Congenital torticollis: Rehabilitative treatment un children
For the rehabilitative treatment it is important a correct adaptation, orientation and psychological support. It is necessary to work with the family so that they can learn more about the child's condition and its management, the importance of the treatment, the benefits and the negative consequences of interrupting or not doing it.
The Physiatrist and the rest of the personnel in charge will explain to the family members a series of aspects regarding the child's postures, since the family should actively contribute with the treatment to achieve better results, because they are the ones who spend the most time with the child.
In this aspect should be avoided:
Prone decubitus (face down position) should be avoided for sleeping because of the risk of sudden infant death syndrome (SIDS) and because it favors facial deformities mainly.
When he/she is awake, he/she should preferably lie in the supine position (face up) and a pillow or cushion should be placed under the head on the side of the contracture to elevate the head. In this position, perform all stimuli (toys, colors, sounds) on the same side of the lesion.
Regularly change the position of the child avoiding incorrect and vicious postures (positions) that worsen torticollis.
In the crib, the child should receive stimuli (both light from the window or sounds through the door) always in the direction of the correction of the deformity (on the side of the affected ECM muscle).
Encourage the child to actively move the neck through play, talk to the child and show him/her toys on the side of the lesion in the corrective direction with the aim of increasing neck rotation.
Apply skin stimuli around the mouth on the side of the lesion to encourage the child to look toward the stimulus site and rotate the neck in that direction.
When carrying the child in your arms, place the child with the head turned in the opposite direction to the deformity and try to hold the child with your chin.
To feed the baby, the bottle or breast should be offered in a way that makes him/her turn his/her head to the opposite side to the one he/she usually does. When breastfeeding on the homolateral side (same side), the mother should bring the nipple forward so that the nipple seeks correction.
You can lay the baby face down on your lap so that his head and gaze are directed away from you; then talk, sing or get his attention by encouraging him to turn his head toward you.
The techniques that will be explained below should always be done initially by a professional, who should then advise and guide the family to indicate which of them can be done at home. For without proper knowledge can cause more harm than good to the child. We will describe the less complex ones to serve as a general guide.
Stretching exercises: They are performed after massage and other techniques that allow relaxation and inhibition of the neuromuscular spindles in order to facilitate the elongation of the shortened ECM muscle to correct the deformity and asymmetries as well as the limitations of the movements of the head and neck.
It consists of passive stretching exercises that have to be performed by two people, so that one performs the neck mobilizations and the other stabilizes the shoulders to avoid compensations (adaptation to a misaligned musculoskeletal pattern). The child is placed in the supine position (face up) with the head off the stretcher and the maneuver consists of lateralizing the neck to the contralateral (opposite) side, rotating it to the homolateral (same side) side, adding a slight neck flexion and a longitudinal kneading of the ECM fibers to achieve an elongation (lengthening) of the muscle.
With the child in prone position (face down) and with the head turned towards the affected side, an elongation (lengthening) of the homolateral trapezius muscle (on the same side) is performed from its origin (beginning) to its insertion (termination). In addition, the muscular body of the trapezius on the opposite side is pinched, accompanied by sound and tactile stimuli on both sides in order to develop its symmetry.
Prone position (face down) supported on the elbows we make smooth changes in the direction of the head.
Supine decubitus (face up) perform flexions and passive turns taking as a key point the head or shoulders.
Active stimulation exercises: Here we must achieve the active movement of the child in the sense of correction. It also allows improving coordination, balance and reflex responses of the child mainly.
Turns: Sensation of turning (giving the impression that the child is going to turn) towards the unaffected side, insisting on the rotation that provokes the elongation (lengthening) of the ECM muscle.
Pull to Sit Maneuver: Pulling the upper limbs from a lying position to a sitting position: passage from lying to sitting from the supine position (face up). Optical reaction (visual) visual stimulations.
Straightening reactions (in response to the force of gravity): They will be made according to their maturational development and in the normalizing sense of contracture.
Reflex (instinctive, involuntary reaction in response to a stimulus) of lateral incurvation of the trunk or Galant's Reflex: we place the child in sedentary position (sitting) and stimulate between the 9th and 12th rib of the paravertebral region (on the sides of the spine) not affected. The response will be to lateralize the trunk, neck and head towards the side we stimulate.
Exercises in seated position: Passive movements of the trunk forward holding the arms behind (originates extension of the shoulders, spine and elevation of the head).
Always before the appearance of any sign that makes you think that the child may have a congenital torticollis, you should seek professional help. In this way, with early treatment, you will avoid future complications and you will give the child the possibility of having a full life without limitations.
These exercises for congenital muscular torticollis should always be accompanied by an appropriate physiotherapeutic treatment. Always adapted to the age of the baby and the severity of the pathology.