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Pediatrics > Torticollis and Plagiocephaly > Flashcards

Torticollis and Plagiocephaly Flashcards

1
Q

What is Congenital Muscular Torticollis (CMT)?

A

idiopathic postural deformity

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2
Q

When is CMT evident?

A

shortly after birth

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3
Q

How does CMT present?

A

Tilting of head (lateral neck flexion) to one side.
Preferred head turning (rotation) to opposite side.
Unilateral shortening or fibrosis of the sternocleidomastoid muscle (SCM).

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4
Q

Who does CMT occur more frequently in?

A

males

multiple birth

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5
Q

Potential CMT causes:

A

packaging’ or positioning in utero, especially final trimester (‘stuck’ in pelvis in vertex position).
Difficult birth, breech presentation

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6
Q

Conditions associated with CMT:

A

cranial deformation,
developmental dysplagia of the hip (DDH) (2.5-17%)
brachial plexus injury,
distal extremity deformities.
facial asymmetry,
early or persistent developmental delays,
TMJ dysfunction

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7
Q

Red flags with CMT:

A

headaches, vomiting, neurologic symptoms

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8
Q

Head tilting could be a sign of what other serious conditions?

A

atlantoaxial rotatory displacement, infection (abscess, spondylitis).
Intermittent torticollis: may be caused by tumors of the posterior fossa;

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9
Q

Rare causes of head tilt?

A

benign or malignant neoplasms of upper cervical spine; cervical dystonia (older adolescents

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10
Q

What are the 3 types of CMT?

A

postural
muscular
SCM mass CMT

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11
Q

Postural CMT:

A

infant’s postural preference, without muscle or PROM restrictions.

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12
Q

Muscular CMT:

A

SCM tightness and passive ROM limitations

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13
Q

SCM mass CMT:

A

fibrotic thickening of SCM, PROM limitations

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14
Q

What is highly predictive of the time required to resolve ROM limitations?

A

presentation in combination with the age of initial diagnosis

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15
Q

Normal ROM achieved how soon of started before 1 month of age?

A

within 1.5 months

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16
Q

Normal ROM achieved when if started after 1 month of age?

A

within 6 months

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17
Q

Normal ROM achieved when if started after 6 months of age?

A

within 9-10 months

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18
Q

PT in CMT:

A

Passive stretching.
Positioning for active movement away from tightness,
Parent education in home exercise program.
Prevention of more invasive interventions, cost-effective

19
Q

What can happen if CMT is left untreated?

A

can reoccur in older children or adults, require Botox injections or surgery for movement limitations, facial asymmetry

20
Q

PT Exam of CMT

A
  1. Birth/delivery, medical, developmental hx
  2. Systems screening
    Activity and Participation
    1, motor abilities
  3. feeding, sleep positions
  4. positional preferences
  5. tummy time
21
Q

What has awake tummy time been positively correlated with:

A

higher scores on Alberta Infant Motor Scale (AIMS).

fewer delays in achieving prone extension, rolling, unsupported sitting, fine motor control

22
Q

Red flags for referral in CMT:

A

Suspected hip dysplagia.
Skull and/or facial asymmetry (rule out craniosynostosis).
Atypical presentation (tilt and turn to same side, plagiocephaly and tilt to same side).
Poor visual tracking, nystagmus, strabismus, gaze aversion.
Abnormal muscle tone.
Extramuscular masses or asymmetries inconsistent with CMT.
Acute onset associated with trauma or illness.
Little or no reduction in neck asymmetry after 4-6 weeks of initial intense intervention

23
Q

When is acquired torticollis usually seen?

A

first 4-6 months

24
Q

Classify Level of Severity of CMT

A 
Early Mild
Early Moderate
Early Severe
Late Mild
Late Moderate
Late Severe
Late Extreme
25
Q

Early mild:

A

0-6 months. Mild- postural preference or muscle tightness with <15 deg rot limitation

26
Q

Early moderate:

A

15-30 deg rotation restriction

27
Q

Early severe:

A

> 30 deg rotation limitation or SCM mass.

28
Q

Late mild:

A

present 7-9 mo, postural preference or <15 deg rotation limitation

29
Q

Late moderate:

A

present 10-12 mo, postural or muscle tightness <15 deg rotation limitation.

30
Q

Late severe

A

present 7-12 mo, >15 deg rot limitation

31
Q

Late extreme:

A

present after 7 mo with an SCM mass or after 12 mo with muscle tightness >30 deg rotation limitation

32
Q

5 Component of Intervention of CMT:

A
  1. Neck PROM
  2. Neck and trunk active ROM
  3. Development of symmetrical movement
  4. Environmental adaptations
  5. Patient caregiver education
33
Q

Neck PROM in CMT:

A

low intensity, sustained, pain-free stretching to avoid microtrauma to muscle.
frequent daily intervention for more rapid resolution (diaper changes).
stabilize the trunk to minimize compensatory movements.

34
Q

Neck and trunk active ROM in CMT:

A

encourage head turning and tilting to non-preferred side.

35
Q

Environmental adaptations in CMT:

A

limit supine positioning in infant equipment after 3 months. Alternate carrying positions, support aligned head positioning in car seat

36
Q

How does Plagiocephaly present?

A

occipital flattening on one side of the head,
possible bulging on the other side of head, or
bulging of forehead on same side as flattening (forehead bossing).
asymmetrical ear position, i.e., one ear forward of other (above view) or one ear lower than other (frontal view).
asymmetrical fullness of cheeks, shape of mandible

37
Q

Risk factors for plagiocephaly?

A

prematurity, decreased amniotic fluid, torticollis, craniosynostosis.

38
Q

Intervention for Plagiocephaly:

A

Repositioning during sleep to remove pressure from flattened area, rounded area against mattress.
Position in crib and equipment to encourage head turning away from flattened side.
Limiting time in supine in infant equipment, i.e., swings, bouncy seats, Rock-a-roo

39
Q

When should plagiocephaly be referred for possible cranioplasty?

A

Cranial vault measurements > 10mm differential

40
Q

Measurement of cranial vault?

A

(R frontal to L occipital,

L frontal to R occipital).

41
Q

Measure of orbital-tragial depth?

A

eye to ear

42
Q

When is cranioplasty less effective?

A

after 10-12 months

43
Q

Brachycephaly

A

Head is disproportionately wide compared to long, flattening across back of head.
Face may appear smaller, forehead inclined.
Prolonged positioning on their backs

Pediatrics (13 decks)

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