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Commentary on “Informing the Update to the Physical Therapy Management of Congenital Muscular Torticollis Clinical Practice Guideline”

Girolami, Gay L. PT, PhD; Chase, Kristine PT, DPT, PCS

Pediatric Physical Therapy: July 2018 - Volume 30 - Issue 3 - p 175
doi: 10.1097/PEP.0000000000000528

Department of Physical Therapy, University of Illinois at Chicago Chicago, Illinois

The authors declare no conflicts of interest.

“How should I apply this information?”

Evidence in this systematic review can be used by clinicians and researchers to supplement content in the Academy of Pediatric Physical Therapy (APPT) Congenital Muscular Torticollis (CMT) Clinical Practice Guidelines (CPG).1 An updated CMT CPG is expected in 2018. The introduction updates clinicians and researchers with evidence on the effectiveness of early intervention for improved range of motion (ROM) outcomes in CMT. Low birth weight, breech delivery, and motor asymmetry are factors that can prolong intervention. A detailed birth history and documentation of movement asymmetry is recommended to support decision-making. Preliminary evidence suggests that increased passive ROM exercise (100×/day) may lead to a reduction in head tilt and muscle stiffness accompanied by increased passive ROM. Group physical therapy may be an effective delivery model for the treatment of CMT and should be investigated by researchers and considered by clinicians. Finally, educating families and caregivers regarding the effect of CMT on age-related activities, and the possible long-term effect on symmetry and function, may improve their adherence to the recommended exercises and positioning protocols as well as their return for routine screening.

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

This review updates physical therapy management of CMT. However, some of the articles reviewed provide information relevant to the treatment of deformational plagiocephaly and/or acquired CMT. Careful analysis is required to extract evidence that can be applied for the treatment of those diagnoses. Research on stretching paradigms for CMT is abundant and surpasses the availability of high-level research on other types of interventions. Therefore, diverse interventions should be clinically explored and scientifically investigated, with the goal of increasing the available evidence, enhancing clinical decision-making, and improving outcomes for infants with CMT.

Gay L. Girolami, PT, PhD

Kristine Chase PT, DPT, PCS

Department of Physical Therapy, University of Illinois at Chicago

Chicago, Illinois

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1. Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther. 2013;25(4):348–394.
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