torticollis/plagiocephally

Question 1

abnormal shape of the head.

Answer 1

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.

Question 2

types of torticollis

Answer 2

congenital muscular torticollis, ocular, osseous, neurologic, sandifers syndrome GERD

Question 3

osseous torticollis

Answer 3

congenital vertebral anomalies:

1. hemivertebrae vertebral formation failure
2. klippel-feil syndrome segmentation failure.

Question 4

ocular torticollis

Answer 4

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.

Question 5

developmental delays caused by torticollis

Answer 5

1. decreased head control
2. limited visual tracking
3. limited reaching on side bent towards (limited supination)
4. preference for rolling to one side only
5. delayed sitting
6. asymmetrical WBing

Question 6

typical cervical rotation ROM infants 2-10 mos

Answer 6

100-120 degrees

Question 7

typical cervical lateral flexion ROM infants 2-10 mos

Answer 7

65-75 degrees

Question 8

landmark for rotation: chin to nipple

Answer 8

40 degrees

Question 9

landmark for rotation: chin btwn nipple and shoulder

Answer 9

70 degrees

Question 10

landmark for rotation: chin to shoulder

Answer 10

90 degrees

Question 11

landmark for rotation: chin past shoulder

Answer 11

100 degrees

Question 12

tx for recalcitrant torticollis

Answer 12

1. surgical release if deficits in rotation and lateral flexion of greater than 15 degrees.
2. Botox

Question 13

SCM Torticollis

Answer 13

SCM Non tender fibrous palpable tumor due to head/neck position in utero or during labor and delivery. risk factors same as for plagiocephaly:

1. large birth weight
2. multiple births
3. breech
4. 1st born
5. forceps or vacuum delivery
6. uterine abnormalities

Question 14

Torticollis interventions

Answer 14

conservative in the first 12 months

1. PROM, AAROM, AROM
2. postural control exercises
3. strengthening
4. positioning, feeding, carrying
5. orthotic

Question 15

Torticollis interventions

Answer 15

conservative in the first 12 months

1. PROM, AAROM, AROM
2. postural control exercises
3. strengthening
4. positioning, feeding, carrying
5. orthotic

Question 16

DOC

Answer 16

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.

Question 17

consequences of not correcting plagiocephally

Answer 17

psychosocial development/self esteem issues, TMJ secondary to lack of mandibular alignment

Question 18

craniosynostosis

Answer 18

premature closure of the cranial sutures. the suture that closes defines the deformity. indicated by absence of soft spots. can increase cranial pressure.

Question 19

deformational plagiocephally

Answer 19

pressure on occiput of growing skull causes it to flatten. more common on R than L. more common in males. asymmetries may occur