Torticollis and Plagiocephaly

Question 1

Cervical ROM of an adult versus an infant

Answer 1

• Adult: 45º lateral flexion and 80º cervical rotation
• Infant: 70º lateral flexion and 110º rotation

Question 2

Describe newborn skull anatomy

Answer 2

• 5 bones
• 4 sutures
• 2 fontanelles: anterior closes 18-24 mo and posterior closes in first few months of life
• Anatomy allows for bones to move during birth & expand as brain grows

Question 3

Definition of Torticollis

Answer 3

• Postural deformity of the neck evident at birth or shortly thereafter
• Characterized by a head tilt to one side & the neck rotated to the opposite side
• Right sided: preference towards right tilt & left rotation
• Left sided: preference towards left tilt & right rotation

Question 4

Define plagiocephaly

Answer 4

• Cranial deformity with flattening of one posterior side of the head

Question 5

Signs of CMT (congenital muscular torticollis)

Answer 5

• Baby holds head tilted or turned to one side
• Baby avoids turning head to one side
• Baby struggles to nurse or feed on one side
• Baby prefers to use one hand more often when reaching or bringing hands to mouth
• Baby’s head is flat on one side

Question 6

Risk factors for CMT (2 or more of the following)

Answer 6

• Body length >51.3cm (20.2in) at birth
• Primiparity (birth of first child)
• Birth trauma (includes use of instruments for delivery)
• Facial asymmetry
• Plagiocephaly

Question 7

Describe the classification of Torticollis

Answer 7

• Grades 1-8 based on age at time of assessment, presence of SCM mass, & difference in PROM of cervical rotation

Question 8

Describe the plagiocephaly classification

Answer 8

• named for side & severity
• Argenta Scale: includes five types that increase in severity

Question 9

Prognosis of CMT

Answer 9

• <3mo 100% resolution with conservative tx
• 75% resolution with conservative tx >3mo
• Mild forms need 2-3 mo of tx
• More severe forms need 5-6 mo of tx

Question 10

Factors associated with full or more complete symptom resolution

Answer 10

-Participation in PT
-Younger age at onset of treatment
-Decreased difference in PROM between sides
-Decreased difference in SCM muscle thickness between sides
-Caregiver’s ability to perform HEP regularly

Question 11

What are the top five first choice interventions for CMT (Torticollis)

Answer 11

• Neck PROM
• Neck/trunk AROM
• Development of symmetrical movement
• Environmental adaptations
• Parent/caregiver education

Question 12

Other interventions for CMT if the top first choice ones aren’t effective

Answer 12

• Microcurrent
• Kinesiotaping
• Soft tissue mobilization
• Myokinetic stretching
• TAMO
• TOT Collar
• Soft foam collars
• Custom cervical orthosis
• Cervical manipulation

Question 13

Treatment for plagiocephaly

Answer 13

• Repositioning & environmental changes
• Cranial orthosis
• Improved outcomes with earlier onset of tx & decreased severity of deformation

Question 14

When to discharge for treatment of CMT (Torticollis)

Answer 14

• PROM within 5º of non-affected side
• Symmetrical active movement patterns
• Age appropriate motor development
• No visible head tilt
• Caregivers understand what to monitor as child grows