Functional and cosmetic status in children treated for congenital muscular torticollis as infants

Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy

BACKGROUND

Congenital muscular torticollis (CMT) is a postural condition evident shortly after birth. The 2013 CMT Clinical Practice Guideline (2013 CMT CPG) set standards for the identification, referral, and physical therapy management of infants with CMT, and its implementation resulted in improved clinical outcomes. It was updated in 2018 to reflect current evidence and 7 resources were developed to support implementation. Purpose: This 2024 CMT CPG is intended as a reference document to guide physical therapists, families, health care professionals, educators, and researchers to improve clinical outcomes and health services for children with CMT, as well as to inform the need for continued research. Results/Conclusions: The 2024 CMT CPG addresses: education for prevention, screening, examination and evaluation including recommended outcome measures, consultation with and referral to other health care providers, classification and prognosis, first-choice and evidence-informed supplemental interventions, discontinuation from direct intervention, reassessment and discharge, implementation and compliance recommendations, and research recommendations.

Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy

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.

Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association

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.

A pilot study on changes in passive range of motion in the cervical spine, for children aged 0-5 years

BACKGROUND

The aim of this study was to investigate the values for passive range of motion (PROM) in rotation and lateral flexion of the neck, for children aged 3.5-5 years, and to compare the results with the measurements carried out on the same group of children as infants.

METHOD

Twenty-three children (10 females) were assessed in PROM in rotation and lateral flexion of the neck. Both measurements were performed with the children in a lying position using a large protractor. The dependent t-test was used to compare PROM with the PROM from an earlier study when the children were infants.

RESULT

PROM of the neck was found to be a mean 100° in rotation and 70° in lateral flexion at the age of 3.5-5 years. There was a significant decrease in rotation when comparing the measurements with values from infancy.

CONCLUSIONS

These data suggest that there is a decrease in PROM in rotation during the first 5 years of life, and that PROM in lateral flexion remains unchanged.

Testing guidelines for child health care nurses to prevent nonsynostotic plagiocephaly: a Swedish pilot study

The aim of the study is to test effectiveness of guidelines for nurses that can be incorporated into the child health care program to prevent nonsynostotic plagiocephaly (NSP) in infants while still following sudden infant death syndrome-preventive recommendations. When guidelines were followed as intended in a Swedish pilot study, only 8.5% of infants had some degree of NSP at 6 months, compared to 25.6% of infants in the comparison group. Results indicate that the early and regular implementation of these guidelines by nurses may be an effective way to prevent NSP.

Developing guidelines for child health care nurses to prevent nonsynostotic plagiocephaly: searching for the evidence

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.

Stretching treatment for infants with congenital muscular torticollis: physiotherapist or parents? A randomized pilot study

OBJECTIVE

To investigate the time needed to achieve a good result in the range of motion (ROM) in the neck for infants with congenital muscular torticollis (CMT).

DESIGN

Comparison of stretching treatments performed by physical therapists and parents.

PARTICIPANTS

Twenty infants (10 female and 10 male) with CMT.

METHOD

The infants were randomly assigned to 1 of 2 groups. Stretching treatment was continued until a good ROM was obtained in both rotation (≥ 90°) and lateral flexion (no side difference). The main outcome measurement was treatment time. The infants were evaluated for ROM in rotation and lateral flexion, muscle function in the lateral flexor muscles of the neck, plagiocephaly, and head tilt.

RESULTS

The time needed to achieve a good result according to the ROM in the neck was significantly shorter (P < .001) in the physical therapist group than in the parent group. Symmetrical head posture was achieved sooner (P = .03) in the physical therapist group.

CONCLUSION

Infants with CMT gained good ROM and symmetric head posture approximately 2 months sooner when treated by an experienced physical therapist; however, interpretation of the results of this small study should be guarded. Further studies are needed to confirm these results.

A developmental perspective on congenital muscular torticollis: a critical appraisal of the evidence

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.

Differential diagnosis of torticollis: a case report

PURPOSE

This case report describes a method of differential diagnosis for torticollis in a 4-month-old male infant who also had hydrocephalus.

SUMMARY OF KEY POINTS

The infant presented to physical therapy (PT) with a "classic torticollis posture." Differential diagnosis was completed to determine the cause of the signs and the appropriate intervention. PT consisted of positioning, strengthening, stretching, and neuromuscular facilitation techniques to assist the infant to develop gross motor skills and a midline head position. A home exercise program was incorporated into the family's routines.

STATEMENT OF CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE

After 6 months of PT, the infant demonstrated considerable gains in cervical range of motion but continued to exhibit gross motor delay and difficulty in maintaining the head in midline. Intervention for infants with torticollis should address corrective positioning to facilitate symmetry during positioning and handling. Differential diagnosis is critical in establishing the appropriate plan of care.

Reference values for range of motion and muscle function of the neck in infants

PURPOSE

To determine reference values for cervical range of motion (ROM) in rotation and lateral flexion and for muscle function in the lateral neck flexors in a sample of infants who were healthy.

METHOD

ROM was measured, and muscle function was estimated in 38 infants at the ages of 2, 4, 6, and 10 months.

RESULTS

For rotation the mean ROM was 110 degrees and for lateral flexion it was 70 degrees. Infants of 2 months of age had a median muscle function score of 1 (interquartile range, 1-2). Muscle function increased to score 3 to 4 by 10 months.

CONCLUSION

Infants below 1 year of age have good ROM in rotation (> or = 100 degrees ) and lateral flexion (> or = 65 degrees ) of the neck. These reference values for passive ROM and muscle function of the neck may have clinical utility in assessing and documenting the initial evaluation and progress of infants with congenital muscular torticollis.