SIDS, cephaly, torticollis Flashcards
Orthopedic conditions related to birth/postnatal positioning (3)
-Cranial deformation
-Torticollis
-Brachial plexus injury
SIDS
Syndrome marked by sudden and unexplained death of an apparently healthy infant aged 1 month - 1 year, during sleep
Risk factors for SIDS
Prone + side sleeping
Soft bedding + inappropriate bed surfaces
Bed sharing
Exposure to tobacco smoke
Prematurity
Protective factors for SIDS
Breastfeeding
Pacifier use
Room sharing
Immunizations
Is SIDS considered a diagnosis of exclusion?
Yes: all other causes of death must be ruled out
maternal factors increasing vulnerability in infants
Limited prenatal care/nutrition
Subsequent birth less than one yr apart
tobacco, alc, drug use during pregnancy
Infant factors increasing vulnerability
Low birth weight (5 lb 8 oz)
Gender (more common in males)
Age (highest risk 2-4 mo)
Preterm birth (before 37 weeks)
Exposure to tobacco smoke
Formula vs breastmilk
Prevention of SIDS
always place baby on back to sleep regardless if they can roll
Firm crib mattress
Keep soft objects, toys, and loose bedding out of sleep area
Avoid letting the baby overheat
Developmental outcomes of back to sleep
Cranial deformation
Decreased time in prone out of fear
decreased upper trunk strength
Decreased eye hand coordination, reaching, fine motor skill development
delays attainment of gross motor developmental milestones, though still in accepted time range
Cranial deformation
Distortion of the skull that occurs in response to prenatal and postnatal external compression forces
Sutures of the skull are open and have not prematurely fused
Characteristics of newborn skulls
-Highly soft + pliable separated by sutures
-8 sutures + 6 fontanels accomodate increased growth of the skull
-Normal head shape should be assumed within 6 weeks of birth
Types of cranial deformities
Plagiocephaly
Brachycephaly
Scaphocephaly
Plagiocephaly
UL occipital flattening
Anterior progression of ear on same side as flattened occiput
varying degrees of ipsilateral frontal and contralateral parietal bossing
How to evaluate plagiocephaly
Cranial Vault Asymmetry Index (CVAI)
Diagonal measurements are taken of the skull
[a-b]x100 / A or B (which ever is greater)
How is brachycephaly measured
Cranial Index (CI)
width/length x 100
Brachycephaly
Wide skull with short length
Prominent/bossed forehead
Increased height of cranial vault
Central occipital flattening
Asymmetric brachycephaly
combo of plagiocephaly and brachycephaly
Associated w proloned supine positioning + infant head rot
Measured using CI and CVAI
Scaphocephaly
Symmetric, BL long + narrow skull
Common in babies with extended time in NICU or positioned in SL
How is scaphocephaly measure
Cranial Index (CI)
What is a positional deficit babies with scaphocephaly have?
Difficult to keep head in midline
Treatment of positional skull deformation
Often treatable with parent education, positioning, and exercise
Examples of tx interventions for positional skull deformation
Alternate head pos in supine
Tummy time with supervision and awake
Avoid too much time in car seats + carriers
Hold baby upright
Change direction the baby faces in the crib from week to week
Goal of tx of positional skull deformation
Shift the baby off the flattened areas to enable the head to assume a symmetrical shape
Tortle
Beanie used to treat positional head deformities that positions the head to limit pressure on the flattened side. Designed to switch sides
Goal of cranial orthoses
Encourage symmetrical skull growth
Indications for cranial orthosis
No response to repositioning therapy
Secondary changes to the skull or frontal facial asymmetries
Contraindications to cranial orthosis
Craniosynostosis
Unshunted hydrocephalus
Children > 18 mo corrected
Babies under 3 months corrected age
Tx factors for cranial orthosis
Optimum age for initiating tx is 4-8 mo
Worn 23 hrs per day for 2-6 months
Follow up 1 week initially and then every 2 weeks
Dynamic orthotic cranioplasty band
DOC band is designed to redirect growth and thus improve craniofacial symmetry in infants 3-18 mo
Results of cranial orthosis
Significant reduction of plagiocephaly
Showed better improvement despite more severe initial asymmetry
Weak correlation between initial asymmetry and amount of improvement
Congenital muscular torticollis
Deformational process resulting in UL tight SCM and loss of ROM of the neck
What is torticollis often associated with
Plagiocephaly and brachycephaly
Cause of congenital muscular torticollis
Intrauterine position (breech)
Birth trauma (vaccuum, forceps)
Positioning post natally
Symptoms of congenital muscular torticollis
Head tilts to IPS side, rotates to CL side
Imbalance in muscle strength around neck of unaffected side (unaffected side is weaker_
Non muscular causes of torticollis
Ocular torticollis
GERD
Vertebral malformation
Hemiparesis
Ocular torticollis
Involved eye drifts medially + superiorly
Head posture attempts to optimize visual acuity
GERD and torticollis
Tip head and neck to relieve pressure on esophagus
vertebral malformation torticollis
disrupt alignment and pull of muscles
hemiparesis and torticollis
Affected side: LF towards, Rot away
Examination for torticollis
Observation
Palpable nodule/skin integrity in SCM
Cranial anthropometry
ROM
Muscle strength
Righting + equilibrium reactions
Developmental assessment
Cervical rot cheat sheet
40 deg: chin to mid clavicle
70 deg: chin between clavicle and shoulder
90 deg: chin over shoulder
100 deg: chin past shoulder
Normal LF and rot for 2-10 month
LF: 65-75
Rot: 100-120
Mild, mod, severe ROM limitations for LF
Mild: 25-45
Mod: 10-25
severe: 0-10
Mild, mod, severe ROM limitations for rot
Mild: 70-85
Mod: 35-70
Severe: 0-35
Muscle function test in torticollis
Place child in sidelying and observe head righting pos
0: below neutral
1: head at neutral (2 mo)
2: slightly past neutral
3: High over neutral
4: Very high over neutral (10 mo)
PT management of torticollis
Stretching: affected side
Strengthening: opp side
(finding balance between strengthening + stretching)
Positioning: SL on affected side to strengthen the unaffected side
Parent ed
Cranial orthosis, orthosis/colar, kinesiotapeM
Medical management of torticollis
Botox, surgery
