child coloring on an art easel made out of a box


If you don’t have an art easel, create one with some cardboard boxes! Painting/coloring on a vertical surface is a great way to give those muscles a workout in a fun and creative context. If your student doesn’t like to paint/draw, try using stickers! 


I love this product! I use them for vertical play all the time! For a student with low tone, it might pose a challenge to ‘un stick’ them but it is super fun squishing them on a surface! At home, my daughter and I put them on our door! You can also use them to create a maze/obstacle course to drive cars through! I like the bigger squiz vs the small ones! 


child playing with a toy sink on a bin
Take a favorite activity and raise it up! This is one of my daughter’s favorite toys!

Work with your OT or PT on different positioning! Different positions target different muscle groups! 

I love taking activities and placing them in different planes! Such as playing a game on the floor where everyone is on their stomachs, or placing the game on a small table and we are kneeing! Another position is called quadruped (all fours). 

Certain upper extremity and full-body exercises are also utilized to work on hypotonia. Always reach out to your school’s OT or PT for some tricks or to trial different tools!

Signature of author: Taylor
blog pin featuring title on the bottom and a picture of letter magnets

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