torticollis/plagiocephally Flashcards
abnormal shape of the head.
can occur as a result of abnormal forces on the skull before or after birth. when the baby descends in to the pelvis, if the mom has an abnormally shaped uterus, if fetus is in an odd position, if mom has twins. baby’s head should return to normal by 6 weeks.
types of torticollis
congenital muscular torticollis, ocular, osseous, neurologic, sandifers syndrome GERD
osseous torticollis
congenital vertebral anomalies:
- hemivertebrae vertebral formation failure
- klippel-feil syndrome segmentation failure.
ocular torticollis
may not have cervical ROM deficits.
1. superior oblique palsy: tilts head away from the affected side
2. lateral rectus palsy-head tilts towards the affected eye.
tilting=better alignment, fixing diplopia, aids binocular vision. treat by patching good eye.
developmental delays caused by torticollis
- decreased head control
- limited visual tracking
- limited reaching on side bent towards (limited supination)
- preference for rolling to one side only
- delayed sitting
- asymmetrical WBing
typical cervical rotation ROM infants 2-10 mos
100-120 degrees
typical cervical lateral flexion ROM infants 2-10 mos
65-75 degrees
landmark for rotation: chin to nipple
40 degrees
landmark for rotation: chin btwn nipple and shoulder
70 degrees
landmark for rotation: chin to shoulder
90 degrees
landmark for rotation: chin past shoulder
100 degrees
tx for recalcitrant torticollis
- surgical release if deficits in rotation and lateral flexion of greater than 15 degrees.
- Botox
SCM Torticollis
SCM Non tender fibrous palpable tumor due to head/neck position in utero or during labor and delivery. risk factors same as for plagiocephaly:
- large birth weight
- multiple births
- breech
- 1st born
- forceps or vacuum delivery
- uterine abnormalities
Torticollis interventions
conservative in the first 12 months
- PROM, AAROM, AROM
- postural control exercises
- strengthening
- positioning, feeding, carrying
- orthotic
Torticollis interventions
conservative in the first 12 months
- PROM, AAROM, AROM
- postural control exercises
- strengthening
- positioning, feeding, carrying
- orthotic
DOC
Dynamic orthotic cranioplasty- for use after trial position head to deal with Plagiocephaly. infant should have adequate head control in order to wear helmet. inner foam lining of the DOC band is changed on a biweekly basis based on changes that occur in the skull. for 3-18 month olds. worn 23/24 hours/day. 1 hour for cleaning and neck ROM. treatment lasts 3-4 months depending on severity could be longer. best between 4-12 months, and initiated by 6 mos.
consequences of not correcting plagiocephally
psychosocial development/self esteem issues, TMJ secondary to lack of mandibular alignment
craniosynostosis
premature closure of the cranial sutures. the suture that closes defines the deformity. indicated by absence of soft spots. can increase cranial pressure.
deformational plagiocephally
pressure on occiput of growing skull causes it to flatten. more common on R than L. more common in males. asymmetries may occur
