Secondary Logo

Journal Logo


Pediatric Physical Therapy: April 2004 - Volume 16 - Issue 1 - p 57-58
doi: 10.1097/01.PEP.0000115221.39160.D5
Section Information: Abstracts of Poster and Platform Presentations for the 2004 Combined Sections Meeting: Poster Presentations
Back to Top | Article Outline


C. Johansson, Elon University, Elon, NC.

BACKGROUND & PURPOSE: To describe the use of craniosacral therapy (CST) to improve ROM and posture in an infant with post-traumatic torticollis and C1–2 subluxation.

CASE DESCRIPTION: A typically developing 6-week-old male experienced head and neck compression when his car seat overturned during a MVA. At 4 months, he was diagnosed with traumatic torticollis. At 9 months, CT scan revealed C1–2 subluxation. Following spinal manipulation under general anesthesia, he was placed in a halo brace with a headband. Two weeks later, he began PT. After 8 weeks in the halo, a repeat CT scan revealed no subluxation improvement. After 2 1/2 months of traditional PT, the patient showed minimal improvement in cervical ROM. At 16 months, his physician recommended that, in the absence of significant improvement, a C1–2 fusion be performed after age 18 to 24 months. The child was then referred to a PT skilled in CST. Examination findings were consistent with the mechanism of injury. The frontal bone was noted to be more anterior on the left than the right, consistent with a lateral strain pattern of the cranial base. Cranial vault palpation revealed lateral spheno-basilar torsion. Dural tube assessment revealed a pronounced abnormal torsion from the cranium to the sacrum. Craniosacral therapy, including cranial base mobilization, sacral decompression, dural tube release, occipito-atlas release, and still point induction, was added to his treatment program 1–2 times a week, following CST guidelines for treatment of infants and small children.

OUTCOMES: Posture and ROM improved markedly in the first 4 weeks. Treatment continued weekly for 6 more months with consistent, though less dramatic, progress. Digital overlays of photographs allow comparative estimates of improvement. At discharge, patient achieved neutral head and neck posture in times of quiet standing and AROM beyond neutral in inversion. Mild asymmetry was still evident in stand-to-squat and in times of dynamic play. The child was discharged at nearly 24 months of age, with no imminent plans for additional CT scans or surgical intervention, to a hippotherapy program.

DISCUSSION: While considerable literature exists on physical and surgical interventions for congenital torticollis, little is written on the treatment of traumatic torticollis in very young children. In this case, CST appeared to be an effective intervention for improving cervical posture and ROM in an infant with post-traumatic torticollis.

© 2004 Lippincott Williams & Wilkins, Inc.