Can you walk us through the progression of your plan of care from eval through discharge? What do you look for before moving to the next step?
First of all, we need to look at the impairment level starting with neck range of motion. We want to see how range affects neck posture in all developmentally appropriate positions. If the child is a newborn, you do not want to necessarily evaluate neck posture in the sitting position, but you will want to assess the neck posture in the supine position. As the child begins to achieve other motor milestones, continue evaluating neck posture. Look at the compensatory thoracolumbar curve. See if there are any other types of postural alignment problems. Make an assessment of visual neglect, upper extremity use, and asymmetric movement patterns. Then try to see if there is any altered midline perception. An assessment of visual neglect and visual field is so important, because going back to neurological development, if a child is only learning about what is on the left side of their body or the right side of their body, and not getting the other side, they are going to have problems with bilateral development and symmetrical patterns of movement that are necessary for locomotion.
Make your problem list based on the areas of deficits. Then, develop a treatment plan that would address each one of those. I work on everything at the same time. I cannot really say I am just going to do one thing first and then go to the next. Use your normal developmental charts to see where a child should be and allow that to guide your progression. Determine where their maturation should be taking them. If an aspect of the torticollis is preventing them from getting to that developmental level, then that area is our target. This is how we determine our goals. I know of a little fellow who was delayed, and now he has just turned 2 and is being discharged from the gross motor aspect of his treatment plan because he is at age appropriate level. He caught up as a result of dealing with his torticollis.