Balance and Bilateral Control in Children with a History of Congenital Muscular Torticollis

Jessie Miller, SPT, Justine Van Zee, SPT, and Holly Watson, SPT

DPT2020 Torticollis

(Click on image to expand)

15 Comments on “Balance and Bilateral Control in Children with a History of Congenital Muscular Torticollis

  1. Was there a particular reason why you chose this age range? Since we know that some motor control aspects such as anticipatory postural adjustments are not fully developed until the age of 7, do you think significant results may be revealed by using older subjects? Perhaps lingering deficits may not be significantly noticeable until late childhood.

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  2. Thanks for your question Molly! Yes, it would be interesting to look at children of different ages. The reason we chose this age range stems from Shumway-Cook who presented some findings about how children had the greatest variability with postural response synergies during the ages of 4-6. Specifically, children ages 4-6 has significantly slower reaction times and diminished amplitude relationships between proximal and distal muscles than for children ages 7-10. By age 7, it was reported that postural responses more closely match those of an adult. We wanted to explore this 4-6 age group for this reason to see how their balance and bilateral coordination is influenced since this information suggested that balance is not fully developed in children 4-6 years old. These thoughts may be due to changes in growth from ages 4-6 as a child begins to transition towards more adult-like forms of sensory integration.

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  3. When deciding on outcome measures, why did you decide on the BOT-2? Were there other outcome measures that were considered?

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    • Ember, thank you for the question. We decided to do the BOT-2 because it is a standardized assessment meaning we are able to compare the results of one child to other children of similar age and gender. There were a couple other tests we looked at but they were battery of tests so they did not get as in depth and they were much longer to administer. Having children of our age range if we ran tests that were longer in time we were worried about the children losing interest. We also officially decided on the BOT-2 because it specifically looked at coordination and balance in the age range of children we were targeting. Hope that answered your question!

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  4. During testing did you run into children that became discouraged from the difficulty of the subtests? If so, do you think this could have impacted the results at all?

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    • Hi Brett, thank you for the excellent question! We certainly did run into children who became bored or frustrated with the BOT-2 tests. As I am sure you know it is quite a long test for a young child to work through. However, since the test is standardized and we performed it per the protocol, I do not believe that this issue affected our results. During testing to obtain the norms for the test, I am sure that those children became bored and frustrated as well, thus this would be taken into account in the normative data to which our results are compared.

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  5. Nice work on the poster! What methods did you use to recruit the subjects of your study? Were they mainly in the same geographical region? If so were they treated at the same clinic or were they treated for torticollis by different clinics? Thanks!

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      • Thanks for your question, Steven! All of our subjects were recruited by a MIdwest outpatient clinic, by word of mouth, and with Facebook advertisements. All of the subjects came from generally the same geographical area and were treated for their torticollis previously at this clinic. It would be interesting to repeat this study with other cultures and in other geographical areas to see if there would be any differences in our findings.

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  6. Hey ladies! Super interesting stuff (: Does your research advisor plan to continue studying these specific children over time? How did you educate the parents of the children about their specific findings and results?
    Thanks!

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    • Carly, thank you for the question!!! Our research advisor does continue to examine this age group but not these specific children over time. So unfortunately when we conducted most of our research we did not really understand what the results were telling us as we had not had our pediatric course where we learned about the BOT-2. We also told the parents that while we had results we needed to compare the results to the standard scores to see where they fall and if there were any deficits. After that we did send out information to the parents if the patient demonstrated any lasting deficits which most of these patients did not.

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  7. Very informative presentation! I may have missed this on the poster but I noticed that 7 participants had CMT treatment for the R side vs 2 for the L side. Is it more common to see CMT affect the R side in children? Also, if you had a larger pool of participants for future studies, would you consider looking for a more equally distributed pool of those treated for CMT? (e.g. whether that be just looking at those who had a history of treatment for R CMT or L CMT or 50/50 of right side & left side)

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    • Emma, we did not see in any of our research if it was more common to have it on the L or the R. We did see in our research that if the torticollis goes untreated it can have an impact on handedness (dominant hand) because they are not looking at or using the side they cannot see. That is something interesting to consider for future studies to get an evenly dispersed sample pool but I think it would limit us on who we are able to accept and not accept because of the restraint. Something interesting to consider for sure

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  8. Nice job on the poster! Were you aware of any differences in treatment/interventions for their torticollis that could have lead to the difference in AROM later on? Or consistencies that results in no significant difference in the coordination and balance? I was thinking of age of intervention, duration, techniques etc.

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    • Thank you Anna! We did not look into or account for differing treatments and interventions though that information would be interesting particularly for a study looking at the effectiveness of different interventions. For the most part, interventions for torticollis are similar I would say but we only looked at the initial evaluation records. I agree that the duration of which intervention needed to be performed might be an important piece of the puzzle that we did not assess. Duration would give us a information about when the child was no longer affected by torticollis and no longer needed treatment. A child that no longer needed treatment by 1 year probably would show fewer deficits that one who needed treatment until 2 years but then again when treatment stops probably isn’t a very consistent measure between therapists and children. The age at which intervention was started does go into the torticollis severity scale so that was accounted for. Thank you for the great question and bringing up these interesting points.

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