by Karen Karmel-Ross
page xiii-xiv
by Daniel R. Cooperman
page 1-11
Torticollis is a term that describes asymmetrical posturing of the head and neck. The majority of children who present with torticollis during the first year of life have congenital muscular torticollis (CMT) secondary to unilateral fibrosis of the sternocleidomastoid muscle. Observation alone leads to residual deformity in up to 20% of these children, but aggressive treatment of CMT improves outcome. One in five children presenting with torticollis have a non-muscular etiology with either soft tissue involvement or bony involvement. Other diagnoses associated with torticollis include benign paroxysmal torticollis, congenital absence of one or more cervical muscles, Klippel-Feil syndrome, hemivertebrae, or other congenital anomalies of the cervical spine. Acquired torticollis may be secondary to trauma, or children can develop torticollis secondary to inflammatory conditions such as pharyngitis. Torticollis is also seen in response to certain ocular lesions as well as in children with symptomatic hiatal hernias. The most dangerous cause of non-muscular acquired torticollis is related to neurologic syndromes, such as syringomyelia, dystonic or post-encephalitic syndromes, herniated cervical discs, and, especially, posterior fossa pathology. In a large series of children with non-muscular torticollis, 10% resulted from neurologic problems, half of which involved tumors. When torticollis is encountered, a search for a diagnosis should begin. After a diagnosis is made, treatment can begin.
by Carolyn Emery
page 13-20
This article provides a review of the literature on the conservative management of congenital muscular torticollis. Variations among studies are found in physiotherapeutic regime, definition of outcomes, and results. All authors, however, report good (mild facial asymmetry, tilt or range restriction) to excellent (full neck range of motion, no facial asymmetry) outcomes for the vast majority of patients who receive conservative management of congenital muscular torticollis. Overall, fewer than about 16% of those treated before one year of age require surgical intervention.
by Karen Karmel-Ross and Michael Lepp
page 21-67
The purpose of this article is to present a systematic approach to the assessment and treatment of children with congenital muscular torticollis. An assessment protocol and form, treatment pathways, and home program exercise sheets are provided in this article.
by Ashwani Rajput and Michael W. L. Gauderer
page 69-80
The majority of children with congenital muscular torticollis are successfully treated with an aggressive physical therapy program. A select group of patients, however, clearly require an operation for a successful outcome. This article takes a historical look at the role of surgery in the management of congenital muscular torticollis and its evolution into today's management principles. By reviewing the literature, we define the subset of children requiring an operation and the ideal timing of the operation. Finally, a brief description of the operative intervention is given.
by Carole Jacques and Karen Karmel-Ross
page 81-90
Standard conservative treatment for infants with congenital muscular torticollis does not consistently resolve lateral head tilt. This paper describes two custom-made neck collars used for this purpose. Indications for use and fabrication, as well as precautions, are discussed. Collars are readily accepted as part of the treatment program and are effective in improving the infant's ability to hold his or her head in midline. In addition, a procedure for splinting following surgery to lengthen the sternocleidomastoid muscle is described.
by Nancy Hylton
page 91-117
This article explores the effect of perinatal injury of the sternocleidomastoid muscle on general postural and movement development in the first year of life. The focus is on infants with no obvious generalized movement problems and no observable on-going muscle pathology. Residual, strong torticollis retained past four months of age appears to have a profound effect on internal sensory maps or body image formation, as well as on the midline axial postural stability and patterns of surface loading necessary for movement and balance development. Torticollis also appears to diminish the infant's ability to organize postural responses, especially ventral trunk muscle activation in response to backwards displacement. The article explores these clinical observations and describes one sensorimotor approach to therapeutic intervention for these infants.
by Karen Karmel-Ross
page 119-120
Transcribed by Emma McCulloch
4 September 1997