THE DETERMINANTS OF TREATMENT DURATION FOR CONGENTAL MUSCULAR TORTICOLLIS

Background and Purpose. Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of response to treatment, such as treatment duration. The purpose of this study was to determine how factors such as severity of restriction of range of motion, age at initiation of treatment, and presence of a palpable intramuscular fibrotic sternocleidomastoid muscle mass affect treatment duration. Subjects. One hundred one children (mean age=4 months, SD=2.87 range=0.5-15.5) who were diagnosed with congenital muscular torticollis and referred to physical therapy at British Columbia's Children's Hospital (Vancouver British Columbia, Canada) prior to 2 years of age were included in the study. Methods. Following a standardized initial assessment, parents were taught the home treatment program, which included passive stretches of the affected sterno-cleidomastoid muscle and strengthening exercises for the contralateral side, and positioning and handling skills. Evaluation at 2-week intervals included measurement of passive neck rotation and lateral flexion using an adapted standard goniometer Treatment duration was defined as the time between initiation of treatment and achievement of full passive neck range of motion. Results. Complete recovery (full passive range of motion) was achieved in all but one of the children in this sample. The mean treatment duration was 4.7 months (SD=5.06 range=1-36). Correlations were noted between severity of restriction and treatment duration (r=.31) as well as between presence of a mass and treatment duration (r=.26). Multiple regression analysis revealed that severity of restriction was the strongest predictor of treatment duration. Conclusion and Discussion. The results of this study will make it possible for therapists to better predict treatment duration at the time of the initial assessment. By providing parents with more precise information about the length of treatment, parents may be more willing to adhere to the exercise program.