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Practice Guideline
. 2018 Oct;30(4):240-290.
doi: 10.1097/PEP.0000000000000544.

Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy

Sandra L Kaplan  1 , Colleen Coulter, Barbara Sargent
Affiliations
Practice Guideline

Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy

Sandra L Kaplan et al. Pediatr Phys Ther. 2018 Oct.

Abstract

Background: Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified.

Purpose: This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice.

Results/conclusions: The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.

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Conflict of interest statement

Conflict of Interest statement: The authors declare no conflicts of interest.

Conflict of Interest Statements

Colleen P. Coulter, PT, DPT, PhD, PCS - nothing to disclose

Barbara Sargent, PT, PhD, PCS – nothing to disclose

Sandra L. Kaplan, PT, DPT, PhD – nothing to disclose

Figures

Figure 1.
Figure 1.
Referral Flow Diagram
Figure 2.
Figure 2.
2018 Classification of Severity and Management of Congenital Muscular Torticollis (CMT) To use this chart: The vertically aligned ovals on the left, list the factors that are most relevant to the classification process (age asymmetry noted, age of referral and PT evaluation, type of CMT); the diamonds below describe the cycle of PT examination, intervention and reassessment. Begin in the larger rectangle with age at evaluation and type of CMT to choose a grade in the ovals below. Abbreviations: PT, physical therapy; TX, treatment; SCM, sternocleidomastoid; L/R, left/right.
See this image and copyright information in PMC

References

    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. - PubMed
    1. Shiffman RN, Michel G, Rosenfeld RM, Davidson C. Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. J Am Med Inform Assoc 2011;19:94–101. - PMC - PubMed
    1. Institute of Medicine. Clinical practice guidelines we can trust Washington, DC: National Academies Press;2011. 9780309164221 (pbk.), 0309164222 (pbk.), 9780309164238 (pdf).
    1. Do TT. Congenital muscular torticollis: current concepts and review of treatment. [Review] [22 refs]. Curr Opin Pediatr 2006;18(1):26–29. - PubMed
    1. Gutierrez D, Kaplan SL. Aligning documentation with congenital muscular torticollis clinical practice guidelines: Administrative case report. Phys Ther 2016;96(1):111–120. - PubMed

Publication types

Supplementary concepts