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Paper- Congenital Muscular Torticollis PT

Paper- Congenital Muscular Torticollis PT

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Published by Daniel Obradovich
Congenital muscular torticollis, physical therapy
Congenital muscular torticollis, physical therapy

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Published by: Daniel Obradovich on Oct 03, 2010
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³What is the optimal
evidence based  physical therapy intervention
for aninfant who is experiencing CongenitalMuscular Torticollis (CMT)?´
Research Project: 
 Daniel Obradovich, SPT University of North Florida
October 2
 What is the optimal evidence based physical therapy intervention for an infant experiencingcongenital muscular torticollis (CMT). To answer this clinical question several online databaseswere used: PubMed, Physical Therapy Journal, Medline, CINAHL, and ProQuest. Thefollowing are the search terms that were used to find high quality peer reviewed articles for theclinical question: Congenital Muscular Torticollis, Torticollis, clinical practice guidelines, and physical therapy.Petronic et al. (2010) conducted a retrospective study to evaluate the proportion of rightversus left sided pediatric clients with Congenital Muscular Torticollis (CMT) in both gendersand different age groups. They also wanted to investigate the duration of physical therapy andtreatment outcomes in defined age groups and genders. The article was a grade B (level 3b) typeof evidence. There were a total of 980 children with clinically diagnosed CMT that wereincluded in the retrospective study. The children were from Serbia, Bosnia, Herzegonia, andMontenegro. I was not able to find what statistical analysis was used to analyze the data becausethere was a page missing from the article. The page was missing probably due to copyright lawsor an error with the upload of the article, which was a major limitation of the study. The resultsfrom the unknown analysis revealed that right CMT is frequent but not significant in bothgenders and different age groups. There was no significant difference with CMT betweengenders. Younger pediatric clients especially younger than one month have lower treatmentdurations and have better outcomes. Infants with CMT who are not diagnosed until 6 monthsrequire more time with treatment and have poor outcomes. The authors highly recommend earlydiagnosis within the first three months of life and start physical therapy treatment (protocol of stretching & active positioning stimulation) as early as possible.Cheng et al. (2001) designed a longitudinal prospective study to investigate the effect of astandardized manual stretching program on pediatric clients with Congenital Muscular Torticollis (CMT). They also evaluated the factors that predict the outcome of treatment. Theauthors advised the importance of classifying the pediatric clients with CMT into three groups.
irst, the sternomastoid tumor group has a palpable mass on the sternocleidomastoid muscle.Second, the muscular torticollis group has only sternocleidomastoid muscle (SCM) tightnesswithout a palpable tumor. Third, the postural torticollis group has no palpable tumor or (SCM)muscle tightness. This article was a grade B (level 3b) type of evidence. There were a total of 821 children within the clinically diagnosed torticollis groups that were included in thelongitudinal prospective study from 1985 to 1997. Statistical analysis was conducted on SPSSusing univariate and multivariate data. The results from the analysis shows good evidence thatcontrolled manual stretching is safe and effective in about 95% of pediatric clients with CMTthat are seen before the first year of life. The results reveal that the most important factors of  predicting the outcome of the manual stretch treatment are the torticollis clinical diagnosiscategory group (sternomastoid tumor= fair/poor outcome), initial cervical rotation deficit (>15deg from neutral= fair/poor outcome), and age at initial treatment (>1 year = fair/poor outcome). Surgical intervention is indicated when manual stretch treatment has gone past sixmonths with no improvement, and the infant continues with deficits.Carolyn Emery (1997) conducted a literature review on conservative management of Congenital Muscular Torticollis (CMT). The literature review was a grade B (level 3a) type of evidence that included only studies that systematically documented their outcomes from theconservative CMT treatments used. No statistical analysis was mentioned in the article, whichwas a major limitation of the literature review. The conclusion of the review stated that fewer than 16% of infants with CMT treated conservatively before one year of age will require surgery.The conclusion also stated that typical treatment duration to produce full neck mobility rangedfrom 3 to 12 months.Ohman et al. (2009) designed a study to investigate whether infants with CMT are at risk of adelay in early motor milestones in comparison with healthy infants. The authors also wanted toinvestigate whether the time spent in the prone position or the presence of plagiocephaly had anyinfluence on motor development. This article was a grade B level (2b) type of evidence. Motor development was assessed with the Alberta Infant Motor Scale (AIMS). There were a total of 122 infants aged 2 to 18 months included in the study; 82 infants with CMT & 40 healthyinfants. Statistical Analysis was conducted on SPSS using analysis of the covariance. Results

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