Congenital muscular torticollis (CMT) is a common postural asymmetry of the neck affecting 3.9% (Aarnivala, Valkama, & Pirttiniemi, 2014; Chen, Chang, Hsieh, Yen, & Chen, 2005) to 16% (Stellwagen, Hubbard, Chambers, & Jones, 2008) of newborns. It results from unilateral shortening of the sternocleidomastoid muscle (SCM) and is typically characterized by ipsilateral cervical lateral flexion and contralateral cervical rotation (Do, 2006). Screening for nonmuscular causes of the asymmetry is essential because the asymmetrical neck posture in up to 18% of infants results from nonmuscular causes, including skeletal, neurological, and visual conditions (Ballock & Song, 1996). It is also important to screen infants for conditions associated with CMT because craniofacial asymmetry is a coexisting impairment in up to 90% of infants with CMT (Cheng, Tang, Chen, Wong, & Wong, 2000). Other associated impairments include developmental dysplasia of the hip (DDH) (Tien, Su, Lin, & Lin, 2001), perinatal brachial plexus palsy (Ballock & Song, 1996), and foot deformities (Cheng et al., 2000).
Early physical therapy intervention for infants with CMT is associated with improved clinical outcomes and shorter episodes of care (Petronic et al., 2010). Petronic and colleagues (2010) found that when physical therapy intervention was initiated before 1 month of age, 99% of infants with CMT achieved excellent clinical outcomes (no head tilt, full passive cervical rotation) with intervention averaging 1.5 months. When initiated between 1 and 6 months, only 62% to 89% of infants with CMT achieved excellent outcomes with intervention averaging 5 to 7 months. When initiated between 6 and 12 months, 19% of infants with CMT achieved excellent outcomes with intervention averaging 8 months (Petronic et al., 2010).
Daily implementation of a comprehensive home program is critical to achieve optimal clinical outcomes. Therefore, parents/caregivers must be educated that they have primary responsibility for the implementation of the daily home program that is necessary to resolve the CMT and that the role of the physical therapist is to guide and advance the home program. Because adherence has been associated with parental perceptions of the effect of CMT on the infant’s current activities and the intervention’s importance for the infant’s future function (Rabino, Peretz, Kastel-Deutch, & Tirosh, 2013), these are important topics for physical therapists to address.
To optimize outcomes and health services for infants with CMT, a clinical practice guideline (CPG) for the physical therapy management of CMT was published in 2013 (Kaplan, Coulter, & Fetters, 2013) and updated in 2018 (Kaplan, Coulter, & Sargent, 2018). The 2018 CMT CPG provides evidence-based recommendations on education for prevention of CMT, referral, screening, examination and evaluation, prognosis, intervention, discontinuation from direct intervention, and reassessment and discharge (Kaplan et al., 2018).
This case study focuses on the physical therapy management of ...