6
Which sided torticollis:
- Right side bending
- Left rotation
Right
Which sided torticollis:
- Left side bending
- Right rotation
Left
Biomechanical perspective:
- Head and neck muscles related control shoulder and rib cage stability
- Abdominals/obliques stabilize rib cage for SCM pull head into flexion
Symmetric motor activities: reinforce sensory body image
Torticollis impact on motor control
- Physicians
- Nurse midwives
- Prenatal educators
- Obstetrical nurses
- Lactation specialist
- NP
- PT
Should educate and document instruction to all expectant parents and parents of newborns, within the first 2 days of birth:
- Prone play
- Symmetrical positioning
#1 Educate expectant parents and parents of newborns on positioning
PT document referral of infants to their physicians for additional diagnostic testing
- Poor visual tracking
- Abnormal muscle tone
- Extra muscular masses
- Cranial deformation
- Asymmetry non consistent with CMT
- Over 7 months of age and SCM mass present
#6 Refer infants from PT to physician if indicated by screen
Torticollis is named on which ___ is tight
If a baby comes to us with torticollis, we also need to check which joint for the possibility of dislocation?
Hip
- Head tilt to one side
- Lateral flexion: head tilt ear close to shoulder
- Neck rotation
- Face rotated toward the opposite side
- ROM deficit
- Age diagnosed
- Birth - 12 months
Clinical definition/presentation of CMT
PT should obtain and document general medical and developmental history of the infant
9 specific health history factors
- Age at initial visit
- Age of onset of symptoms
- Pregnancy history
- Delivery history including birth presentation
- Use of assistance during delivery
- Head posture/preference
- Family history of torticollis or other congenital or developmental conditions
- Other unknown or suspected medical conditions
- Developmental milestones appropriate for age
#4 Document infant history
Assess and document the presence of neck and/or facial or cranial asymmetry within the first 2 days of birth
- First born order (6x)
- Multiple births
- Forceps and birth trauma
- Long body length
- Breech
- Hip dislocation
Causes of torticollis (maybe)
- Birth trauma/difficult delivery
- Venous compression
- Myopathy of the SCM
- Fetal malpositioning
- Intrauterine crowding
- First born (male)
- Prematurity
- Breech
Etiology of torticollis -- undefined origin
What is the first line of treatment for treating CMT?
Change parents holding position and put baby on their stomach during waking hours ***
- Increased supine positioning
- Increased positional preference
- Increased incidence SCM dysfunction
- Increased incident positional torticollis
- Positional/deformation plagiocephaly
Implications of AAP guidelines for CMT
Cervical PROM/AROM
- Arthrodial protractor
AROM/PROM UE/LE
Palpation of SCM
- Fibrotic mass present
- Tissue mobility
- Skin integrity
Pain
Craniofacial asymmetries
Muscle strength/function
Bilateral hip assessment: Barlow/Ortolani
Resting posture: prone, supine, sitting, standing
#8 Examine body structure
- GERD; Sandifers syndrome
- Malformation atlas
- Inflammatory conditions
- Cervical/clavicular fractures
- Ocular disorders
- C1/C2 rotary subluxation
Differential diagnosis
What is the hypothesis for the current reason of CMT rate?
Back to sleep campaign
- Origin: manubrium and medial portion of the clavicle
- Insertion: mastoid process of the temporal bone, superior nuchal line
- Action
- Acting unilaterally: contralateral cervical rotation, ipsilateral cervical lateral flexion
- Acting bilaterally: protracts the head, extends incompletely extended cervical spine
Tightening of the SCM
- 1-3: education, identification and referral of infants with CMT
- 4-12: PT examination and evaluation of infants with asymmetries/CMT
- 13-15: PT intervention for infants with CMT
- 16-17: PT discontinuation, reassessment and D/C of infants with CMT
APTA clinical practice guidelines
PT should perform documented screens of systems
- Neurological
- MSK
- Integumentary
- Cardiopulmonary
PT should include screens:
- Vision
- GI history: needs to be added reflux/constipation or preferential feeding from one side
- Postural preference
- Structural/movement symmetry
#5 Screen infants for non-muscular causes of asymmetry and conditions associated with CMT
- Congenital muscular torticollis is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the SCM
CMT definition
- Implement best practice into everyday care
- Understand complexity of client
- Create movement environments
- Provide personal and environmental constraints
- Actively problem solving
- Engage in successful learning
- Promote functional actions
PT treatment for CMT
- Infant learns from experience and practice to contend with gravity
- Practice increases strength and control
- Consistent sensory input face and oral motor area
- Sensory input, practice, experience and environment circumstances lead to the progression of increased motor control and delicate balance between flexors and extensors
- Critical for upright developmental and postural control
Infants need prone play
Refer infants identified as having postural preference, reduced cervical range of motion, SCM masses and/or craniofacial asymmetry notes
#3 Refer infants with asymmetries/CMT to PT
PT should request all medical records including:
- All images
- Interpretive report
- Completed diagnostic work up
#7 Request images and reports