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Pediatrics > Torticollis and Plagiocephaly > Flashcards

Torticollis and Plagiocephaly Flashcards

1
Q

What were some of the consequences of the “back to sleep” program?

A
  1. Decrease in sudden infant death syndrome
  2. Missed “tummy to play” time
  3. Weak arm, neck, shoulder and trunk muscles
  4. Delays in developmental milestones
    - baby containers exacerbate problems
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2
Q

an idiopathic postural deformity of the neck evident at birth or shortly therafter

A

congenital muscular torticollis

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3
Q

What are the characteristics of torticollis?

A
  1. Ipsilateral Head Tilt
  2. Contralateral Cervical Rotation
    - Secondary to unilateral shortening of the SCM
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4
Q

What are the comorbid conditions associated with torticollis?

A
  1. Cranial Deformation (typically Plagiocephaly)
  2. Hip Dysplasia
  3. Brachial Plexus Injury
  4. Distal Extremity Deformation
  5. Early Developmental Delay
  6. Persistent Developmental Delay
  7. Facial Asymmetry that may affect cosmesis
  8. Temporal-mandibular joint dysfunction
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5
Q

What are the risk factors for torticollis?

A
  1. Large birth weight*
  2. Breech presentation
  3. Use of forceps at delivery
  4. Asymmetrical head or face (22 fold increase)
  5. 1st pregnancy (6 fold increase)
  6. Birth trauma (4 fold increase)
  7. Birth length (2 fold increase)
    - CPG suggests presence of 2+ of these factors (those italicized) warrants referral for preventative care and parent education
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6
Q

When a child presents with torticollis, what systems should you screen for?

A
  1. Musculoskeletal: Symmetry, screen for cervical vertebrae anomaly, rib cage symmetry, hip dysplasia
  2. Neurological: Tone, Reflexes, Cranial Nerve Integrity, Brachial Plexus Injury, Temperament, Milestones
  3. Integumentary: Abnormal skin folds at the hips (indicative of developmental hip dysplasia), color and condition of skin, signs of trauma that may cause asymmetric posture
  4. Cardiopulmonary: Symmetrical coloration, rib cage expansion, clavicle movement to rule out Brachial Plexus Injury
  5. Vision: Screen Tracking, check for nystagmus
  6. Gastrointestinal: History of reflux or constipation, preferential feeding from one breast
  7. Positional preference
  8. Structure and movement symmetry of the neck, face, head, spine, trunk, hips, upper and lower extremities
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7
Q

What are red flags that require referral?

A
  1. Hip dysplasia
  2. Skull and/or facial asymmetry, including plagiocephaly & brachycephaly
  3. Atypical presentation
    - Lateral flexion and rotation to the same side – not consistent with torticollis
    - Plagiocephaly and tilt to the same side – indicative of ^^
  4. Abnormal tone
  5. Late-onset torticollis (>6 months) – with no hx, concerning
  6. Visual abnormalities -Nystagmus, strabismus, abnormal visual tracking, gaze aversion
  7. History of acute onset
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8
Q

What are the markers for measuring rotation ROM?

A
  1. Nipple = 40 degrees
  2. Between nipple and shoulder = 70
  3. Shoulder = 90 degrees
  4. Beyond shoulder = 110 degrees, normal
    - rotation ROM norm = 110
    - lat flex ROM norm = 70
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9
Q

How are the grades for testing the SCM strength graded? (tilting baby to one side, seeing how they hold their head up)

A 
4-very high over horizontal line
3 -high over horizontal line
2-slightly above horizontal line
1-holding on horizontal line
0-below horizontal line
- infant held horizontally >5s
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10
Q

how can you assess torticollis through digital imagery?

A

baby lays supine

  • draw straight line between acromion processes
  • draw line through eyes
  • assess angle between the two, should be 0 for normal
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11
Q

What is present in a Grade 1 level of severity with torticollis?

A
  1. Present from 0-6 months
  2. Postural Preference
  3. Muscle tightness lacking <15 degrees of cervical rotation
    “Early Mild”
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12
Q

What is present in a Grade 2 level of severity with torticollis?

A
  1. Present from 0-6 months
  2. Muscle tightness lacking 15-30 degrees of cervical rotation
    “Early Moderate”
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13
Q

What is present in a Grade 3 level of severity with torticollis?

A
  1. Present from 0-6 months
  2. Muscle tightness indicated by >30 degree loss of cervical rotation ROM
  3. Presence of an SCM Mass
    “Early Severe”
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14
Q

What is present in a Grade 4 level of severity with torticollis?

A
  1. Presentation at 7-9 months
  2. Postural Preference
  3. <15 degree loss of cervical rotation
    “Late Mild”
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15
Q

What is present in a Grade 5 level of severity with torticollis?

A
  1. Present at 10-12 months
  2. Muscle tightness lacking <15 degrees of cervical rotation
    “Late Moderate”
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16
Q

What is present in a Grade 6 level of severity with torticollis?

A
  1. Present from 7-12 months
  2. Muscle tightness lacking >15 degrees of cervical rotation
    “Late Severe”
17
Q

What is present in a Grade 7 level of severity with torticollis?

A
  1. Present after 7 months with SCM mass
  2. Present after 12 months with muscle tightness indicated by >30 degree loss of cervical rotation ROM
    “Late Extreme”
18
Q

What are the recommended tools for assessment of activity and developmental status?f

A
  1. Test of Infant Motor Performance (TIMP)
    - Up to 4 months corrected age
    - Common in NICU, looking for symmetrical movement
  2. Alberta Infant Motor Scales (AIMS)
    - 4-18 months corrected age
    - Symmetrical movement and gross motor development
  • there is increased incidence of persistent developmental delay with CMT, usually resolves around 10 mos but up to 10% do not
19
Q

How long should intervention last when treatment of CMT is initiated at 3 months?

A
  1. 5 - 3 months (6-12 weeks)

- rotation resolves first, then flexion

20
Q

How long should intervention last when treatment of CMT is initiated in children over 3 months?

A

3-6 months

- rotation resolves first, then flexion

21
Q

What is a poor prognostic indicator for CMT?

A

presence of an SCM mass at initial diagnosis

- increased tx time necessary for increased fibrosis within mass

22
Q

What are the alternative options after conservative treatment of CMT has failed?

A
  1. Zplasty (surgery)
  2. Botox - off label usage with black box warnkingl long term studies on effectiveness and safety are warranted
    - only considered if a 6 month bout of PT has failed, or if child is > 12 months at age of referral
23
Q

How should CMT be managed with PT?

A
  1. AROM & PROM to address impairments in body structure and function - Neck, trunk, UE
  2. Promote fine and gross motor development as well as cognition
  3. Positioning for active movement away from the tightness
    - Infants suspected of having a nonmuscular condition causing asymmetry or torticollis posturing should have a full evaluation prior to initiation of PT treatment
24
Q

What are the risk factors for plagiocephaly?

A
  1. premature birth
  2. hypotonic muscle disorders
  3. congenital torticollis
  4. difficult delivery
  5. intrauterine constraint
  6. environmental factors
25
Q

What facial characteristics are seen in plagiocephaly?

A
  1. Asymmetry of the craniofacial skeletal structures
  2. Asymmetry of the masticatory and tongue muscles
  3. Jaw - Contralateral underdevelopment; Deviation of the mandible and gum line toward contralateral side
  4. Ear- Ipsilateral anterior
  5. Eye - Ipsilateral eye forward and forehead larger; Contralateral recessed eyebrow and zygoma (squinty eye)
  6. Nose - Deviation toward contralateral side
26
Q

in the case of plagiocephaly, how often should head measurements be taken?

A

every 4-6 weeks

27
Q

How can you diiferentiate synostotic plagiocephaly from positional head deformity?

A
  1. Palpable ridge suggests synostosis
  2. Ear on flattened side more posterior than the other ear suggests synostosis
  3. Forehead protruding on the side of the flattening suggests PHD
  4. A unilateral bald spot suggests PHD. Physician should palpate occiput for flattening
  5. “Parallelogram-shaped” head suggests PHD
28
Q

Wehn is the optimal time to treat plagiocephaly?

A

0-3 months

- rapid brain growth, skull is still malleable

29
Q

with a 4 mm CVAI, intervention suggested is:

A
  1. Monitoring (measurements)
  2. Early sleep positioning program & awake supervised tummy time
  3. Avoidance of lying (pressure) on flattened areas
30
Q

What is the cranial orthotic treatment length?

A

Length of treatment is 3-5 months and increases up to 5-6 months when patients are 12 months and older
- if CMT present, additional 2-4 weeks needed

Pediatrics (19 decks)

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