Physical Therapy Management ofCongenital Muscular Torticollis
I. EDUCATION, IDENTIFICATION AND REFERRAL OF INFANTS WITH CONGENITAL MUSCULAR TORTICOLLIS (CMT)
1: EDUCATE EXPECTANT PARENTS AND PARENTS OF NEWBORNS TO PREVENT ASYMMETRIES/CMT
2: ASSESS NEWBORN INFANTS FOR ASYMMETRIES/CMT
3: REFER INFANTS WITH ASYMMETRIES/CMT TO PHYSICIAN AND PHYSICAL THERAPIST
II. PHYSICAL THERAPY EXAMINATION AND EVALUATION OF INFANTS WITH ASYMMETRIES/CMT
4: DOCUMENT INFANT HISTORY
5: SCREEN INFANTS FOR NON-MUSCULAR CAUSES OF ASYMMETRY AND CONDITIONS ASSOCIATED WITH CMT
6: REFER INFANTS FROM PHYSICAL THERAPISTS TO PHYSICIANS IF INDICATED BY SCREEN
7: REQUEST IMAGES AND REPORTS
8: EXAMINE BODY STRUCTURES
- Infant posture and tolerance to positioning in supine, prone, sitting and standing for body symmetry, with or without support, as appropriate for age.
- Bilateral passive range of motion (PROM) into cervical rotation and lateral flexion.
- Bilateral active range of motion (AROM) into cervical rotation and lateral flexion.
- PROM and AROM of the trunk and upper and lower extremities, inclusive of screening for possible developmental dysplasia of the hip (DDH).
- Pain or discomfort at rest, and during passive and active movement.
- Skin integrity, symmetry of neck and hip skin folds, presence and location of a SCM mass, and size, shape & elasticity of the SCM muscle and secondary muscles.
- Craniofacial asymmetries and head/skull shape.
9: CLASSIFY THE LEVEL OF SEVERITY
10: EXAMINE ACTIVITY AND DEVELOPMENTAL STATUS
11: EXAMINE PARTICIPATION STATUS
- Positioning when awake and asleep.
- Infant time spent in the prone position.
- Whether the parent is alternating sides when breast or bottle feeding the infant.
- Infant time spent in equipment/positioning devices, such as strollers, car seats or swings.
12: DETERMINE PROGNOSIS
III. PHYSICAL THERAPY INTERVENTION FOR INFANTS WITH CMT
13: PROVIDE THESE FIVE COMPONENTS AS THE FIRST CHOICE INTERVENTION
- Neck PROM.
- Neck and trunk AROM.
- Development of symmetrical movement.
- Parent/caregiver education.
- Environmental adaptations.
14: PROVIDE SUPPLEMENTAL INTERVENTION(S), AFTER APPRAISING APPROPRIATENESS FOR THE INFANT, TO AUGMENT THE FIRST-CHOICE INTERVENTION
15: INITIATE CONSULTATION WHEN THE INFANT IS NOT PROGRESSING AS ANTICIPATED
IV. PHYSICAL THERAPY DISCONTINUATION, REASSESSMENT, AND DISCHARGE OF INFANTS WITH CMT
16: DISCONTINUE DIRECT SERVICES WHEN THESE 5 CRITERIA ARE ACHIEVED
17: REASSESS INFANTS 3-12 MONTHS AFTER DISCONTINUATION OF DIRECT SERVICES AND THEN DISCHARGE IF APPROPRIATE
Physical Therapy Management of Congenital Muscular Torticollis
October 1, 2018
External Publication Status
Country of Publication
Informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat.
Adolescent, Child, Infant
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant
Assessment and screening, Rehabilitation, Management, Treatment
D014103 - Torticollis
Congenital Muscular Torticollis, Pediatric Torticollis
Kaplan, Sandra L. PT, DPT, PhD; Coulter, Colleen PT, DPT, PhD, PCS; Sargent, Barbara PT, PhD, PCS Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy, Pediatric Physical Therapy: October 2018 - Volume 30 - Issue 4 - p 240-290 doi: 10.1097/PEP.0000000000000544