Anna Öhman

Reference Values for Range of Motion and Muscle Function of the Neck in Infants

Purpose: To determine reference values for cervical range of motion (ROM) in rotation and lateral flexion and for muscle function in the lateral neck flexors in a sample of infants who were healthy. Method: ROM was measured, and muscle function was estimated in 38 infants at the ages of 2, 4, 6, and 10 months. Results: For rotation the mean ROM was 110° and for lateral flexion it was 70°. Infants of 2 months of age had a median muscle function score of 1 (interquartile range, 1–2). Muscle function increased to score 3 to 4 by 10 months. Conclusion: Infants below 1 year of age have good ROM in rotation (≥100°) and lateral flexion (≥65°) of the neck. These reference values for passive ROM and muscle function of the neck may have clinical utility in assessing and documenting the initial evaluation and progress of infants with congenital muscular torticollis.

Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants

Recently it has been claimed that infants with congenital muscular torticollis (CMT) are at risk of a delay in early motor milestones. The aim of the present study was to investigate whether infants with CMT are indeed at risk in comparison with a control group of healthy infants. A second aim was to investigate whether the time spent in a prone position and plagiocephaly had any influence on motor development. Eighty‐two infants with CMT (35 females and 47 males) were compared with 40 healthy infants (18 females and 22 males). Motor development was assessed with the Alberta Infant Motor scale (AIMS). Multiple regression showed that infants in the CMT group had a significantly lower AIMS score than the control group at 2 months (p=0.03) and 6 months of age (p=0.05). Infants who spent at least three occasions daily in a prone position when awake had significantly higher AIMS scores than infants who spent less time prone at 2 months (p=0.001), 6 months (p<0.001), and 10 months of age (p<0.001). The CMT group achieved early motor milestones significantly later than the control group until the age of 10 months, but the risk of delay seems to be more strongly associated with little or no time prone when awake than with CMT.

Validity and reliability of the muscle function scale, aimed to assess the lateral flexors of the neck in infants

Infants with congenital muscular torticollis (CMT) often have an imbalance in muscle function in the lateral flexors of the neck, and the need for a valid and reliable assessment tool to determine muscle function in these muscles is essential. The lateral uprighting response is used to examine and to strengthen the sternocleidomastoid muscle. A Muscle Function Scale (MFS) has been refined and used for several years in a clinic for infants with CMT. The MFS describes an infants muscle function in the lateral flexors of the neck through ordered categorical scores. The aim of this study was to find out if the muscle function scale (MFS) is valid and reliable. A panel of experts examined validity, and the kappa statistic and intraclass correlation coefficient were calculated for interrater and intrarater reliability. The MFS is found to be a valid tool to measure the muscle function of the lateral flexors of the neck in infants with CMT. The interrater and intrarater reliability is high for both novice and experienced physiotherapists (kappa>0.9; ICC>0.9).

Stretching treatment for infants with congenital muscular torticollis: physiotherapist or parents? A randomized pilot study.

To investigate the time needed to achieve a good result in the range of motion (ROM) in the neck for infants with congenital muscular torticollis (CMT).

Evaluation of treatment strategies for muscle function in infants with congenital muscular torticollis

This study focuses on the treatment of the muscle function imbalance and asymmetric head posture for infants with congenital muscular torticollis (CMT). The aim of this study was to compare treatment time for groups with different strategies for muscle function training. The treatment goal was to achieve a symmetric head posture. Thirty-seven infants were randomised to three groups. Group I was treated only with handling strategies. Group II got the same handling strategies but also received specific strength exercises. Group III received the same treatment as group II but was also provided with weekly training by a physiotherapist. Mean age at the start of treatment was 4.5 months of age, range 1–10.5. The possible effect of covariates was also investigated; age at the start of treatment, range of motion (ROM) in rotation of the neck, ROM in lateral flexion of the neck, the muscle function scale (MFS) score, plagiocephaly, and gender were analysed with ANCOVA. Thirty-one treated infants achieved symmetric head posture before the age of 12 months. Mean treatment time (3.5 month) did not differ significantly between the groups. All infants randomised to group I could stay in that group. The MFS score and age at the start of the treatment influenced treatment time (p < 0.05). The treatment time for all groups was similar. Early referral to physical therapy of infants with CMT and muscle function imbalance in lateral righting could shorten treatment time. Studies about natural course and long-term effects of muscular imbalance must be investigated in future research.

Pain, balance, activity, and participation in children with hypermobility syndrome.

Purpose: To describe hypermobility, balance, pain, activity, and participation in children with hypermobility and compare these characteristics with those of a control group. Method: Twenty children aged 8 to 16 years with hypermobility syndrome (HMS) or Ehlers-Danlos syndrome and a control group of 24 children of the same age participated in the study. Hypermobility was assessed according to the Del Mar scale, balance was assessed with the Bruininks-Oseretsky test of motor proficiency, and participation in daily life activities was assessed with the frequency of participation questionnaire. Pain and physical activity were assessed in a diary. Results: In comparison with the control group, the children with hypermobility had significantly more hypermobile joints and more pain and scored lower in the balance test, and their activity was affected on a daily basis. Conclusion: Pain appears to affect activity and participation in children with HMS. Balance is decreased in children with HMS compared with healthy controls.

The inter-rater and intra-rater reliability of a modified "severity scale for assessment of plagiocephaly" among physical therapists

Infants with congenital muscular torticollis (CMT) are at risk of developing skull asymmetry. The aim of this study was to investigate the inter-rater and intra-rater reliability of a modified “severity scale for assessment of plagiocephaly” among physical therapists (PT). Thirty-nine members of a network of PTs working with infants with CMT participated in the study. Photos of infants were used in this study. They were taken from above (superior view) to estimate posterior flattening and forehead asymmetry, and from the front (anterior view) to estimate neck involvement and facial asymmetry. The photos were coded and sent to the PTs together with instructions and a protocol for estimation. A second estimate was carried out with the same photos in a different order. The PTs also answered questions concerning their experience of CMT and the scale used. The participants had worked as PTs for an average of 20 years, and with CMT for an average of 7 years. The inter-rater reliability kappa was 0.71, and the intra-rater reliability was mean 0.68. Intra-rater reliability was significantly higher for years of experience and for years working with CMT. There was no significant impact on reliability in relation to how many infants the PTs usually examine yearly, whether they found the scale easy to use, or how much experience they had using it. In conclusion, the modified “severity scale for assessment of plagiocephaly” has satisfying statistical agreement. Reliability is affected by the number of years of experience of the PTs.

Children Who Had Congenital Torticollis as Infants Are Not at Higher Risk for a Delay in Motor Development at Preschool Age

To investigate whether congenital muscular torticollis (CMT) or the time in a prone position as an infant had any influence on motor development at preschool age.

Functional and cosmetic status after surgery in congenital muscular torticollis

The aim of this study was to assess status after surgery for congenital muscular torticollis. Twenty-eight children were evaluated once and the scoring system used included functional and cosmetic results. Neck movement, muscle strength and endurance were compared with the uninvolved side. Head tilt, elevation of the shoulder, craniofacial asymmetry, and lateral band and operative scar were evaluated by clinical observations and photographs. Limited range of motion was significant in both rotation (p=0.027) and side flexion (p=0.005) on the operated side. Most children achieved an overall excellent or good result after surgery but a tendency for head tilt and some degree of facial asymmetry were common.

The Immediate Effect of Kinesiology Taping on Muscular Imbalance in the Lateral Flexors of the Neck in Infants: A Randomized Masked Study

To investigate the immediate effect of kinesiology taping (KT) on muscular imbalance in the lateral flexors of the neck.