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PT 641 Peds > Torticollis and Plagiocephaly > Flashcards

Torticollis and Plagiocephaly Flashcards

1
Q

CMT

A

congenital muscular torticollis

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2
Q

what does torticollis lead to (positioning)

A

ipsilateral SB and contralateral rotation

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3
Q

what side is torticollis named by

A

side of muscle shortening

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4
Q

what does torticollis commonly occur with

A
  • hip dysplasia
  • brachial plexus injury
  • metatarsus adductus
  • plagiocephaly
  • facial asymmetries
  • may see shortening of scalenes, levator scapulae, upper trap
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5
Q

prenatal and perinatal theories for torticollis

A

prenatal
- ischemic injury, intrauterine compartment syndrome, intrauterine crowding, hereditary factors

perinatal
- neurogenic injury, birth trauma (direct injury to the muscle or rupture of muscle during birthing process)

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6
Q

risk factors for torticollis

A
  • large birth weight
  • multiple birth
  • male gender
  • breech position
  • difficult labor or delivery
  • use of vacuum or forceps for delivery
  • maternal uterine abnormalities
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7
Q

3 types of ways to differentially diagnosis torticollis when it is a non-muscular etiology

A
  • osseous (klippel-feil syndrome and hemivertebrae)
  • non-ossseous (grisels syndrome, sandifer syndrome)
  • neurologic (brachial plexus injury, ocular dysfunction, arnold-chiari malformation)
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8
Q

klippel feil syndrome

A

fusion of 2 cervical vertebrae

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9
Q

hemivertebrae syndrome

A

one cervical vertebrae develops on one side and not the other

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10
Q

grisel’s syndrome

A

atlanto-axial subluxation caused by upper respiratory issue

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11
Q

sandifer syndrome

A

caused by GERD

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12
Q

what are the 3 types of CMT

A
  • postural/positional torticollis
  • muscular torticollis
  • sternomastoid tumor
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13
Q

postural/positional preference

A
  • infants born with postural preference
  • no tightness of SCM and no PROM restrictions
  • no mass, x-rays normal
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14
Q

muscular torticollis

A
  • tightness of SCM with ROM limitations
  • no mass, x-rays normal
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15
Q

sternomastoid tumor

A
  • discrete mass or fibrotic thickening of SCM
  • PROM limitations
  • x-rays normal
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16
Q

found within SCM belly and appears within first 2 weeks of life and gradually disappears

A

associated fibrotic tumor

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17
Q

dx of torticollis

A
  • often within first 2-3 weeks after birth, milder cases up until 6 months of age
  • parents or pediatricians note a head tilt or rotational preference
  • clinical presentation
  • palpation of SCM
  • x-rays (not always)
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18
Q

important aspects of birth/health history for torticollis

A
  • chronological/corrected age
  • age of onset
  • pregnancy hx
  • delivery hx
  • birth presentation
  • head posture/preference and head/face asymmetries
  • family hx
  • other medical conditions
  • developmental milestones
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19
Q

assessing posture in torticollis

A
  • general posture in all developmental positions
  • measure degree of resting head tilt via still photography in supine
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20
Q

how to measure resting head tilt

A
  • draw line through acromion and through midpoints of both eyes
  • intersection angle to measure head tilt
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21
Q

ways to measure cervical rot and SB

A
  • % of unaffected side
  • tape measure
  • arthrodial protractor
  • anatomical landmarks
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22
Q

normal lateral flexion

A

70 deg

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23
Q

normal rotation

A

110 deg

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24
Q

nipple line rotation

A

40deg

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25
Q

between nipple line and shoulder

A

70deg

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26
Q

shoulder

A

90 deg

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27
Q

past shoulder

A

100deg

28
Q

how to perform AROM in infants <3 m/o

A

performed in supine

29
Q

how to perform AROM in infants > 3 m/o

A

performed in sitting

30
Q

how to measure muscular strength in infants less than 2 m/o

A

muscle function scale (MFS)

31
Q

score of 5 on MFS

A
  • head held high above horizontal line, almost vertical
  • > 75deg
32
Q

score of 4 on MFS

A
  • head held high over horizontal line > 45deg
  • > 45 <75
33
Q

score of 3 on MFS

A
  • head held high over horizontal, but < 45 deg
  • > 15 deg < 45deg
34
Q

score of 2 on MFS

A
  • head held slightly over horizontal line
  • > 0 < 15 deg
35
Q

score of 1 on MFS

A
  • head held in horizontal
  • 0 deg
36
Q

score of 0 on MFS

A
  • head below horizontal
  • < 0deg
37
Q

how to perform MFS and how is it scored

A
  • hold infant vertically in front of mirror and then tip them horizontally
  • observe righting position
  • must be held for 5 seconds
38
Q

head tilt to maintain binoocularity or to optimize visual acuity

A

ocular torticollis

39
Q

how to test for ocular torticollis

A

sit up test

40
Q

easy outcome to measure developmental/gross motor exam for torticollis

A

AIMS

41
Q

infants with CMT, prone positioning at least _____ x/day is correlated with higher AIMS scores

A

3

42
Q

interventions started ____ will have 98% of pts with normal ROM within 1.5 months

A

before 1 month

43
Q

interventions beginning _____ may need interventions for > 6 months

A

after 1 m/o

44
Q

waiting until ____ may require 9-10 months of tx and may not achieve full ROM without surgical intervention

A

after 6 months

45
Q

5 first choice interventions for torticollis

A
  • PROM
  • neck and trunk AROM
  • developmental exercises to promote symmetry of movements
  • environmental adaptations
  • parent education
46
Q

supplemental interventions for torticollis

A
  • STM
  • kinesiotape
  • TOT collar
47
Q

if conservative tx fails after how many months should you refer and at what age should surgery be performed by to allow for better outcomes

A
  • 6 months of conservative tx
  • before age 8
48
Q

criteria for discharge from PT for torticollis

A
  • PROM within 5 deg of non-effected side
  • symmetrical active movement patterns
  • age appropriate motor development
  • no visible head tilt
  • parents/caregivers understand what to monitor as child grows
49
Q

asymmetrical flattening of skull

A

plagiocephaly

50
Q

causes of skull deformation

A
  • neonatal: first born, prolonged labor or tool assisted delivery, prematurity or low birth weight, torticollis
  • environmental factors: prolonged placement in one position, lack of prone position, increased time in positioning device
51
Q

premature fusion of cranial sutures

A

craniosynostosis

52
Q

positional plagiocephaly features

A
  • ipsilateral frontal bossing
  • ipsilateral ear displaced anteriorly
  • contralateral occipital bossing
  • parallelogram shape
53
Q

craniosynpstosis features

A
  • contralateral frontal bossing
  • ipsilateral ear displaces posteriorly
  • ipsilateral occipitoparietal flattening
  • contralateral parietal bossing
  • trapezoid shape
54
Q

which is conservatively managed is which has to be managed surgically (plagiocephaly vs craniosynostosis)

A
  • conservative = plagiocephaly
  • surgically = craniosynostosis
55
Q

back of head becomes flattened symmetrically

A

brachycephaly/dolichocephaly

56
Q

sagittal synostosis - skull becomes enlarged

A

scaphocephaly

57
Q

1st choice interventions for plagiocephaly for infants 0-4 m/o without torticollis

A
  • parent education, repositioning exercises
  • goal: shift infant off flattened areas to encourage symmetrical head shape
  • referral to PT if resistant to repositioning, neck tightness, head shape worsens or does not improve
58
Q
  • goal: encourage symmetrical skull growth
A

cranial remodeling orthosis (CRO)

59
Q

what age group is CRO for

A

3-18 months with moderate to severe skull deformity

60
Q

optimal age for initiating CRO tx

A

4-6 months

61
Q

how often is CRO worn

A

23 hours/day

62
Q

how often is follow up for CRO

A

2-3 weeks

63
Q

goal: parent education, resolve ROM deficits, strengthen weak muscle groups, promote age appropriate motor development

A

PT

64
Q
  • measures plagiocephaly
  • measurement is taken diagonally
  • 3 measurements and take the average
A

cranial vault asymmetry index (CVAI)

65
Q
  • measures brachycephaly
  • 3 measurements
  • measure medial/lateral and anterior/posterior
A

cephalic index (ratio) (CI)

PT 641 Peds (16 decks)

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