Torticollis
SCM; cervical lateral flexion to same side and rotation to opposite side
What is plagiocephaly?
asymmetrical flattening of the skull
ATNR should not be present in a child after what age?
4-5 months
First choice intervention for CMT should include what 5 components?
1. Neck PROM (stretching)
2. Neck and trunk AROM (strengthening)
3. development of symmetrical movement
4. Environmental adaptations/positioning
5. Parent/caregiver education
What is the definition of DCD?
developmental coordination disorder: motor disorder in which a child shows "substantially lower motor coordination skills compared to the child's chronological age that interferes with activities of daily living, academic achievement, leisure, or play" not caused by a neurological condition affecting movement or intellectual disability
How is torticollis named?
for the side they are tilting towards
Name some causes of plagiocephaly. (8)
multiples (twins+), assisted delivery with forceps or vacuum, premature birth, prolonged labor, inadequate "tummy time", non-varying nursing/bottle feeding habits, developmental delay, torticollis
Name 4 common asymmetries in the ipsilateral upper extremity for children with torticollis.
1. decreased reaching, holds arm by side ("neglects")
2. decreased hand to mouth
3. decreased reach to and across midline
4. decreased development of protective extension reactions
The goal of PROM/AROM of cervical lateral flexion and rotation in CMT is that the affected side is within how many degrees of the uninvolved side?
5 degrees
What are the major problem areas for these children? (5)
low muscle tone, muscle weakness, motor incoordination, poor postural control, delayed acquisition of motor milestones
Name risk factors for torticollis. (6)
large birth weight or increased birth length, male gender, mother's first live birth, nuchal cord, mother with uterine abnormalities, difficult labor and delivery
Name and define the three types of plagiocephaly.
plagiocephaly: ipsilateral flattening and contralateral occipital bossing or bulging
brachycephaly: central occipital flattening
Scaphocephaly: long narrow skull
Name 7 common trunk and LE asymmetries in children with torticollis.
C curve in trunk during floor skills, C or S curve during sitting skills, Decreased kicking with ipsilateral LE, decreased hands to feet ipsilateral LE, asymmetry in leg positioning in sitting, tripod ("hitch") positioning during creeping, asymmetry in supported standing and standing
lateral flexion: stabilize ipsilateral shoulder
rotation: stabilize contralateral shoulder
What kinds of problems do they have in moving around the school, in P.E., in sports, in socialization?
fine motor sequencing: handwriting
complex motor tasks: skipping, kicking a ball
learning new tasks that require integration of sensory input and motor planning, such as climbing on playground structures
Name 3 types of CMT and explain.
postural--infants postural preference, no SCM tightness/no PROM restrictions
muscular--tightness of SCM and PROM restrictions
SCM Nodule--discrete mass or fibrotic thickening palpable in SCM, PROM limitations (most severe form)
What four things are evaluated for children with plagiocephaly?
1. Ipsilateral ear positioned anterior or inferior
2. Frontal bossing
3. Facial asymmetry
4. Temporal bossing
At what age should children be able to have head right reactions?
4 months
When strengthening the cervical lateral flexors in a child with CMT through head righting in rolling, what side should the child be laying on? Affected side or unaffected side?
affected side
child cannot do these activities later in life and then as the child ages, they cannot get physically fit
Name common comorbidities associated with torticollis. (4)
hip dysplasia, brachial plexus injury, club foot, metatarsus adductus
By 7 weeks of age, how much tummy time is recommended per day?
15-30 minutes