This handout is for reference only. Non- essential images have … · postural presentation Posture...
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Transcript of This handout is for reference only. Non- essential images have … · postural presentation Posture...
� If you are viewing this course as a recorded course after the live webinar, you can use the scroll bar at the bottom of the player window to pause and navigate the course.
� This handout is for reference only. Non-essential images have been removed for your convenience. Any links included in the handout are current at the time of the live webinar, but are subject to change and may not be current at a later date.
No part of the materials available through the continued.com site may be copied, photocopied, reproduced, translated or reduced to any electronic medium or machine-readable form, in whole or in part, without prior written consent of continued.com, LLC. Any other reproduction in any form without such written permission is prohibited. All materials contained on this site are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of continued.com, LLC. Users must not access or use for any commercial purposes any part of the site or any services or materials available through the site.
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12/10/19
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Introduction to Torticollis & Plagiocephaly Presented by: "Lisa J Roehl, PT, DPT"Board-Certified Clinical Specialist"in Pediatric Physical Therapy
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About Me § Physical Therapist with 10 years of experiences
within pediatrics, focus on neurological patient populations and infants.
§ Trained in TheraSuit® and TheraSuit Method®, with provision of an intensive therapy model.
§ Board-Certified Specialist in Pediatric Physical Therapy in 2019.
§ Advanced Therapy Solutions, Kids, Greenville, SC
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Learning Outcomes § After this course, participants will be able to identify the
possible causes and basic postural presentation of torticollis.
§ After this course, participants will be able to identify the basic head shape and facial presentation of plagiocephaly.
§ After this course, participants will be able to identify how torticollis and plagiocephaly affect early fine and gross motor development.
§ After this course, participants will be able to identify frontline treatment strategies for the progression of symmetry in early fine and gross motor development.
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Torticollis definition"and basic postural presentation Posture of the head and neck from unilateral shortening of the sternocleidomastoid (SCM) causing the head to tilt in one direction and rotate in the opposing direction
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Causes & contributors to torticollis
§ Intrauterine positioning § Multiple birth
pregnancies § Breech presentation § Trauma during labor
and delivery
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Torticollis effects on postural presentation § First line:
§ Head tilt to the right § Mild left cervical rotation
§ Second line: § Asymmetrical jaw line § Ear flare on right side § Right shoulder elevation § Right shoulder/trunk
retraction § Right trunk lateral flexion >
Left § Right hip flexed > Left § Right hip external rotated
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Plagiocephaly and Torticollis “partnership” § Asymmetrical positioning
can cause increased dependence and pressure on the growing skull
§ Causing oblique distortion § Area of more bulk: Bossing § Areas of less bulk: Flattening § Diagonal A>B"
Left Plagiocephaly § Diagonal B>A "
Right Plagiocephaly
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Plagiocephaly effects on facial presentation § Ear to eye distance § Eye opening § Ear symmetry and
alignment § Fatty deposits in
cheeks § Tongue and lip
movement/adhesions
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Plagiocephaly Intervention
§ Ideal time frame of influence 3-5 months § Complete fusion of the
cranial sutures by 12 months
§ Reduce pressure § Change in positioning § By 6 months, ability to sit/
remain upright & slowed intrinsic brain growth
§ Cranial Helmet 9
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Asymmetry in early milestones and reflexes
§ Early asymmetry: think C § In torticollis, the C is tighter on the side of the tilt, and more
shallow on the contralateral side.
§ Questions to ask: § What do you see now? § How will this impact development now? § How will this impact development later?
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§ Rolling: child will learn to roll where they can laterally correct easier – tighter C side coming off the ground.
§ Head will rest in opposite direction due to inability to lift off the ground.
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§ Sitting: will laterally flex towards side of tilt § Residual postural effects into the trunk and UE
§ Delayed UE protective reactions § Early hand dominance § Poor transitions into and out of sitting
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§ Prone: Inability to hold head at midline § Unilateral attention and coordination for advancing
mobility
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Reflexes § ATNR
§ Poor hand to mouth
§ Poor midline § STNR
§ Collapse into prone
§ Poor UE weightbearing
§ Limited hand strength
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Treatment strategies § Passive stretches
§ First choice of intervention
§ Contraindications: § Down Syndrome § Ruptured or lax
ligaments § Shunt § Arnold-Chiari
malformations § Compromised
respiratory or circulatory system
§ Infection
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Treatment strategies § Focus on midline § Activation to opposite
side of tilt § Periods of influence
during bilateral skill development
§ Rolling § Sitting – transitions in
and out § Prone reaching and
pivoting § Progressing whole body -
quadruped
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Case Study: Logan § Full term pregnancy § Frank breech
presentation § Noted in last trimester § Inability to correct
§ Born via c-section
§ Immediate presentation of right torticollis
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§ Started OT and PT immediately § Mom pediatric OT
§ Formally started PT intervention at 1 month 23 days § 2x/wk.
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§ Reduced to 1x/wk. after 6 months
§ Best response to stretching
§ Plagiocephaly resolved § Early removal of
dependent positioning § Parent education
§ Cervical positioning near resolved
§ Residual effects § Early UE and vision
integration § All periods of mobility
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Key Components to consider during plan of care § Parent education § Sensory management/
State control § For therapist AND
parent § Minimizing residual
effects § Preventing the “outgrow” it
idea
§ Extensive, regularly updated HEP
§ Provide handouts § Allow parent to
demonstrate § Allow videos during
treatment § Involve Speech and PT
§ Speech – review for tongue ties, feeding consult
§ PT – gross motor milestones
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Important things to keep in mind § Torticollis and
plagiocephaly will not resolve without intervention
§ Parent and/or therapist § Effects on postural and
facial presentations § Affects early fine and
gross motor development
§ Passive stretching is first line of intervention
§ Residual effects may occur § Never skip crawling! § Encourage midline
§ Always screen for history of torticollis if any asymmetry or coordination deficits present later in development
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References: § Holowka, M. A., Reisner, A., Giavedoni, B., Lombardo, J. R., & Coulter, C. (2017).
Plagiocephaly Severity Scale to Aid in Clinical Treatment Recommendations. Journal of Craniofacial Surgery, 28(3), 717–722. doi: 10.1097/scs.0000000000003520
§ Kaplan, S. L., Coulter, C., & Fetters, L. (2013). Physical Therapy Management of Congenital Muscular Torticollis. Pediatric Physical Therapy, 25(4), 348–394. doi: 10.1097/pep.0b013e3182a778d2
§ Palisano, R. J., Campbell, S. K., & Orlin, M. (2015). Physical Therapy for Children (4th ed.). Elsevier Health Sciences.
§ PLAGIOCEPHALY TREATMENT OVERVIEW. (2019). Retrieved October 10, 2019, from http://hangerclinic.com/pediatrics/pediatric-orthotics/plagiocephaly-services/Pages/default.aspx.
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Frequent asked questions from parents § Do I do anything wrong to cause my child’s torticollis or
plagiocephaly? § How long will this last? Will they outgrow it? § Do I have to get a helmet to fix head shape? § Will insurance cover a helmet? § Do I need still get bring my child to therapy if I get a
helmet? § How long will my child need therapy? § Why does my baby need OT if they have PT? § Why does my baby need PT if they have OT?
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Questions? § Email: [email protected]
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