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Pediatric PT > Torticollis > Flashcards

Torticollis Flashcards

1
Q

(true/false) Torticollis may be a clinical sign of one of a variety of underlying pathologies, some benign and some quite serious

A

true

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2
Q

What does an infants positioning look like if they have L sided torticollis?

A

R ROT and SB

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3
Q

Torticollis occurs in every 1 and ___ newborns.

A

1 in 6

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4
Q

What population is torticollis more frequent?

A

White males and infants exposed to opioids in utero

First born infants

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5
Q

80-90% of torticollis cases also has what condition?

A

plagiocephaly

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6
Q

What sided torticollis is more common?

A

Left

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7
Q

Most torticollis cases are identified by when?

A

3 months

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8
Q

What are the origins of torticollis? Which is more common?

A

muscular (80%)
non-muscular

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9
Q

What developmental disorders commonly have torticollis due to asymmetry?

A

CP, down syndrome, and myelomeningocele

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10
Q

(true/false) it is common to see a sudden onset of torticollis within the first year.

A

FALSE

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11
Q

definition: describes the posture of the head and neck from unilateral shortening of the sternocleidomastoid (SCM) muscle, causing the head to tilt toward and rotate away from the affected SCM muscle.

A

congenital muscular torticollis

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12
Q

What are the sutypes of congenital muscular torticollis?

A
  1. postural
  2. muscular
  3. SCM mass
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13
Q

What are the characteristics of postural congenital muscular torticollis?

A
  • has a postural preference
    NO muscular or PROM restrictions
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14
Q

What is the mildest form of congenital muscular torticollis?

A

postural

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15
Q

What are the characteristics of congenital muscular torticollis with a SCM mass?

A
  • Fibrotic thickening of the SCM
  • PROM limitations
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16
Q

What is the most severe type of congenital muscular torticollis?

A

SCM mass

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17
Q

What are the forms of postnatal muscular torticollis?

A

environmental-induced
plagiocephaly- induced
positional preference-induced

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18
Q

What are the etiologies of congenital muscular torticollis?

A
  • ischemia to the muscle belly
  • birth trauma
  • intrauterine malposition leading to compartment syndrome
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19
Q

(smaller/larger) babies are more likely to develop torticollis

A

larger

20
Q

(true/false) Fetal position in utero may injure the SCM, leading to a compartment syndrome. The MOI in congenital muscular torticollis cases is therefore a kink or crush with subsequent ischemia

A

true

21
Q

What are risk factors for torticollis?

A
  • large birth weight
  • male
  • breech position
  • multiple pregnancies
  • primiparous mother
  • difficult labor/delivery
  • vacuum/forceps
  • nuchal cord
  • uterine abnormalities
22
Q

What are the causes of non-muscular torticollis?

A
  • Skeletal malformation - klippel-feil syndrome
  • neurologic - brachial plexus injury
  • ocular lesion
  • sandifer syndrome
  • benign paroxysmal torticollis
  • dystonia
  • pathology of the posterior fossa
  • postenecephalitis syndromes
  • arnold-chiari malformation
  • syringomyelia
23
Q

What can be the first sign of an ocular deficit?

A

torticollis

24
Q

What is sprengel’s deformity?

A

a condition where the scapula (shoulder blade) on one or both sides are underdeveloped (hypoplastic) and abnormally high. It is due to failure of descent of the scapula during embryonic development from its position in the neck to its normal position in the posterior thorax

25
Q

What is klippel-feil syndrome?

A

rare disorder characterized by the congenital fusion of any 2 of the 7 cervical (neck) vertebrae.

–> It is caused by a failure in the normal segmentation or division of the cervical vertebrae during the early weeks of fetal development.

–>The most common signs of the disorder are short neck, low hairline at the back of the head, and restricted mobility of the upper spine

26
Q

What is sandifer syndrome?

A

involves spasmodic torsional dystonia with arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia

27
Q

What can benign paroxysmal torticollis be related to?

A

infant migraines or vestibular dysfunction

28
Q

What are secondary impairments of torticollis?

A
  • plagiocephaly/cranial deformation
  • facial deformation
  • compensatory scoliosis (Cx and T-spine)
  • metatarsus adductus
  • GERD
  • developmental hip dysplasia
29
Q

What does facial deformations caused by torticollis look like?

A
  • flattening of the affected side
  • downward displacement of eye, ear, and mouth
30
Q

(true/false) GERD is common in infants with torticollis

A

true

–> can be due to tongue and lip ties

31
Q

(true/false) Infants who spent 3 periods of awake time in prone has significantly lower AIMS scores

A

FALSE (higher score)

32
Q

What are reasons for referral?

A
  • Suspected hip dysplasia
  • Skull or facial asymmetry
  • Atypical presentation
  • Abnormal tone
  • Late onset torticollis at 6 months or older
  • Visual abnormalities
  • Acute onset
  • Changes in color when screening neck PROM
  • > 12 months at initial screen and either facial asymmetry and/or 10-15 degree difference in AROM/PROM
  • > 7 months at initial screen and has SCM mass
33
Q

What outcome measures can you use on infants with torticollis?

A

AIMS, TIMP, PDMS-2

34
Q

What are contraindications for PROM to treat torticollis?

A
  • Bony abnormalities
  • Fracture
  • Down syndrome
  • Myelomeningocele
  • Compromised circulatory or respiratory system
  • Malignancy
  • Osteomyelitis
  • Tuberculosis
  • Ruptures or lax ligaments
  • Infection
  • Shunt
  • Arnold-Chiari malformation
35
Q

If interventions are started before one full month of having torticollis, 98% will achieve PROM by ____ months.

A

1.5 months

36
Q

If interventions to treat torticollis are started after 1 month of onset, it can take up to __ months to treat.

A

6 months

37
Q

If interventions for torticollis are started after 6 months of onset, it required ____ months of care.

A

9-10 months

38
Q

PROM is tolerated better in (younger/older) infants with torticollis

A

younger

39
Q

What are stretching parameters to treat torticollis?

A

one 30 second hold rep at end range passive stretch

4x/day

40
Q

Infants with torticollis should have prone play for > ___ hour/day

A

1 hour

41
Q

(true/false) you want to maximize time in a car seat/carrier if an infant has GERD

A

FALSE

42
Q

Those with torticollis who are treated prior to ___ months has 100% resolution of symptoms

A

3 months

43
Q

What are prognostic indicators for a longer treatment duration?

A
  • low birth weight
  • breech presentation
  • motor asymmetry
44
Q

What intervention helps improve outcomes?

A

increased stretching frequency

45
Q

When is surgery indicated for torticollis?

A

Indicated if torticollis has not resolved by 12 months; significant loss of ROM; severe plagiocephaly

46
Q

What is a ToT collar used for?

A

for infants with torticollis that is unresolving

47
Q

What is the optimal age range for helmets? how long should they be work?

A

4-8 months
23 hrs/day for 7 days/wk

Pediatric PT (14 decks)

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