The Effects of Congenital Muscular Torticollis on Postural Control Among Four to Six-Year-Old Children
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Josh Henderson, SPT, Alyssa Matson, SPT, Nicci McGuire, SPT, & Brett Steffen, SPT
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Josh Henderson, SPT, Alyssa Matson, SPT, Nicci McGuire, SPT, & Brett Steffen, SPT
USD PT Research 
Great work, everyone! I have one general question and one question about your poster/presentation. First, what are the percentage differences in the diagnosis of mild vs. moderate vs. severe CMT? Are most diagnoses mild? For my next question, do you believe there may have been a significant difference if you were able to include more patients with severe CMT when looking at the balance assessment? Thanks!
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Hi Luke! Thanks for the questions. Of our participants, 10 of the children had mild severity CMT, 1 child had early severe CMT, and 1 child did not report their severity. CMT classifications are on a scale of grade 1 through grade 7 (1 being the least severe, 7 being the most). We did not find any solid statistics on what classification is the most common, but based on our small sample size I would assume mild is the most common. I do believe that we may have found a significant relationship in our study had we have had more severe cases and also more participants. Dr. Berg-Poppe also thought that earlier detection and interventions may be a reason that we are not seeing a significant relationship in our study. Hope this helps answer your questions! Thanks again.
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Could other AROM measurements besides cervical rotation be included for application of severity in children with CMT? If not, why?
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Hi Mattison! Great question! During our research, we did obtain other AROM and PROM measurements (cervical flexion, cervical extension, cervical lateral flexion, shoulder flexion, shoulder extension, shoulder abduction, internal and external rotation). Many of these measurements help get an overall picture of the ROM deficits of a child with CMT, but since we know that CMT is characterized by the ipsilateral cervical lateral flexion and contralateral cervical rotation due to the shortening of the SCM, the severity scales use the limited cervical rotation as their bases to classify the torticollis. Hopes this answers your question! Thank you!
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Great work. It looks like there were only 2 subjects in your research with left sided CMT. Is it more commonly seen on the right side as the large majority of your subjects were? If so, does left sided CMT tend to be more severe? Thanks!
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Thanks for the question! We did not find anything in our research that would indicate why one direction is more common than the other. There are a few reports that fetal positioning could contribute to the development of CMT and the directionality. We also dont have any strong evidence to indicate that left sided CMT is more severe.
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Nice job on the poster presentation! With the essential early detection and management of CMT in adolescents, how would you go about managing/treating these patients in PT?
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Hi Christian, thanks for the question! Treatment for CMT consists of a lot of stretching for the SCM muscles to allow for motion to be equal bilaterally. In cases with plagiocephaly helmet use may be considered to allow the skull to develop more evenly and to decrease favoritism to one side. I have seen interventions where toys are placed on the side with the involved SCM to promote the infant to actively stretch the tightened SCM in order to interact with that toy. Additionally, rolled up towels/blankets may be placed along the tight side to promote a more neutral head/neck alignment and help stretch the tight SCM. Hope this helps answer your question!
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Great work! My question has a couple parts to it. Since you were testing children that had CMT 4.5 years prior, do you think that if you were to test a younger age group, possibly 3 year olds, there would be a significant difference? How long do you think it takes for there to no longer be a significant difference in posture between children who previously had CMT and their age matched norms?
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Great question Jenna! It is of course difficult to know for certain but if we did our research with 3 year olds, it is likely there still would not be a significant difference. Children that are 3 years old would have had less time to develop their postural control and therefore its harder to see differences. Of course we would need to test this to see for certain. As far as your second question, we believe it greatly varies from case to case. Some children may have significant postural changes for several years while some may more closely resemble their age matched peers within a a shorter period of time closer to a couple years.
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Nice job on the presentation, I thought you all did a great job! So obviously the sample size here was a smaller one, but if there was a larger sample size equally for males and females, do you think that there would be any difference on postural control between male and females between the age group of 4-6 year old children? Great Job again on this presentation!
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Tristen, great question! As to differences between males and females, our small sample size did not have any differences in postural control. I believe that several key factors that would contribute to the differences seen between males and females would be the severity of the CMT, any other co-morbidities, and when the CMT was caught. Our study had no correlation between severity and gender. As our study also showed that there were many children classified as mild and that was due to the early detection rates and early treatment. Perhaps a larger sample size would show differences between males and females, but I don’t believe that gender would be the only contributing factor.
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Great presentation, it was very informative! I believe that us as future clinicians need to bridge the gap between research and clinical practice with evidence on CMT and postural control in children. What are ways we can advocate and inform our PT colleagues as well as other health care professionals about this research evidence to optimize patient outcomes and healthcare services to children with CMT?
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Hi Rachael, thanks for the question. Developing relationships with other therapists that often treat these kids and sharing the results is one way to start. Also connecting with pediatricians or other health care providers that often see children and letting them know that you treat children with CMT is another option. This would especially be important for therapists working in rural areas as there may not be many cases and it could easily go undiagnosed.
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Excellent responses, CMT Researchers!
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