Question
The best intervention for torticollis starts as soon as possible. How do you alter your plan of care when you have a child who is a toddler with torticollis and cranial deformations as well as motor delay?
Answer
The toddlers are going to be so much harder to work with as far as the stretching programs would go. Evidence has also shown that the intervention is going take a lot longer to get good results. First of all, motor delays are certainly an easier target. We can deal with that through play and through the child's natural environments. For a toddler with torticollis, I definitely recommend using the tot collar. Kids can usually do a lot of their regular natural activities while getting that noxious stimulus to the tight muscles.
As far as cranial deformations, there is a point where you can no longer expect any improvement with any type of helmet device. I do not know what the exact cut off is, but as the sutures in the skull begin to close and the bones begin to be more ossified, there is probably very little chance. There are some children who actually get surgeries if they are seen too late.
The plan of care in the older child is going to be focused more on active stretches with a move away from manual and passive stretching. I am a very big advocate for a focus on active exercises, because you are going to have the added benefit of reciprocal inhibition. Design all of your activities to use the opposite muscles and see if you can get the movement that you need within the natural environment.
