SIDS, cephaly, torticollis Flashcards by caley patton

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Orthopedic conditions related to birth/postnatal positioning (3)

-Cranial deformation
-Torticollis
-Brachial plexus injury

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SIDS

Syndrome marked by sudden and unexplained death of an apparently healthy infant aged 1 month - 1 year, during sleep

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Risk factors for SIDS

Prone + side sleeping
Soft bedding + inappropriate bed surfaces
Bed sharing
Exposure to tobacco smoke
Prematurity

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Protective factors for SIDS

Breastfeeding
Pacifier use
Room sharing
Immunizations

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Is SIDS considered a diagnosis of exclusion?

Yes: all other causes of death must be ruled out

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maternal factors increasing vulnerability in infants

Limited prenatal care/nutrition
Subsequent birth less than one yr apart
tobacco, alc, drug use during pregnancy

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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

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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

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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

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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

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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

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Types of cranial deformities

Plagiocephaly
Brachycephaly
Scaphocephaly

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Plagiocephaly

UL occipital flattening
Anterior progression of ear on same side as flattened occiput
varying degrees of ipsilateral frontal and contralateral parietal bossing

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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)

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How is brachycephaly measured

Cranial Index (CI)

width/length x 100

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Brachycephaly

Wide skull with short length
Prominent/bossed forehead
Increased height of cranial vault
Central occipital flattening

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Asymmetric brachycephaly

combo of plagiocephaly and brachycephaly

Associated w proloned supine positioning + infant head rot

Measured using CI and CVAI

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Scaphocephaly

Symmetric, BL long + narrow skull

Common in babies with extended time in NICU or positioned in SL

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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