Ciencia

Original Research

Stretching Treatment for Infants With Congenital Muscular Torticollis: Physiotherapist or Parents? A Randomized Pilot Study
Anna Öhman, PT, PhD, Staffan Nilsson, PhD, Eva Beckung, PT, PhD
Objective: To investigate the time needed to achieve a good result in the range of motion (ROM) in the neck for infants with congenital muscular torticollis (CMT). Design: Comparison ofstretching treatments performed by physical therapists and parents. Participants: Twenty infants (10 female and 10 male) with CMT. Method: The infants were randomly assigned to 1 of 2 groups. Stretching treatment was continued until a good ROM was obtained in both rotation ( 90°) and lateral flexion (no side difference). The main outcome measurement was treatment time. The infants were evaluated forROM in rotation and lateral flexion, muscle function in the lateral flexor muscles of the neck, plagiocephaly, and head tilt. Results: The time needed to achieve a good result according to the ROM in the neck was significantly shorter (P .001) in the physical therapist group than in the parent group. Symmetrical head posture was achieved sooner (P .03) in the physical therapist group. Conclusion:Infants with CMT gained good ROM and symmetric head posture approximately 2 months sooner when treated by an experienced physical therapist; however, interpretation of the results of this small study should be guarded. Further studies are needed to confirm these results. PM R 2010;2:1073-1079

INTRODUCTION
Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletalanomaly in infants next to congenital hip dysplasia and clubfoot. The reported incidence is 0.4% to 2.0% [1]. CMT is a result of shortening or contracture of the sternocleidomastoid muscle (SCM); the infant holds his or her head tilted to one side and rotated to the opposite side [2-4]. Often range of motion (ROM) in both rotation and lateral flexion is limited, and there is also an imbalance ofmuscle function around the neck. It has been found that lateral head righting on the contralateral side is weakened compared with the affected side [5,6]. At 1 to 4 weeks after birth, a sternomastoid tumor (SMT) may be found, which consists of fibrous tissue and normally disappears in a few months [2,3,7]. The birth history of children with CMT demonstrates an unusually high incidence of difficultiesduring labor. For instance, breech delivery is common [4,8-10]. First-born children are predominant among infants with CMT [9-11]. A high rate of hip dysplasia in coexistence with CMT is reported [4,12,13]. An increased risk of developmental plagiocephaly is also found among infants with CMT [9-11,14-17]. The primary goal of physiotherapy treatment for infants with CMT is to prevent facial and skulldeformities, limitation in neck movement, muscular imbalance, and postural changes [5,18]. Treatment includes stretching of the affected SCM muscle, active positioning, handling to stimulate symmetry, and strengthening exercises for the opposite SCM muscle [5]. Physiotherapy treatment achieves a good-to-excellent result in approximately 90% of children, but a few will require surgery to increaseROM [1,5,9,19]. In U.S. and European countries, articles report that parents perform the treatment after an examination and evaluation is performed by a physical therapist (PT) and home program instructions are
PM&R
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A.Ö. Department of Physiotherapy, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital/Östra, SE-416 85 Gothenburg,Sweden.Address correspondence to: A.Ö.; email: anna.ohman@vgregion.se Disclosure: nothing to disclose S.N. Department of Mathematic Statistics, Chalmers University of Technology, Gothenburg, Sweden Disclosure: nothing to disclose E.B. Department of Physiotherapy, SU/Mölndal, Sahlgrenska University Hospital, Gothenburg, Sweden Disclosure: nothing to disclose Disclosure Key can be found on the Table of...