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Pediatric Physical Therapy:
doi: 10.1097/PEP.0b013e318fabf12
Clinical Bottom Line

Commentary on Reliability of Still Photography Measuring Habitual Head Deviation From Midline in Infants With Congenital Muscular Torticollis

Armstrong, Dayle C. PT, MS, DPT; Redman-Bentley, Donna PT, PhD

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Author Information

Department of Physical Therapy Education, Western University of Health Sciences, Pomona, California

College of Allied Health Professions, Western University of Health Sciences, Pomona, California

“How should I apply this information?”

The incidence of torticollis is 1 in every 250 live births. In addition, congenital muscular torticollis is the third most common congenital muscular skeletal anomaly of infancy (following congenital hip dysplasia and clubfoot). Evidence for a reliable procedure to measure head deviation is clinically useful. The authors present an option for assessing function via the use of still photography to measure neck range of motion in children with congenital muscular torticollis. The procedure presented is beneficial because of the following reasons:

* It is cost-effective and requires only a camera, a ruler, and a protractor.

* Standardizing the child's position and the landmarks for angle measurement allows reliable measurements by different physical therapists.

* Babies are seen for therapy in various settings, including home and clinic. Still photography could be performed in any setting.

* Still photography provides an objective means of establishing a baseline measurement and allows progress to be tracked.

“What should I be mindful about in applying this information?”

Unfortunately, there is a lack of previous research on still photography with which to compare reliability and validity. Reliability can be greatly affected by potential errors when taking the pictures. Videotaping with editing to identify a single frame may provide more accurate capturing of function but may not be practical because of time, effort, and cost. While this method is designed to measure lateral flexion, the rotation component is not considered. As lateral flexion decreases, the measurement lines become parallel and this could affect reliability. The authors did provide excellent methods to maintain consistency and eliminate bias. In addition, they presented a concept of variability as a measure of treatment effectiveness. However, it is important to note that the youngest babies in the study were 4.5 months old. Symmetry begins at 4 months; therefore, studying younger subjects may confound results because the change in movement to midline could be due to typical developmental changes rather than intervention. Further investigation is needed to elucidate this concept. The reader should pay particular attention to the 5 modifications recommended in the conclusion to improve reliability.

Dayle C. Armstrong, PT, MS, DPT Department of Physical Therapy Education, Western University of Health Sciences, Pomona, California

Donna Redman-Bentley, PT, PhD College of Allied Health Professions, Western University of Health Sciences, Pomona, California

© 2010 Lippincott Williams & Wilkins, Inc.

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