Congenital Muscular Torticollis
Conditions
Keywords
congenital muscular torticollis, infants, perception-action approach
Brief summary
Infants with congenital muscular torticollis (CMT) display postural and functional asymmetry that interferes with their development. The use of the Perception-Action Approach (P-AA) intervention in infants with CMT is supported by a single case report and needs to be researched further to determine its efficacy. This study will investigate the immediate effects of the P-AA intervention on habitual head deviation from midline, active head rotation range of motion, and functional use of both sides of the body in infants with CMT. The participants will be 3 infants with CMT, aged birth to 9 months. A randomized, nonconcurrent A-B multiple baseline design across subjects will be used. The intervention phase will include 5 daily PT sessions, with outcome data collected at the end of each session. It is hypothesized that improvements on all outcome measures will be documented upon the initiation of the P-A Approach intervention, with the most substantial change expected in habitual head deviation from midline measured by still photography.
Detailed description
This study will have a randomized, nonconcurrent A-B multiple baseline design across subjects. The purpose of this study will be to investigate the immediate effects of the P-AA intervention on habitual head deviation from midline, active head rotation range of motion (ROM), and functional use of both sides of the body in infants with CMT. The participants will be 3 infants with CMT, aged birth to 9 months, recruited from a private pediatric physical therapy (PT) practice. Baseline and intervention data will be collected 5 days per week, Monday through Friday, until the study is completed. The length of the baseline phase will be randomly assigned to each consecutively enrolled participant. The appropriate measurements will be taken at every baseline phase session but no intervention will be provided until the intervention phase is initiated. The intervention phase will include 5 daily PT sessions during which the P-AA intervention will be used, with outcome data collected at the end of each session. Additionally, the participants' therapy-related behavior during intervention sessions will be documented. Measurements of still photos and scoring of video recordings to evaluate the participants' habitual head deviation from midline and functional use of both sides of the body for movement and play will be performed by an assessor blind to the timing of when the photos and videos are obtained within the study. The active head rotation ROM measurements and assessment of therapy-related behavior will be performed by the treating therapists. Prior to initiating this research, a pilot reliability study will be conducted for all outcome measures. A total of 3 to 5 infants will be recruited for the pilot project. Fidelity of intervention will be evaluated during the pilot study using a checklist. During the main study, intervention adherence will be assessed by tracking attendance, session duration, and intervention frequency.
Interventions
BEHAVIORALPerception-Action Approach
Environmental set-up, gentle manual guidance, and caregiver education
Sponsors
Ability Pediatric Physical Therapy, LLC
Rosalind Franklin University of Medicine and Science
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 9 Months
Healthy volunteers
No
Inclusion criteria
* age between birth and 9 months at the time of recruitment * diagnosis of CMT as documented in the medical record * parents/guardians agree not to have their child participate in any additional interventions for CMT during the course of the study
Exclusion criteria
* diagnosis of neuromuscular torticollis, Sandifer syndrome, acute torticollis, benign paroxysmal torticollis, ocular torticollis, torticollis related to bony anomalies, or another non-muscular type of torticollis * being seen for torticollis by another health care provider * receiving a passive stretching intervention for CMT prior to referral for PT at the research site
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Functional Symmetry Observation Scale (FSOS) | Up to 12 days (assessed at every baseline session and at the end of every intervention session for a total of 10, 11 or 12 sessions, depending on the length of the baseline phase) | Change in the FSOS score that reflects functional use of both sides of the body during spontaneous movement and play |
| Still Photography | Up to 12 days (assessed at every baseline session and at the end of every intervention session for a total of 10, 11 or 12 sessions, depending on the length of the baseline phase) | Change in the angle of habitual head deviation from midline assessed in a supine position |
| Arthrodial Goniometry | Up to 12 days (assessed at every baseline session and at the end of every intervention session for a total of 10, 11 or 12 sessions, depending on the length of the baseline phase) | Change in the angular difference in active cervical rotation range of motion between the involved and uninvolved sides |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Therapy Behavior Scale (TBS), Version 2.2 | 5 days (assessed after each of 5 intervention sessions) | The TBS score documents therapy-related behavior during intervention sessions |
Countries
United States
Outcome results
None listed