Plan Progression when Treating Congenital Muscular Torticollis

Carolyn B. Armstrong, PT, DPT, PCS

November 6, 2013

Share:

Question

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?

 
 

Answer

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.  

 


carolyn b armstrong

Carolyn B. Armstrong, PT, DPT, PCS

Carolyn B. Armstrong, PT, DPT, PCS has practiced pediatric physical therapy in a variety of settings for over 35 years.  She is the owner of Armstrong Physical Therapy, LLC in Colorado providing early intervention physical therapy services, and works in a public school setting providing school-based services to children ages 3-21.  Dr. Armstrong specializes in clients with neurological impairment and has presented continuing education seminars on clinical management of this population.  


Related Courses

Power Wheelchair Assessment: Mobility Training as a Part of the School Day
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Recorded Webinar

Presenter

Michelle Lange, OTR, ABDA, ATP/SMS
Course: #21961 Hour
  'Well organized, clear and concise'   Read Reviews
The average teenager spends 40 supervised driving hours before even taking a motor vehicle test. Mobility training optimizes power wheelchair use for clients of all ages and abilities. This webinar will present a variety of mobility training strategies.

Introduction to Cascade Dafo and Fast Fit Orthoses
Presented by Loretta Sheldon, COA, CFO
Recorded Webinar

Presenter

Loretta Sheldon, COA, CFO
Course: #18092 Hours
  'I use these products frequently in my practice, have seen the results and have observed that they are very effective'   Read Reviews
This distance learning course provides an introduction to Cascade Dafo and an overview of the philosophy behind dynamic lower extremity bracing for pediatric patients. The course also discussed Cascade Dafo's prefabricated Fast Fit orthotic solutions and examines which common pediatric gait deviations can be addressed with Fast Fit products.

Series: The Pediatric Hand
Presented by Valeri Calhoun, MS, OTR/L, CHT
Recorded Webinar

Presenter

Valeri Calhoun, MS, OTR/L, CHT
Course: #33712 Hours
  'Very well presented all around, style, organization, content, clinical examples'   Read Reviews
Part I: This course will outline the evaluation and treatment principles for the pediatric orthopedic hand patient, including the traumatic hand injured patient, and how it differs from the adult hand population. This course will provide specific evaluation techniques along with treatment ideas. Part II: This presentation will build on the foundational information provided in Part I. It provides the learner with specific information on the evaluation and treatment of the congenital hand patient and the unique challenges this brings to clinicians. Explore functional issues unique to this population and interventions that may assist in improving their abilities.

Please note: This course series is comprised of the following individual recordings: #2533 and #2599.

This course is part of the “Hand and Upper Extremity Review Series.”

Promising Apps, Preventing Mishaps, and More: Technology in Pediatric Therapy
Presented by Amy M. Schlessman, PT, DPT, DHS
Recorded Webinar

Presenter

Amy M. Schlessman, PT, DPT, DHS
Course: #23762 Hours
  'There is much to consider about managing records'   Read Reviews
It is essential that OT/OTAs and PT/PTAs are seeking the knowledge of current laws and considering patient protection with electronic documentation. In a world where technological advances are rapidly occurring, it is essential that OT/OTAs and PT/PTAs stay abreast of the latest research regarding implementing technology into clinical practice.

Aquatic Therapy for Those With Spinal Cord Injuries
Presented by Rachel Mertins, PT, DPT
Recorded Webinar

Presenter

Rachel Mertins, PT, DPT
Course: #23602 Hours
  'Very Informative and Evidence Based!'   Read Reviews
The purpose of this course is to provide an overview of aquatic therapy and how it can be applied specifically to those suffering from spinal cord injuries (SCI). Physical therapists and physical therapy assistants will be exposed to indications, contraindications and precautions for aquatics with this population, in addition to various treatment options and current research for best practice. This course is directly related to practice of physical therapy and athletic training and is therefore appropriate for the Physical Therapist, Physical Therapist Assistant and Athletic Trainer.