Treating Torticollis: Looking Beyond the Neck for Better Results – Rosemary Peng

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My name is Rosemary Peng, PT, MST. As a clinician who has worked for more than 20 years in pediatric settings, I’ve seen and treated patients with congenital muscular torticollis (CMT). In the past, I focused too much of my attention on treating the neck only and not checking for other asymmetries that can occur. This resulted in seeing minimal gains. What was I missing? There had to be a better way to treat this population. Finally, I discovered that by including 7 body structures in my examination I could effectively treat my patients by strengthening neck muscles, promoting better head posture, and improving fine and gross motor development of the child.

In this recording, learn and practice evidence-based tools found in the updated 2018 Clinical Practice Guidelines which I use to accurately assess and treat infants. You’ll enhance your skills by learning proven treatment techniques as well as alternative approaches that don’t make your patient feel discomfort and results in better outcomes. Ease the fear of parents or caregivers with clear goals and education. Walk away feeling confident and comfortable using these proven strategies that immediately carry over into your clinical setting.

1. Evaluate types and causes of infant torticollis and positional skull deformities.
2. Demonstrate evidenced-based examination and treatment strategies for infants with CMT.
3. List seven red flags that may warrant referral to a physician.
4. Develop a plan of care using five components of first-choice interventions based on the Clinical Practice Guidelines (CPG).
5. Examine emerging interventions that have not yet established efficacy.
6. Create evidenced-based discharge planning, caregiver education, and recommendations for follow-up care.

TORTICOLLIS AND POSITIONAL SKULL DEFORMITIES – WHEN TO TREAT OR REFER

• Three types: Brachycephaly, plagiocephaly, scaphocephaly
• Craniosynostosis
• When and how to treat it
• When is it time for consultation with neurosurgery

HOW TO PROPERLY ASSESS A CHILD WITH CMT

• Posture
• Cervical range of motion: active and passive
• Muscle function scale for Infants
• Thoracic and lumbar spine
• Muscle flexibility of extremities
• Screen for developmental hip dysplasia
• Skin, facial, and skull asymmetries
• Visual motor skills: tracking, presence of nystagmus, midline control
• Classification of level of severity

EXAM LAB

HOW TO BEST TREAT CMT – LOOKING BEYOND THE NECK

• Cervical PROM
• Addressing other asymmetries below the neck
• Positioning
• Incorporate play into treatment
• Strengthening
• Addressing vision
• Why and how we address fine and gross motor skills
• Tummy time challenges
• Adapting the environment
• Caregiver education

INTERVENTION LAB

OTHER THERAPEUTIC APPROACHES FOR CMT

• Microcurrent
• Myokinetic stretching
• Kinesiological taping
• TAMO approach
• TOT and other collars
• Botox
• Surgery

EMERGING INTERVENTIONS WITHOUT EVIDENCE OF EFFICACY

• Manual therapy/cervical manipulation
• Craniosacral therapy
• Soft tissue massage
• Feldenkrais
• Total Motion Release

WHEN TO REFER FOR CONSULTATION

• 7 Red flags that indicate the need for referral to MDs

HOW TO IMPROVE YOUR GOAL WRITING

• Symmetrical movement
• Motor development
• Parent/caregiver understanding

DISCHARGE PLANNING AND FOLLOW-UP RECOMMENDATIONS

• Criteria for discharge
• Parent/caregiver understanding
• Follow-up screening recommendations

CASE EXAMPLES