Postsurgical Physical Therapy Management of Congenital Muscular Torticollis.

PURPOSE: To present 2 cases with severe congenital muscular torticollis and describe postsurgical physical therapy management. DESCRIPTION: Two children diagnosed with severe congenital muscular torticollis underwent surgical release of the involved sternocleidomastoid muscle with subsequent physical therapy. Presurgical examination findings, surgical technique, and postsurgical rehabilitation guidelines are described. RESULTS: Both cases achieved full range of motion and symmetrical muscle strength. Functionally, they were able to maintain consistent midline posture, perform transitions with symmetrical head righting, and demonstrate age-appropriate motor skills. CLINICAL IMPLICATIONS: Children with surgical management of congenital muscular torticollis tend to have more severe involvement of the sternocleidomastoid. Prolonged experience in atypical postures may result in potential asymmetrical development of visual, vestibular, and proprioceptive systems. Perception of midline was reestablished through integration of visual, vestibular, and proprioceptive stimuli. VIDEO ABSTRACT: For more insights from the authors, access Supplemental Digital Content 1, at http://links.lww.com/PPT/A141.

Considerations and intervention in congenital muscular torticollis.

PURPOSE OF REVIEW: To present the current literature regarding congenital muscular torticollis (CMT) to promote the most effective and evidence-based intervention. CMT is a musculoskeletal deformity observed at birth or in infancy, characterized by persistent head tilt toward the ipsilateral side with the chin rotated toward the contralateral side. The incidence of torticollis is on the rise and as a result there has been a surge in the literature on the topic, however, until recently, there was little consensus on the treatment approach. RECENT FINDINGS: Research on CMT has gone in several directions. One branch is looking at diagnostics, imaging, and attempting to understand the underlying disease behind torticollis, down to the cellular level. This information may be helpful in the other, more clinical research vein to determine prognosis, establish plan of care, and create guidelines for the treatment of infants with torticollis. SUMMARY: CMT presents as a muscular imbalance. We know from the pediatric and adult literature, whether it is about cerebral palsy or anterior cruciate ligament reconstruction, that muscle imbalances can lead to skeletal changes, postural dysfunction, and impaired movement patterns. These can lead to functional limitations and limitations in participation. CMT, therefore, needs to be addressed. Although this article presents the current evidence and guidelines for treatment, there is still much to be learned regarding disease, optimal intervention, duration of treatment, and timing of follow-up. VIDEO ABSTRACT: http://links.lww.com/MOP/A24.

Retrospective case study of team approach to omphalocele orthosis fabrication and implementation.

PURPOSE: The purpose of this case report is to describe an interdisciplinary approach to orthotic intervention in a neonate with giant omphalocele. SUMMARY OF KEY POINTS: An infant with a giant omphalocele was presented to the Neonatal Intensive Care Unit (NICU) for management. An interdisciplinary team including a neonatal surgeon, physical therapists, orthotist, and family collaborated to determine appropriate orthotic intervention. A custom stabilizing orthosis and prone positioning device were fabricated and fit to the infant. The omphalocele was secure and the family felt confident that the omphalocele was protected during physical interaction. SUMMARY AND RECOMMENDATIONS FOR CLINICAL PRACTICE: In this case, a custom orthosis was shown to be a valuable tool to provide external support for a giant omphalocele and facilitate safe interaction between infant and family. An interdisciplinary approach is recommended to best accommodate the patient's needs.