Congenital Muscular Torticollis Questions Flashcards
What are the risk factors that might cause CMT to occur?
Breech presentation Multiple births - twins Increased birth wieght Plagiocephaly Trauma at birth intrauterine mal positioning
What are the 3 subtypes of CMT?
Tumor inside the SCM
Muscular torticollis - tightness in the muscle
Postural/ Positional torticollis- secondary to plagiocephaly
What is the common presentation of CMT?
Ipsilateral lateral cervical flexion
Contralateral cervical rotation
What differential diagnoses need to be ruled out with CMT?
Skeletal and Vertebral abnormalities- disc herniation, hemi vertebrae
Neuro- brachial plexus injury, arnold chiari malformation, ocular lesion
What are commonly associated comorbidities with CMT?
- Plagiocephaly
- Reflux
- Developmental dysplasia of the hip-
- Craniofacial asymmetry
What should be examined in a child with CMT?
AROM of c/spine/ UE joints Palpation of the SCM MMT of contralateral SCM - lateral head righting Asymmetries of the trunk and pelvis Integumentary system - esp the skin on the side that is affected Developmental reflexes Motor mile stones Pain
What are the participation restrictions that a baby with CMT has?
- Playing
- Daily routines- feeding , sleeping positioning, prone play
- Participation in family routines
What are common activity limitations?
• Intolerance to certain positions
• Don’t meet as many motor milestones
- Tests and measures to use for those delays
AIMs , PDMS2, Bailey 3
• Difficulty with symmetrical purposeful movements such as playing
• Neglect to the ipsilateral side of the body
• Altered sensory information
What are the most typical impairments in CMT?
Limited cervical ROM -active and passive
Decreased sensation
decreased contractile head righting
muscle imbalance which could lead to scoliosis
ROM and strength of ipsilateral UE
ATNR may persist ipsilaterally
Plagiocephaly
What determines the prognosis of CMT?
The age that the baby received treatment Classification of severity intensity of intervention presence of comorbidities rate of change adherence to HEP
What are the 5 components of intervention for CMT that has the best evidence?
- Neck PROM
- Neck and trunk AROM
- Development of symmetrical movement
- Environmental adaptations
- Parent/caregiver education
When should you refer for additional consultation?
o When the asymmetry is not resolving after 4-6 weeks
o If the infant is older than 7 months
o If the side of torticollis changes- red flag!
When should you discharge the infant from PT?
- When the infant has full passive ROM within 5 degrees of the non-affected side
- Symmetrical active movement patterns throughout the passive range
- Age appropriate motor development
- No visible head tilt
- Parents/caregivers understand what to monitor as the child grows
