Experiences of Parents of Infants Diagnosed With Mild or Severe Grades of Congenital Muscular Torticollis.

PURPOSE: The primary purpose of this study was to describe the experiences of parents of infants diagnosed with congenital muscular torticollis (CMT). A secondary purpose was to compare the experiences of parents of infants with mild grades versus severe grades of involvement based on the CMT severity classification system. METHODS: Through semistructured interviews, a qualitative phenomenological approach of inquiry was used to investigate the lived experiences of 12 parents. RESULTS: Eight themes common to both groups of parents were identified. Findings indicated having an infant with CMT has a significant effect on the parents and other caregivers. Two themes were unique to parents of the infants with severe CMT. CONCLUSIONS: Parents are faced with a diagnosis that requires regular therapy visits and a challenging home program. A multimodal approach by clinicians for teaching and supporting parents during the episode of care may best address their unique challenges and stresses.

Interrater and Intrarater Reliability of the Congenital Muscular Torticollis Severity Classification System.

PURPOSE: To establish inter- and intrarater reliability for determining severity grades of the congenital muscular torticollis severity classification system (CMT-SCS). METHODS: A prospective reliability study with 145 physical therapists recorded severity ratings on 24 randomly-ordered patient cases including age of infant, cervical range of motion, and presence or absence of sternocleidomastoid mass. To compute intrarater reliability, cases were randomly reordered and graded by 82 of the original raters. RESULTS: For the CMT-SCS, overall reliability was good with an interrater reliability intraclass correlation coefficient (ICC) (2,1) of 0.83 (95% confidence interval [CI], 0.74-0.91) and an intrarater reliability ICC (3,1) of 0.81 (95% CI, 0.66-0.91). CONCLUSIONS: The CMT-SCS has good reliability for infants up to 12 months of age. Physical therapists can use the scale for initial assessment of infants suspected to have CMT. The CMT-SCS should be standard documentation for infants with CMT.

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.

[Evaluation of changes in the mode of twin deliveries over the years]. / Ocena zmian w sposobie prowadzenia porodu ciaz blizniaczych na przelomie lat.

AIM: The aim of the study was to evaluate changes in the course of twin deliveries over the years, with particular emphasis on the history of infertility duration of pregnancy mode of delivery indications for caesarean section (CS) and infant condition. MATERIAL AND METHODS: The study consisted of three groups of patients who delivered twins at the First Department of Obstetrics & Gynecology Medical University of Warsaw: 92 women in years 1987-1991 (G1), 62 in years 1997-2001 (G2) and 126 in years 2007-2010 (G3). The history of infertility treatment (especially in vitro fertilization), mode of delivery indications for cesarean section and newborn condition were taken into account. The results were afterwards compared among the groups and the differences were analyzed with the use of Statistica 10.0 software, with p value <0.05 considered as significant. RESULTS: The rate of twin deliveries in G1 was 1.03% of all deliveries, 1.09% in G2 and 1.77% in G3 (p=0.049 G3 vs. G1). An increase of twin deliveries among primiparas (from 44.5% in G1 through 48.3% in G2 to 66.7% in G3; p=0.0016) and primiparas after in vitro fertilization (from 9.76% in G1 through 26.67% in G2 to 58% in G3; p<0.001) was noted. The average age of patients and mean duration of pregnancies were similar in G1, G2 and G3. However there was a significant increase in preterm delivery rate in G2 and G3 in comparison to G1 (G1 - 38.4%; G2 - 63.3%; G3 - 64.3%; G1 vs G2 and G3 p<0.001). CS was performed in 47.8% vs. 58% vs. 90.5% of all cases (p<0.0001). In G1 CS was most often performed when the presentation of the 1st fetus was non-cephalic (53.3%). In G2 and G3 the non-cephalic presentation of the 1st or 2nd fetus was equally important as an indication for CS (30.5%, 30.5% and 19.3%, 21.9%, respectively). Manual maneuvers on the 2nd twins were applied in 25% vs. 6.5% vs. 0.79% of deliveries (p<0.01). Cesarean section on the second twin, after the first twin was delivered vaginally was performed in 1.07% of the cases in G1, 1.61% in G2 and in 0.79% in G3 (p=ns). There were no differences in the Apgar scores of the first twins in the 1st and 5th minute of life among the studied groups. However, second twins were delivered in significantly better condition in G2 and G3 than in G1 (5-minute Apgar of 8-10 points: 79.7% vs. 93.3% vs. 92.6%; p<0.05). CONCLUSIONS: Twin pregnancy rate almost doubled over the years, mostly due to a growing popularity of the infertility treatment. Cesarean section is increasingly being chosen to deliver twins. The non-cephalic position of the 2nd fetus has become an important indication for cesarean section. Change in the mode of twin deliveries can be beneficial for the condition of the 2nd twin.