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Williams E, Galea M. Another look at “tummy time” for primary plagiocephaly prevention and motor development. Infant Behav Dev 2023; 71:101839. [PMID: 37030250 DOI: 10.1016/j.infbeh.2023.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
It is three decades since it was recommended that infants sleep on the back to reduce risk of sudden unexpected infant death (SUID). The SUID prevention program is known as "back to sleep" or "safe sleeping", and this initiative is not questioned. Sleeping on the back is associated with, but not the cause of, the development of infant positional plagiocephaly, also known as deformational or a non-synostotic misshapen head when the skull sutures are open, not fused. This paper provides a synthesis of the history and impact of positional plagiocephaly. It includes a scoping review of plagiocephaly prevention facilitating motor development and reveals few articles on primary prevention which aims to prevent it developing in the first place. It is concerning that preschool-aged children with a history of infant plagiocephaly continued to receive lower developmental scores, particularly in motor development, than unaffected controls, and this may be a marker of developmental delay. Tummy-time (prone) for play is the mainstay of plagiocephaly prevention advice to minimize development of plagiocephaly and to facilitate infant motor development, particularly head control. While tummy-time has shown benefit for infant development, there is limited evidence of its effectiveness in preventing plagiocephaly and some evidence that it promotes only prone-specific motor skills. Most of the published literature is concerned with treatment post-diagnosis, in the form of reviews, or clinical notes. There is a plethora of opinion articles reinforcing tummy-time from birth for plagiocephaly prevention. The review shows that there are gaps in advice for early infant development of head control. An accepted test of head control in infants is "pull to sit" from supine which demonstrates antigravity strength of the neck flexors and coordination of the head and neck when the infant is drawn to sit from supine. This motor skill was cited as achievable by 4 months in the earliest paper on plagiocephaly in 1996. Physical therapists and others should revisit the mechanism of early infant head control development against gravity, particularly antigravity head, neck and trunk coordinated flexion movement in supine, as there has been little attention to early facilitation of this motor skill as a plagiocephaly prevention strategy. This may be achieved by considering "face time" as well as tummy time for primary prevention of plagiocephaly.
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Affiliation(s)
- Elizabeth Williams
- The University of Melbourne, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, VIC 3010, Australia.
| | - Mary Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne.Academic Director, Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, VIC 3010, Australia
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Ledwoń D, Danch-Wierzchowska M, Doroniewicz I, Kieszczyńska K, Affanasowicz A, Latos D, Matyja M, Mitas AW, Myśliwiec A. Automated postural asymmetry assessment in infants neurodevelopmental evaluation using novel video-based features. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107455. [PMID: 36893565 DOI: 10.1016/j.cmpb.2023.107455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/15/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Neurodevelopmental assessment enables the identification of infant developmental disorders in the first months of life. Thus, the appropriate therapy can be initiated promptly, increasing the chances for correct motor function. Posture asymmetry is one of the crucial aspects evaluated during the diagnosis. Available diagnostic methods are mainly based on qualitative assessment and subjective expert opinion. Current trends in computer-aided diagnosis focus mostly on analyzing infants' spontaneous movement videos using artificial intelligence methods, based primarily on limbs movement. This study aims to develop an automatic method for determining the infant's positional asymmetry in a video recording using computer image processing methods. METHODS We made the first attempt to determine positional preferences in a recording automatically. We proposed six quantitative features describing trunk and head position based on pose estimation. As a result of our algorithm, we estimate the percentage of each trunk position in a recording using known machine learning methods. The training and test sets were created from 51 recordings collected during our research and 12 recordings from the benchmark dataset evaluated by five of our experts. The method was assessed using the leave-one-subject-out cross-validation method for ground truth video fragments and different classifiers. Log loss for multiclass classification and ROC AUC were determined to evaluate the results for both our and benchmark datasets. RESULTS In a classification of the shortened side, the QDA classifier yields the most accurate results, gaining the lowest log loss of 0.552 and AUC of 0.913. The high accuracy (92.03) and sensitivity (93.26) confirm the method's potential in screening for asymmetry. CONCLUSIONS The method allows obtaining quantitative information about positional preference, a valuable extension of basic diagnostics without additional tools and procedures. In combination with an analysis of limbs movement, it may constitute one of the elements of a novelty computer-aided infants' diagnosis system in the future.
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Affiliation(s)
- Daniel Ledwoń
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland.
| | - Marta Danch-Wierzchowska
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland
| | - Iwona Doroniewicz
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, Mikołowska 72A, 40-065 Katowice, Poland
| | - Katarzyna Kieszczyńska
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, Mikołowska 72A, 40-065 Katowice, Poland
| | - Alicja Affanasowicz
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, Mikołowska 72A, 40-065 Katowice, Poland
| | - Dominika Latos
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, Mikołowska 72A, 40-065 Katowice, Poland
| | - Małgorzata Matyja
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, Mikołowska 72A, 40-065 Katowice, Poland
| | - Andrzej W Mitas
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland
| | - Andrzej Myśliwiec
- Institute of Physiotherapy and Health Science, Academy of Physical Education in Katowice, Mikołowska 72A, 40-065 Katowice, Poland
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Ploeger MM, Trillhaase C, Rommelspacher C, Bornemann R, Ossendorf R, Placzek R. [Surgical treatment of congenital muscular torticollis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023:10.1007/s00064-023-00805-x. [PMID: 37079025 DOI: 10.1007/s00064-023-00805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Surgical treatment of congenital muscular torticollis with tripolar release of the sternocleidomastoid muscle, followed by modified postoperative treatment with a special orthosis. INDICATIONS Muscular torticollis due to contracture of the sternocleidomastoid muscle; failure of conservative therapy. CONTRAINDICATIONS Torticollis due to bony anomaly or other muscular contractures. SURGICAL TECHNIQUE Tenotomy of the sternocleidomastoid muscle occipitally and resection of at least 1 cm of the tendon at the sternal and clavicular origin. POSTOPERATIVE MANAGEMENT Orthosis must be worn for 6 weeks 24 h/day, then for another 6 weeks 12 h/day. RESULTS A total of 13 patients were treated with tripolar release of the sternocleidomastoid muscle and modified postoperative management. Average follow-up time was 25.7 months. One patient presented with recurrence after 3 years. No intra- or postoperative complications were observed.
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Affiliation(s)
- Milena M Ploeger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Christoph Trillhaase
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Charlotte Rommelspacher
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Rahel Bornemann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Robert Ossendorf
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Richard Placzek
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Wilczyński J, Sowińska A, Mierzwa-Molenda M. Physiotherapy as a Specific and Purposeful Form of Physical Activity in Children with Idiopathic Body Asymmetry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15008. [PMID: 36429727 PMCID: PMC9690881 DOI: 10.3390/ijerph192215008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study was to determine the relationship between idiopathic asymmetry in infants and body posture in children at an early school age. The study included 45 girls aged nine. The Diers Formetric III 4D device was used to assess body posture, which allows photogrammetric registration of the back surface using the raster stereography process. For the purposes of the re-search project, the examination was performed via DiCAM using the "Average measurement" mode. Despite physiotherapy, these children had more postural defects later on compared to the control group due to asymmetry. They mainly concerned pelvic skewness, scoliosis angle, deviation from the vertical line and lateral deviation, as well as surface rotation. Positive correlations were observed between direction of asymmetry and pelvic skewness (r = 0.40), and between the location of asymmetry and the location of curvature (r = 0.39). Significant negative correlations were also found between the age of treatment initiation and trunk length (r = -0.42). There was also a negative correlation between the number of physiotherapeutic appointments and deviation from the vertical line, which means that along with an increase in the number of physiotherapeutic visits, the value of deviation from the vertical line decreased (p = -0.40). For scoliosis angle, the most important predictor was the direction of asymmetry (p = 0.05). For the location of the curvature, the most important predictor was the direction of asymmetry (p = 0.04), as well as the number of physiotherapeutic appointments (p = 0.04). Additionally, regression analysis allowed us to show that the number of physiotherapeutic visits (p = 0.03) was the most important predictor of curvature direction. The applied physiotherapy probably contributed to the occurrence of a smaller number of postural defects in these children at a later age. Physiotherapy as a specific and targeted form of physical activity among infants with idiopathic asymmetry should play a very important role in the prevention of body posture defects.
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Affiliation(s)
| | - Anita Sowińska
- Correspondence: (J.W.); (A.S.); Tel.: +48-603-703-926 (J.W.)
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Stȩpień A, Maślanko K, Rekowski W, Fabian K, Tuz J, Graff K. Analysis of the prevalence of asymmetry and muscle tone disorders in the first year of life among youth with idiopathic scoliosis: A retrospective case-control study. J Back Musculoskelet Rehabil 2022; 35:1003-1011. [PMID: 35431225 DOI: 10.3233/bmr-171075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Not much is known about developmental motor disorders in the first year of life of children diagnosed with idiopathic scoliosis (IS). OBJECTIVE This study aimed to compare the occurrence of asymmetry or muscle tone disorders in the first year of life in adolescents with IS and their healthy counterparts. METHODS The parents of adolescents with IS and without scoliosis completed a survey on the occurrence of asymmetry, abnormal muscle tone, and physiotherapy in their children in the first year of life. Pearson's chi square test and Cramer's coefficient were used. RESULTS The final analysis included 527 surveys completed by parents of adolescents with idiopathic scoliosis (150) and without scoliosis (377). A significantly higher frequency of asymmetry (p= 0.001) and muscle tone disorders (p= 0.001) was noted in adolescents with idiopathic scoliosis. The results also revealed a significant association between scoliosis and asymmetry (p= 0.001), as well as muscle tone (p= 0.001). CONCLUSIONS Developmental asymmetry or improper muscle tone in the first year of life could be considered a potential factor in the development of scoliosis; however, this hypothesis should be confirmed in future studies. Infants diagnosed with developmental disorders require systematic observation.
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Affiliation(s)
- Agnieszka Stȩpień
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | | | - Witold Rekowski
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | | | - Jacek Tuz
- Physiotherapy Practice Jacek Tuz Certified McKenzie Clinic, Tychy, Poland
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Most common infant health concerns in osteopathic practices in Germany. A survey. J Bodyw Mov Ther 2021; 28:114-120. [PMID: 34776127 DOI: 10.1016/j.jbmt.2021.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/03/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND In Germany, more parents have been seeking help from osteopaths for their infants and children in recent years. This implies an increasing demand of reliable evidence regarding the effectiveness of osteopathic intervention for this group. OBJECTIVE To identify the 'typical' (most common) health concerns of parents when presenting their infants (age 0-12 months) in pediatric osteopathic practices. METHODS For the purpose of this survey, well-trained osteopaths who specialize in the treatment of children and infants were selected. A documentation form containing a list of the likely most common infant health problems, developed by means of systematic literature analyses, was provided to experienced osteopaths to assess which health problems were seen most frequently. RESULTS Eighty-one osteopaths were contacted, of which 64 (79 %) responded and returned the documentation form. Nine documentation forms could not be evaluated. The remaining 55 documentation forms included information on 2833 health concerns. Quantitatively, there was no dominant health problem, but five problems were found to be common: 21 % of the cases were idiopathic infant asymmetry, 17 % were plagiocephaly, 16 % were excessive crying, and 14 % were feeding and sleep disorders. All other problems were observed as far less frequent. In addition, osteopaths reported 423 other health concerns that were not specified in the documentation form. CONCLUSIONS In this survey, infants that were presented in osteopathic practices often had one or more of those five health problems mentioned above. A large observational trial is currently underway to document changes observed during osteopathic treatment of these health problems.
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Towers CV, Knapper A, Gaylord M, Burnette T, Neal R, Hennessy M. Torticollis in infants with neonatal abstinence syndrome. J Perinatol 2021; 41:615-618. [PMID: 31907397 DOI: 10.1038/s41372-019-0580-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/04/2019] [Accepted: 12/18/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To report the incidence of torticollis diagnosed in infants treated for neonatal abstinence syndrome (NAS) and compare neonates with and without torticollis. STUDY DESIGN This prospective cohort study reports on infants examined at 1-4 months of age. Numerous obstetrical/newborn factors and other drugs used during gestation were compared. RESULTS Of 501 neonates treated for NAS, 421 (84%) were seen for follow-up. Of these, 105 (24.9%) were diagnosed with torticollis. The only significant obstetrical/newborn factor identified was a lower rate if the parents were the primary caregiver after hospital discharge. Of the 105 cases, 88 (84%) were right-sided and 17 (16%) were left-sided. CONCLUSIONS These data demonstrate that torticollis is a common diagnosis in infants examined at 1-4 months of age after being treated for NAS with a predilection for this to be right-sided. The etiology for this is uncertain, but newborns treated for NAS need close follow-up post discharge.
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Affiliation(s)
- Craig V Towers
- Department of Obstetrics & Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA.
| | - Amber Knapper
- Department of Neonatology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Mark Gaylord
- Department of Neonatology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Tara Burnette
- Department of Neonatology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Ryan Neal
- Department of Obstetrics & Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Mark Hennessy
- Department of Obstetrics & Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
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Schwerla F, Daake B, Moeckel E, Resch KL. Osteopathic Treatment of Infants in Their First Year of Life: A Prospective Multicenter Observational Study (OSTINF Study). Complement Med Res 2021; 28:395-406. [PMID: 33601373 DOI: 10.1159/000514413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Germany in recent years, a growing number of parents are seeking help from osteopaths for the perceived health complaints of their infants and children. However, reliable evidence for the effectiveness of osteopathic interventions for this group of patients is largely lacking. OBJECTIVE To observe and document changes in the symptoms of certain health disturbances, as perceived by parents, during the course of an osteopathic treatment of their baby, and associated side effects. METHODS A single-arm, prospective, multicenter, observational study was chosen as the study design. Parents who contacted an osteopathic practice with any of the following 5 health disturbances were invited to include their baby into the study: idiopathic infant asymmetry (IA), deformational plagiocephaly (DP), feeding disorders (FD), excessive crying (EC), and sleep disorders (SD). Osteopaths performed osteopathic treatment as usual for these conditions, and the parents were asked to rate the perceived severity of symptoms on standardized forms including numerical rating scales (NRS 0-10). In DP, the head circumference of the child's skull was measured with a craniometer, and the cranial vault index (CVAI) was calculated. RESULTS 230 osteopaths agreed to participate, 151 osteopaths returned parental ratings. 1,136 infants were treated 2.8 ± 1.1 times (mean ± SD). IA was the most prevalent disturbance (48%), followed by EC (18%), FD (15%), DP (14%), and SD (4%). In IA, perceived asymmetry as rated on the NRS improved from 6.1 to 1.1, a mean improvement of 82%. In DP, the CVAI improved from 8.0 to 4.0%, a mean improvement of 51%. FD improved by 77%, EC by 70% (from 7.7 to 2.3 on the NRS) and SD by 56%. Adverse reactions with a timely association with osteopathic treatments were reported in 3.5% of all treatments, probably reflecting typical day-to-day variations in symptoms. In a total of 3,212 treatments, there was not a single serious adverse reaction affecting infant health. CONCLUSIONS This is one of the largest studies worldwide to date on the osteopathic treatment of infants. Osteopathic treatment was associated with major positive changes in the severity of perceived health complaints as assessed by parents, which in most cases were resolved as a matter of concern, and was proved to be a safe treatment modality among a large number of therapists. Based on these results, confirmatory intervention studies can and should be planned and conducted.
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Yankova G, Tur D, Parshin D, Cherevko A, Akulov A. Cerebral arterial architectonics and CFD simulation in mice with type 1 diabetes mellitus of different duration. Sci Rep 2021; 11:3969. [PMID: 33597584 PMCID: PMC7889636 DOI: 10.1038/s41598-021-83484-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022] Open
Abstract
Type 1 diabetes is a chronic autoimmune disease that affects tens of millions of people. Diabetes mellitus is one of the strongest factors in the development of cerebrovascular diseases. In this study we used NOD.CB17 Prkdcscid mice and the pharmacological model of type 1 diabetes mellitus of different duration to study changes in the cerebral vasculature. We used two combined approaches using magnetic resonance angiography both steady and transient CFD blood flow modeling. We identified the influence of type 1 diabetes on the architectonics and hemodynamics of the large blood vessels of the brain as the disease progresses. For the first time, we detected a statistically significant change in angioarchitectonics (the angles between the vessels of the circle of Willis, cross-sections areas of vessels) and hemodynamic (maximum blood flow rate, hydraulic resistance) in animals with diabetes duration of 2 months, that is manifested by the development of asymmetry of cerebral blood flow. The result shows the negative effect of diabetes on cerebral circulation as well as the practicability of CFD modeling. This may be of extensive interest, in pharmacological and preclinical studies.
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Affiliation(s)
- Galina Yankova
- Lavrentyev Institute of Hydrodynamics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia.
| | - Darya Tur
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Daniil Parshin
- Lavrentyev Institute of Hydrodynamics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Alexander Cherevko
- Lavrentyev Institute of Hydrodynamics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Andrey Akulov
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
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Madrid M, Brianza-Padilla M, Echeverría JC, Rivera-González R, Bojalil R. The Severity of Neurological Dysfunction in Preschool Children, Secondary to Damage Generated During the Perinatal Period, is Associated With a Pro-Inflammatory Pattern of Serum Molecules. Front Immunol 2021; 11:595309. [PMID: 33584663 PMCID: PMC7876313 DOI: 10.3389/fimmu.2020.595309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/11/2020] [Indexed: 11/17/2022] Open
Abstract
Disorders in the child’s neurological development caused by perinatal risks can lead to long-term altered neurological signs that begin at an early age and involve persistent functional disorders. Recent data suggest that tissue dysfunction, not just acute damage, may initiate or perpetuate an inflammatory response. The aim of this study was to find out if any neurological dysfunction in preschool children secondary to damage generated during the perinatal period is associated with the magnitude of perinatal risks and long-term modifications in the serum concentrations of inflammatory molecules. The participants, aged 1–4 years, were on neurodevelopmental follow-up and rehabilitation therapy from the first three months of life and had no acute disease data. We classified the children into three groups according to the importance of their perinatal risks: low, medium, and high. The results show that 1) the magnitude of perinatal risks correlated with the severity of neurological dysfunction; 2) the greatest changes in the concentrations of the molecules of the inflammatory process were associated with the most altered neurological signs. This suggests that persistent nervous system dysfunction keeps inflammatory responses active even in the absence of an acute process of infection or damage.
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Affiliation(s)
- Miriam Madrid
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | | | - Juan C Echeverría
- Department of Electric Engineering, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Rolando Rivera-González
- Neurodevelopment Monitoring Laboratory, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Rafael Bojalil
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Seager A, Meldrum D, Conroy R, French HP. Congenital muscular torticollis: the reliability of visual estimation in the assessment of cervical spine active rotation and head tilt by physiotherapists and the impact of clinical experience. Eur J Pediatr 2020; 179:1823-1832. [PMID: 32468158 DOI: 10.1007/s00431-020-03691-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
There is a lack of reliable and valid measurement tools to assess neck function in infants with congenital muscular torticollis, and most physiotherapists use visual estimation, which has not been adequately tested for reliability in this population. We examined the reliability of visual estimation of head tilt and active neck rotation in the upright position, on infants with congenital muscular torticollis by physiotherapists. We recruited 31 infants and 26 physiotherapists. Therapists rated videos of infants' head position in the frontal plane (tilt) and transverse plane (active rotation) using visual estimation, on two occasions at least one week apart. Overall, inter-rater reliability was good (mean ICC, 0.68 ± 0.20; mean SEM, 5.1° ± 2.1°). Rotation videos had better reliability (mean ICC, 0.79 ± 0.14) than head tilt videos (mean ICC, 0.58 ± 0.20). Intra-rater reliability was excellent (mean ICC, 0.85 ± 0.08). Both head tilt and rotation had excellent reliability (mean ICC, 0.84 ± 0.08 for head tilt and 0.85 ± 0.09 for rotation). There was no correlation between intra-rater reliability and clinical experience.Conclusion Visual estimation had excellent intra-rater reliability in the assessment of neck active rotation and head tilt on infants with congenital muscular torticollis. Visual estimation had acceptable inter-rater reliability in the assessment of neck active rotation but not of head tilt. There was a wide variation in reliability with no correlation between reliability and clinical experience. Assessment tools for head tilt that are more psychometrically robust should be developed. What is Known: • A thorough assessment of infants presenting with torticollis is essential, using assessment tools with robust psychometric properties • Visual estimation is the most commonly used method of assessment of neck function in infants with torticollis What is New: • Visual estimation had excellent intra-rater reliability in the assessment of neck active rotation and head tilt in the upright position in videos of infants and acceptable inter-rater reliability in the assessment of rotation but not of head tilt • Physiotherapists' clinical experience had minimal relationship with reliability.
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Affiliation(s)
- Anthea Seager
- Department of Physiotherapy, Children's Health Ireland at Temple Street, Dublin, 1, Ireland.
| | - Dara Meldrum
- School of Medicine, Trinity College, Dublin University, Dublin 2, Ireland
| | - Ronan Conroy
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland
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Diagnosis and management of Sandifer syndrome in children with intractable neurological symptoms. Eur J Pediatr 2020; 179:243-250. [PMID: 31925500 PMCID: PMC6971150 DOI: 10.1007/s00431-019-03567-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 11/23/2022]
Abstract
Sandifer syndrome is a rare complication of gastro-oesophageal reflux disease (GERD) when a patient presents with extraoesophageal symptoms, typically neurological. The aim of this study was to review the existing literature and describe a typical presentation and most appropriate investigations and management for the Sandifer syndrome. A comprehensive literature search was performed via PubMed, Cochrane Library and NHS Evidence databases. Twenty-seven cases and observational studies were identified. The literature demonstrates that presenting symptoms of Sandifer's may include any combination of abnormal movements and/or positioning of head, neck, trunk and upper limbs, seizure-like episodes, ocular symptoms, irritability, developmental and growth delay and iron-deficiency anaemia. A 24-h oesophageal pH monitoring was positive in all the cases of Sandifer's where it was performed, while upper GI endoscopy ± biopsy and barium swallow were diagnostic only in a subset of cases. Successful treatment of the underlying gastro-oesophageal pathology led to a complete or near-complete resolution of the neurological symptoms in all of the cases.Conclusion: It is evident from the literature that many patients with Sandifer syndrome were originally misdiagnosed with various neuropsychiatric diagnoses that led to unnecessary testing and ineffective medications with significant side effects. Earlier diagnosis of Sandifer's would have allowed to avoid them.What is Known:• Sandifer syndrome is a rare complication of gastro-oesophageal reflux disease (GERD) when a patient presents with extraoesophageal symptoms, typically neurological.• It may be difficult to recognise due to its non-specific presentation and lack of gastrointestinal symptoms.What is New:• Based on the review of 44 clinical cases of suspected Sandifer syndrome, the clinical picture was clarified: the presenting symptoms of Sandifer's may include any combination of abnormal movements and/or positioning of head, neck, trunk and upper limbs, seizure-like episodes, ocular symptoms, irritability, developmental and growth delay and iron-deficiency anaemia.• Successful treatment of the underlying gastro-oesophageal pathology led to a complete or near-complete resolution of the neurological symptoms in all of the reviewed cases.
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Seager A, French H, Meldrum D. Measurement properties of instruments for assessment of cervical spine function in infants with torticollis: a systematic review. Eur J Pediatr 2019; 178:657-671. [PMID: 30778746 DOI: 10.1007/s00431-019-03338-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to systematically review the measurement properties of instruments which assess cervical spine function in infants with torticollis. Electronic searches were performed in MEDLINE, CINAHL, Embase, Web of Science and the Cochrane Library, combining three constructs ('torticollis', 'cervical spine assessment' and 'measurement properties'). Two reviewers independently rated the methodological quality and the quality of measurement properties of identified articles, using both the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist and quality criteria for measurement properties. Five studies, using six instruments, met the inclusion criteria and were analysed. Included instruments were the goniometer, electronic pendular goniometer, protractor, still photography, Muscle Function Scale and a range of motion limitation scale. All studies assessed reliability, and one study also assessed content validity and hypothesis testing. The methodological quality of the studies varied from poor to excellent according to the COSMIN checklist. Two instruments were found to have good measurement properties from high-quality studies: still photography for the assessment of habitual head tilt in supine and the Muscle Function Scale for the assessment of side-flexor muscle function in lateral head righting.Conclusion: This systematic review identified two reliable tools for the assessment of cervical spine function in infants with torticollis. Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in this population. What is known? • A thorough assessment of the infant presenting with torticollis is essential, in order to correctly diagnose, rule out 'red flags' and manage appropriately • Assessment tools need to have robust measurement properties in order to be of value for clinical practice and research What is new? • This systematic review identified two valid and reliable tools for the assessment of cervical spine function in infants with torticollis • Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in infants with torticollis.
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Affiliation(s)
- Anthea Seager
- Department of Physiotherapy, Temple Street Children's University Hospital, Dublin 1, Ireland.
| | - Helen French
- Department of Physiotherapy, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland
| | - Dara Meldrum
- Department of Physiotherapy, Trinity College, Dublin University, Dublin 2, Ireland
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Abstract
PURPOSE Although pediatric physical therapists may evaluate and treat infants with both congenital muscular torticollis (CMT) and gastroesophageal reflux disorder (GERD), a literature review found only 1 article suggesting a connection between these diagnoses. This study investigates a correlation between CMT and GERD. METHODS A retrospective chart review spanning 5 years including 2519 infants younger than 12 months examined the correlation between CMT, GERD, and other comorbidities including developmental dysplasia of the hip, oligohydramnios, multiparity, and breech positioning. RESULTS The CMT cohort had a significantly higher rate of GERD versus the general population. For all age groups, the GERD rate was significantly higher in the CMT population than in the reference population. The rate of developmental dysplasia of the hip, oligohydramnios, and breech positioning was higher in infants with both CMT and GERD. CONCLUSIONS The increased likelihood of infants with CMT also having GERD has clinical implications for the pediatric physical therapist.
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Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther 2018; 30:240-290. [PMID: 30277962 PMCID: PMC8568067 DOI: 10.1097/pep.0000000000000544] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) 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 sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified. PURPOSE This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice. RESULTS/CONCLUSIONS The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.
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Affiliation(s)
- Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences (Dr Kaplan), Rutgers, The State University of New Jersey, Newark, New Jersey; Orthotics and Prosthetics Department (Dr Coulter), Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry (Dr Sargent), University of Southern California, Los Angeles, California
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Saedt ERIC, Driehuis F, Hoogeboom TJ, van der Woude BH, de Bie RA, Nijhuis-van der Sanden MWG. Common Manual Therapy Practices in the Netherlands for Infants With Upper Cervical Dysfunction: A Prospective Cohort Study. J Manipulative Physiol Ther 2017; 41:52-61. [PMID: 29254625 DOI: 10.1016/j.jmpt.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/01/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to describe common clinical practices of manual therapists (MTs) in the Netherlands for infants with indications of upper cervical dysfunction (UCD). METHODS A prospective observational cohort study was conducted to gain insight into characteristics, reasons for seeking care, and common clinical practice for infants (<27 weeks) with indications of UCD, referred to MTs. Pre- and posttreatment self-reported questionnaires were used to collect data from parents and MTs. Parents reported on infant characteristics and perceived effect of treatment. Manual therapists reported on diagnostics, therapeutic procedures, and outcomes. RESULTS Between 2006 and 2007, data regarding 307 referred infants (mean age: 11.2 weeks) were collected by parents and 42 MTs. The most frequent reasons for seeking care were positional preference, restlessness, and/or abnormal head position. Manual therapists observed active, spontaneous, and provoked mobility and passive upper cervical mobility. Of the 307 infants, 295 were diagnosed with UCD based on positive outcomes on the flexion-rotation test and/or lateral flexion test. After treatment with mobilization techniques, positive outcomes on the flexion-rotation test decreased from 78.8% to 6.8%. For the lateral flexion test, the positive outcomes decreased from 91.5% to 6.2%. All parents perceived positive treatment effects. No serious adverse events were reported during this study. CONCLUSIONS This is the first study to describe common clinical practice for infants referred for manual therapy. Infants with UCD were treated mainly with upper cervical mobilization techniques, and the greatest perceived effect was observed after approximately 2 treatment sessions.
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Affiliation(s)
- Eric R I C Saedt
- Practice for physical and manual therapy, Saedt and Daanen, Ravenstein, The Netherlands
| | - Femke Driehuis
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - Thomas J Hoogeboom
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Bé H van der Woude
- Practice for manual therapy and (pediatric) physical therapy, Boxmeer, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, Caphri research school, Maastricht University, Maastricht, The Netherlands
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Ellwood J, Ford M, Nicholson A. The association between infantile postural asymmetry and unsettled behaviour in babies. Eur J Pediatr 2017; 176:1645-1652. [PMID: 28921382 DOI: 10.1007/s00431-017-2993-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Unsettled infant behaviour is a common problem of infancy without known aetiology or clearly effective management. Some manual therapists propose that musculoskeletal dysfunction contributes to unsettled infant behaviour, yet reported improvement following treatment is anecdotal. The infantile postural asymmetry measurement scale is a tool which measures infantile asymmetry, a form of musculoskeletal dysfunction. The first part of the study aimed to investigate its reliability and validity for measuring infantile postural asymmetry. This study also aimed to investigate whether there was an association between infantile postural asymmetry and unsettled infant behaviour and whether an association was mediated by, or confounded with, the demographic variables of age, sex, parity, birth weight and weight gain in 12- to 16-week-old infants. Fifty-eight infants were recruited and a quantitative cross-sectional observational design was used. An association between unsettled behaviour and infantile postural asymmetry was not found. A significant difference between high and low cervical rotation deficit groups for surgency was detected in female babies and needs further examination. CONCLUSION Questions remain regarding the construct validity of the infantile postural asymmetry scale. No association between unsettled infant behaviour and infantile postural asymmetry was found in 12- to 16-week-old infants. The influence of sex on the interaction between infantile postural asymmetry and infant behaviour needs further examination. An association between unsettled infant behaviour and infantile postural asymmetry is still unproven. What is known: • Unsettled infant behaviour has a considerable impact on many family situations. • Identifying a definitive cause has been a source of much examination and research. Many different hypotheses have been suggested yet much is still unknown. What is new: • The association between unsettled infant behaviour and infantile postural asymmetry is still unproven. • The need to validate a reliable tool to measure infantile postural asymmetry, with particular focus on cervical spine rotation deficit, is indicated.
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Affiliation(s)
- Julie Ellwood
- Research Department, British School of Osteopathy, London, UK.
| | - Michael Ford
- Research Department, British School of Osteopathy, London, UK
| | - Alf Nicholson
- Paediatric Department, Children's University Hospital, Dublin, Ireland
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Watemberg N, Ben-Sasson A, Goldfarb R. Transient Motor Asymmetry Among Infants With Congenital Torticollis-Description, Characterization, and Results of Follow-Up. Pediatr Neurol 2016; 59:36-40. [PMID: 27020737 DOI: 10.1016/j.pediatrneurol.2016.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/01/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Abstract
AIM The purpose of this study was to assess the prevalence of transient functional motor asymmetry in infants with congenital postural torticollis. METHODS This was a retrospective review of the medical records of infants with postural torticollis. We analyzed epidemiological, obstetric, perinatal data, physical therapy, physician assessments, and clinical follow-up for two years after diagnosis. RESULTS Of 173 children, 44 (25.4%, 95% confidence interval = 19.5 to 32.4) demonstrated functional asymmetry. Demographic and obstetrical data did not differ between the asymmetry/nonasymmetry groups. Delayed motor development (P = 0.01) and plagiocephaly (P = 0.032) were more common in infants with motor asymmetry. No difference was observed in the frequency of referral for further neurological diagnosis between the group with functional asymmetry and that without asymmetry. Among the 44 patients with functional asymmetry, 78% depicted no evidence of torticollis by age two years, and the motor asymmetry had disappeared in 82%. CONCLUSION Benign, transient functional motor asymmetry occurred in a quarter of infants with congenital postural torticollis. Transient motor delay was also significantly more common in the asymmetry group. In most instances, motor asymmetry and motor delay disappeared by age two years. Plagiocephaly was more common in the asymmetry group. Clinician awareness of this transient asymmetry may have avoided unnecessary diagnostic tests in these infants.
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Affiliation(s)
- Nathan Watemberg
- Child Development Center, Meir Medical Center, Tel Aviv University, Kfar Saba, Israel.
| | - Anat Ben-Sasson
- Child Development Center, Meir Medical Center, Tel Aviv University, Kfar Saba, Israel
| | - Rachel Goldfarb
- Department of Pediatrics, Meir Medical Center, Tel Aviv University, Kfar Saba, Israel
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Cabrera-Martos I, Valenza MC, Valenza-Demet G, Benítez-Feliponi Á, Robles-Vizcaíno C, Ruiz-Extremera Á. Repercussions of plagiocephaly on posture, muscle flexibility and balance in children aged 3-5 years old. J Paediatr Child Health 2016; 52:541-6. [PMID: 27329908 DOI: 10.1111/jpc.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/04/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022]
Abstract
AIM The objective of the study was to assess posture, muscle flexibility and balance in children aged 3-5 years old with a history of nonsynostotic plagiocephaly. METHODS Fifty-two children with previous history of plagiocephaly were evaluated, along with 52 control subjects matched for age, sex, height, weight and physical activity. The outcome measures included static posture, assessed through the measurement of angles and distances between anatomical landmarks; muscle flexibility, evaluated with the Stibor, Shober and finger-to-floor distance tests and balance, assessed by the Pediatric Balance Scale. RESULTS One-way analysis of variance afforded statistically significant differences (P < 0.05) in head position, muscle flexibility (thoracic mobility and trunk and lower limbs muscle shortening) and balance. CONCLUSION Children with previous history of non-synostotic plagiocephaly present changes in head position, muscle shortening and a poor balance when compared to control children at 3-5 years old.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Gerald Valenza-Demet
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | | | - Ángeles Ruiz-Extremera
- Early Care and Monitoring Unit, Pediatrics Service, San Cecilio University Hospital, Granada, Spain, Granada, Spain
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Aligning Documentation With Congenital Muscular Torticollis Clinical Practice Guidelines: Administrative Case Report. Phys Ther 2016; 96:111-20. [PMID: 26381809 DOI: 10.2522/ptj.20150012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 09/09/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). CASE DESCRIPTION The Pediatric Therapy Services of St Joseph's Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. OUTCOMES A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. DISCUSSION Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture supportive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations.
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Stokes V, Fertleman C. Late neonatal presentation of reduced arm movement due to painful infective lymphadenopathy. BMJ Case Rep 2015; 2015:bcr-2015-210966. [PMID: 26153292 DOI: 10.1136/bcr-2015-210966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report two cases of 21-day-old male infants, Baloo and Bagheera, both admitted with unilateral reduced arm movement secondary to painful lymphadenopathy, which is a presentation previously unreported in the paediatric literature. The only abnormal finding following investigations in both neonates was infective lymphadenopathy; we hypothesise that the inflamed lymph nodes were tender when the surrounding muscles, fascia or skin were moved, so that the infants learnt to reduce arm movement to minimise pain. This report explores the differential diagnoses for reduced arm movement in neonates, and highlights the importance of sepsis with painful lymphadenopathy as a differential diagnosis in neonates presenting with reduced arm movement.
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Affiliation(s)
- Victoria Stokes
- Department of Paediatrics, The Whittington Hospital, Basildon, UK
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Nuysink J, Eijsermans MJC, van Haastert IC, Koopman-Esseboom C, Helders PJM, de Vries LS, van der Net J. Clinical course of asymmetric motor performance and deformational plagiocephaly in very preterm infants. J Pediatr 2013; 163:658-65.e1. [PMID: 23706356 DOI: 10.1016/j.jpeds.2013.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 02/20/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the clinical courses of positional preference and deformational plagiocephaly up to 6 months corrected age (CA) in infants born at gestational age <30 weeks or birth weight <1000 g, and to explore predictive factors for the persistence of these phenomena. STUDY DESIGN A total of 120 infants were examined 3 times each. The presence of deformational plagiocephaly and a score of 0-6 on an asymmetry performance scale served as outcome measures at 6 months CA. Predictive factors were determined using regression analysis. RESULTS The prevalence of a positional preference of the head was 65.8% (79 of 120) at term-equivalent age (TEA) and 36.7% (44 of 120) at 3 months CA and that of deformational plagiocephaly was 30% (36 of 120) at TEA and 50% (60 of 120) at 3 months CA. At 6 months CA, 15.8% of the infants (19 of 120) scored ≥ 2 of a possible 6 on the asymmetry performance scale and 23.3% (28 of 120) had deformational plagiocephaly. Sleeping in the supine position was predictive of an asymmetric motor performance at 6 months CA. Chronic lung disease and/or slow gross motor maturation at 3 months CA predicted the persistence of deformational plagiocephaly. CONCLUSION Infants born very preterm may develop deformational plagiocephaly. A positional preference of the head at TEA seems to be a normal aspect of these infants' motor repertoire, with limited ability to predict persistence of an asymmetric motor performance. The decreased prevalence of deformational plagiocephaly between 3 and 6 months CA indicates an optimistic course. Infants with a history of chronic lung disease and/or slow gross motor maturation merit timely intervention.
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Affiliation(s)
- Jacqueline Nuysink
- Child Development and Exercise Center, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Jiménez Sarmiento A, Conejero Casares J, Romero Romero B, Rodríguez-Piñero Durán M. Tortícolis secundario a hipoplasia del esternocleidomastoideo. An Pediatr (Barc) 2013; 79:127-8. [DOI: 10.1016/j.anpedi.2012.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/15/2012] [Accepted: 11/16/2012] [Indexed: 11/26/2022] Open
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Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther 2013; 25:348-94. [PMID: 24076627 DOI: 10.1097/pep.0b013e3182a778d2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. CMT may be accompanied by other neurological or musculoskeletal conditions. KEY POINTS Infants with CMT are frequently referred to physical therapists (PTs) to treat their asymmetries. This evidence-based clinical practice guideline (CPG) provides guidance on which infants should be monitored, treated, and/or referred, and when and what PTs should treat. Based upon critical appraisal of literature and expert opinion, 16 action statements for screening, examination, intervention, and follow-up are linked with explicit levels of evidence. The CPG addresses referral, screening, examination and evaluation, prognosis, first-choice and supplemental interventions, consultation, discharge, follow-up, suggestions for implementation and compliance audits, flow sheets for referral paths and classification of CMT severity, and research recommendations.
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Nuysink J, van Haastert IC, Eijsermans MJC, Koopman-Esseboom C, van der Net J, de Vries LS, Helders PJM. Prevalence and predictors of idiopathic asymmetry in infants born preterm. Early Hum Dev 2012; 88:387-92. [PMID: 22051525 DOI: 10.1016/j.earlhumdev.2011.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 07/18/2011] [Accepted: 10/03/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND An idiopathic asymmetry in posture of the head is recognized as a risk factor to develop a deformational plagiocephaly (DP). In our neonatal follow-up clinic, an IA is often observed in infants born preterm at term-equivalent age (TEA). AIMS To explore (1) the prevalence of an idiopathic asymmetry in 192 infants (gestational age ≤32.0 weeks) at TEA and 6 months corrected age (CA), (2) whether demographical, perinatal, and medical factors were predictors of the asymmetry, and (3) differences in motor maturation between infants with and without asymmetry. METHODS In a retrospective study, frequencies of idiopathic asymmetry and DP, putative predictors, and Alberta Infant Motor Scale scores at 6 months CA were abstracted and analyzed with Chi(2), Mann-Whitney, logistic regression and T-test. RESULTS The prevalence rate of a positional preference of the head at TEA was 44.8% (n=86), 10.4% (20/192) had a DP at TEA and 13% (25/192) at 6 months CA. Positional preference, multiple birth and male gender predicted the presence of DP (p<.05, odds ratio 3.0, 3.2, and 3.1 respectively). Gross motor maturity at 6 months CA was less developed in infants with a positional preference at TEA compared to preterm norms (p=0.01). CONCLUSIONS The high prevalence of a positional preference in infants born preterm at term equivalent age requires extra alertness to prevent the development of a deformational plagiocephaly, especially in boys and twins. Although, considering the lower prevalence of plagiocephaly at 6 months CA, therapists should be aware of over treating these infants.
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Affiliation(s)
- Jacqueline Nuysink
- Child Development and Exercise Center, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Lennartsson F. Developing guidelines for child health care nurses to prevent nonsynostotic plagiocephaly: searching for the evidence. J Pediatr Nurs 2011; 26:348-58. [PMID: 21726785 DOI: 10.1016/j.pedn.2010.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 01/01/2023]
Abstract
The aim of the project was to develop guidelines for nurses that can be incorporated into the Swedish child health care program to prevent nonsynostotic plagiocephaly in infants while still following sudden infant death syndrome preventive measures. Guidelines were developed by reviewing the literature, compiling evidence, appraising recommendations, and formulating a condensed version of relevant information for nurses. The guidelines were tested clinically in a Swedish pilot project.
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Affiliation(s)
- Freda Lennartsson
- Primärvården Skaraborg, Sweden and School of Life Sciences, University of Skövde, Skövde, Sweden.
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Prevalence and characteristics of abnormal head posture in children with Down syndrome: a 20-year retrospective, descriptive review. Ophthalmology 2011; 118:1859-64. [PMID: 21665280 DOI: 10.1016/j.ophtha.2011.02.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 01/13/2011] [Accepted: 02/14/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To characterize the abnormal head posture (AHP) in children with Down syndrome (DS). The study had 3 aims: to estimate the prevalence of AHP, to describe the distribution of different causes for AHP, and to evaluate the long-term outcomes of AHP in children with DS evaluated at the University of Iowa Hospitals and Clinics between 1989 and 2009. DESIGN Retrospective chart review. PARTICIPANTS Two hundred fifty-nine patient records. METHODS The study data were analyzed using chi-square tests (the Fisher exact test when appropriate) to describe the relationship between the outcome of interest and each study covariate. A predictive logistic regression model for AHP was constructed including all the significant covariates. MAIN OUTCOME MEASURES Abnormal head posture. RESULTS Over the study period, 259 records of patients with DS were identified. Of these, 64 (24.7%) patients had AHP. The most frequent cause of AHP was incomitant strabismus in 17 (26.6%) of 64 patients. The second most frequent cause of AHP was nystagmus, in 14 (21.8%) of 64 patients. For a substantial number of patients with AHP, the cause could not be determined. They represented 12 (18.8%) of all the patients with AHP in this study and 12 (4.6%) of all patients with DS examined. When compared with patients with AHP from a determined cause, this subgroup has a statistically significantly (P = 0.027, Fisher exact test) higher percentage of atlantoaxial instability. In the study population, 9 (14.1%) of 64 patients with AHP had more than 1 cause for AHP. Refractive errors, ptosis, unilateral hearing loss, and neck and spine musculoskeletal abnormalities were responsible for AHP in a small percentage of patients. Of all the patients with AHP, 23 (35.9%) improved their head posture with treatment (glasses or surgery). An additional 6 (9.4%) patients improved their posture spontaneously, over time and without treatment. CONCLUSIONS The prevalence of AHP in the children with DS evaluated was 24.7%. From this analysis, having strabismus of any kind and particularly incomitant strabismus, nystagmus, or both is highly correlated with the development of an AHP. Almost 19% of DS patients with AHP had no definitive cause that could be determined.
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Nuysink J, van Haastert IC, Takken T, Helders PJM. Symptomatic asymmetry in very young infants: A Delphi study on the development of a screening instrument. Physiother Theory Pract 2010; 27:194-212. [DOI: 10.3109/09593985.2010.487146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE The aims of this review were to (1) identify and evaluate research evidence regarding the developmental outcomes of infants with congenital muscular torticollis (CMT) and (2) critically appraise and compare the outcomes of interventions targeting neck muscle extensibility and strength with those considering neck muscle function within the broader context of global infant development. SUMMARY An association between CMT and early developmental delay is supported by levels 3B, 4, and 5 evidence; no evidence was found of longer-term influences of CMT on the development of perceptual, cognitive, and motor skills. The effectiveness of passive manual stretching is supported by levels 2A, 3B, 4, and 5 evidence; no clear evidence was found of the effectiveness of developmentally supportive interventions. CONCLUSION Controlled studies are needed to clarify the developmental consequences of CMT.
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