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- Öhman, Anna, 1957
(författare)
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Congenital muscular torticollis
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The purpose of these studies was to undertake a survey of functional and cosmetic status in children treated for congenital muscular torticollis (CMT), to examine validity and reliability of the Muscle Function Scale (MFS), to find reference values for rotation and lateral flexion of the neck and muscle function of the lateral flexors in the neck for the normally developing infant, to investigate if infants with CMT are at higher risk of achieving the early motor milestones later compared to a control group of healthy infants and to investigate if treatment duration is affected when stretching is carried out by an experienced physiotherapist compared to parents. Methods: Range of motion (ROM) in neck rotation was measured with an arthrodial protractor. Lateral flexion was measured with the infant/child lying in supine on a big protractor. Muscle function of the lateral flexor muscles of the neck was measured with MFS, which was also tested for validity by a panel of experts. Physiotherapists and students tested intra-rater and inter-rater reliability of the MFS using photos. The presence of asymmetry of the face, posture and lateral band were observed and estimated according to a scoring sheet in study I. In study IV and V craniofacial asymmetry and head posture was assessed with the visual scale ?severity assessment for plagiocephaly?. Motor development was assessed with Alberta Infant Motor Scale. A questionnaire about time spent in prone when awake and sleep position was used. Infants with CMT were randomized to stretching treatment by physiotherapist or parent in study V. Results: The majority of the children who had received earlier treatment for torticollis attained an overall excellent/good status and the most notable findings were remaining craniofacial asymmetry and asymmetry in muscle function. The MFS had high inter-rater and intra-rater reliability, weighted Kappa and intraclass correlation both >0.9. Reference values for the mean ROM in neck rotation in healthy infants were in mean 110° with SD 6,2° and a range of 100°-120°. In lateral flexion the mean ROM was 70° with SD 2,2° and a range of 65°-75°. Infants of two months of age had the mean muscle function score of 1, which increased to 3-4 at the age of ten months. Difference in scores on the left and right side were rare. Multiple regression analysis showed that infants in the CMT group had a significantly lower score at AIMS compared to the control group at two (p=0.03) and six months of age (p=0.05). Infants who spent ? three times daily in a prone position when awake, had significantly higher scores at AIMS than infants who spent less time in prone at two (p=0.001), six (p <0.001) and ten months of age (p <0.001). When stretching treatment was performed by an experienced physiotherapist the time to achieve satisfactory ROM in both rotation and lateral flexion was significantly (P<0.01) shorter compared to the parents group. Symmetrical head posture was achieved earlier (P=0.05) in the physiotherapist group than in the parent group Conclusion: Most children with CMT had an overall excellent/good status at follow up after physiotherapy treatment and the most notable findings were remaining craniofacial asymmetry and asymmetry in muscle function. The MFS was found to be valid and reliable. Infants under one year of age have good ROM in rotation and lateral flexion of the neck. Infants with CMT seem to be at higher risk of achieving the early motor milestones late compared with a healthy control group. However time spent in prone position seems to have a positive influence on this. Infants with CMT gained full ROM and symmetric head posture earlier when treated by an experienced physiotherapist compared to parents. Nevertheless parents can achieve a good result within a couple of months.
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| 2. |
- Klackenberg, Eva, 1947, et al.
(författare)
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Kongenital muskulär torticollis
- 2002
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Ingår i: Sjukgymnastik för barn och ungdom Red. Eva beckung, Eva Brogren & Birgit Rösblad. - Lund : Studentlitteratur. ; , s. 216-219
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Öhman, Anna, 1957
(författare)
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Congenital muscular torticollis
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Congenital Muscular torticollis Anna Öhman. Institute of Neuroscience and Physiology, Division of Physical Therapy, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. Abstract Aim: The aim of study I was to describe the functional and cosmetic status in children earlier treated for congenital muscular torticollis (CMT) with regard to asymmetry of head position, range of motion (ROM), muscle function i.e. strength/endurance and craniofacial asymmetry. The aim of study II was to find reference values for ROM in rotation and lateral flexion in the paediatric cervical spine and also to find reference values muscle function in the lateral neck flexorers of infants. Methods: Fifty-four children treated for CMT between the years 1999 and 2001 at the Department of Physiotherapy at Queen Silvia Children’s Hospital, Göteborg, Sweden participated in study I. In study II 38 healthy infants participated, they were recruited between October 2004 and October 2005 from the Child Health Centre in Göteborg, Sweden. In both studies ROM in rotation and lateral flexion of the neck were measured and muscle function i.e. strength/endurance of the lateral flexor muscles of the neck were estimated. Neck rotation was measured with an arthrodial protractor. Lateral flexion was measured with the infant/child lying in supine on a big protractor. Muscle function i.e. strength/endurance of the lateral flexor muscles of the neck was measured in study I with the child lying on the side lifting their head up. In study II muscle function of the neck lateral flexor muscles was estimated with a five-degree scale. Also the presence of asymmetry of the face, posture and lateral band were observed and estimated according to a scoring sheet in study I. The parents answered a questionnaire about birth history and completed a subjective assessment. Results: In study I the majority of the children attained an overall excellent/good status and the most notable findings were craniofacial asymmetry and asymmetry in muscle function i.e. strength/endurance. There were moderate correlations between craniofacial asymmetry and rotation (p=0.00, r=0,39), between rotation and side flexion (p=0,00 r=0.47) and a strong correlation between head tilt and subjective assessment (p=0.00 r=0,62). The overall score had a moderate correlation with both craniofacial asymmetry and rotation and a strong correlation with head tilt. In study II reference values for the mean ROM in neck rotation in healthy infants were in mean 110° with SD 6,2° and a range between 100°-120°. The measurements in rotation at two months of age were about 5° less than at the other ages. In lateral flexion the mean ROM was 70° with SD 2,2° and a range between 65°-75°. Infants of two months of age had the median muscle function score of 1 interquartile range 1 to 2. Infants of four months of age had the median score 3 interquartile range 2 to 3. Infants of six months of age had the median score of 3 and interquartile range 3. Infants of ten months of age had the median score 3 interquartile range 3 to 4. There was no significant difference between genders. Conclusion: In study I most children had an overall excellent/good status and the most notable findings were craniofacial asymmetry and asymmetry in muscle endurance. Functional problems were rare. More studies are needed to find out the importance of muscular balance between the affected and non- affected side and also suitable treatment and duration of treatment. In study II reference values for ROM in infants in rotation of the neck were 110° with a range 100°-120° and in lateral flexion 70° with a range 65°-75°. In muscle function most two months old infants scored 1 and the scores increased with age. Reference values for muscle function in the neck can be used in clinic to grade muscle function in infants with CMT. Keywords: Craniofacial asymmetry, rotation, lateral flexion, muscle function, infants, reference values, torticollis, physiotherapy.
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| 4. |
- Öhman, Anna, 1957, et al.
(författare)
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En kartläggning av barn födda mellan 1990 och 1996 som tidigare har behandlats för congenital muscular tosticollis (CMT)
- 2004
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Ingår i: Nordisk Fysioterapi. ; 8:2, s. 63-73
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Tidskriftsartikel (refereegranskat)abstract
- Every year about 70-80 infants receive treatment for congenital muscular torticollis at the Department of Physiotherapy, The Queen Silvia Children’s Hospital, Göteborg, Sweden. A few children return at the age of 5-15 years, often with a need for surgery. It is important that an earlier short m. sternocleidomastoideus is extended at the time of skeleton growth (to avoid any new problems). There are no criteria for follow up after treatment today. All children born 1990-1996 treated for congenital muscular torticollis were asked to participate in a survey study. Twenty-eight children aged 6-12 years participated in the study. The children came once, 6 to 12 years after the treatment, and were concluded for an evaluation of mobility, strength of the neck, asymmetry of the face and posture of head and shoulders. The most important findings in this study were a significant difference between affected and non-affected side in mobility and strength of the neck. There was also a correlation between facial asymmetry and mobility, residual band and the subjective assessment by parents. The conclusion is that it is important to follow up children with CMT to reduce asymmetry.
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| 5. |
- Öhman, Anna, 1957, et al.
(författare)
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Functional and cosmetic status after surgery in congenital muscular torticollis.
- 2006
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Ingår i: Advances in Physiotherapy. ; 8:4, s. 182-187
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to follow up children who have had surgery for congenital muscular torticollis. The children were evaluated once and the scoring system used, included functional and cosmetic results. Neck movement, strength, endurance, elevation of the shoulder and lateral band were compared with the uninvolved side. Head tilt, craniofacial asymmetry and operative scar were evaluated by clinical observations and photographs. The operated muscle had a limited range of movement that was significant in both rotation (p=0,027) and side flexion (p=0,005). However, the limitation in range of movement seldom caused any functional problems. 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. A long follow up period to prevent the tendency for recurrent head tilt is desirable.
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| 6. |
- Öhman, Anna, 1957, et al.
(författare)
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Functional and cosmetic status in children treated for congenital muscular torticollis as infants.
- 2005
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Ingår i: Advances in Physiotherapy. ; 7, s. 135-140
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Tidskriftsartikel (refereegranskat)abstract
- Every year about 60 infants receive treatment for congenital muscular torticollis, (CMT), at the Department of Physiotherapy. The aim of this study was to do a survey of children treated for CMT, and investigate if they had functional and cosmetic problems. All children born 1999-2001 treated for CMT at The Queen Silvia Children’s Hospital were asked to participate in a survey. Fifty-four children participated in this study. The children were evaluated once and a scoring system was used, which included functional and cosmetic results. The neck movement, endurance, elevation of the shoulder and lateral band were compared with the uninvolved side. Head tilt and craniofacial asymmetry were evaluated by the use of clinical observations and photographs. The majority (96 %) had excellent/good range of motion and excellent/good posture (94,5 %) of the head. The most notable findings were craniofacial asymmetry and asymmetry in endurance of neck muscles. The conclusion was that most children had an overall excellent or good result after treatment and functional problems were rare. For fifty percent of the children craniofacial asymmetry was still present and for forty-one percent there was asymmetry in endurance of neck muscles. If asymmetric muscle endurance is an important factor has to be further examined
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