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CONGENITAL MUSCULAR TORTICOLLIS – A CASE REPORT

Autor: Cristina Bojan Ligia Robănescu
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This material present the therapeutic conduct in the case of a patient under the age of 3 months with Global development disorder, left torticollis.The protocol in our clinic for left torticollis is Vojta therapy (4 sessions per day) and elongation for recovery.

 


 

HISTORY: Mother’s Reminiscences

The patient is aged 3 months and one week, was born after a 42-week physiologically developed pregnancy; weight at birth = 3900 g, APGAR score = 6.He is presented to our clinic for neurological evaluation of the delay in psycho-motor development. Transfontanellar ultrasound (ETF) (in maternity) = normal.

 

SOMATIC AND NEUROLOGICAL EXAM

Somatic examination: afebrile, general well-being, balanced cardio-respiratory and digestive functions, weight = 6300 grams.

Neurological examination:

  • PC = 42 cm
  • FA = 2/2
  • Left laterocollis
  • Unsteady control of the head
  • Open fist
  • In prone position does not lift his head from the examination table
  • Bone-tendon reflexes (BTR) symmetrical without plantar clonus
  • Babbles
  • Follows a moving object with the sight
  • Age of motor development – 1-2 months.

 

LABORATORY INVESTIGATIONS:

ETF – normal
Abdominal ultrasound – normal
Consultation in paediatric surgery – right testicular ectopia
Electroencephalogram (EEG) during wakefulness no epileptiform changes
Consultation in functional recovery: at the age of 3 months and 1 week – first hospitalization in our clinic

  • At traction from dorsal decubitus position, the head lags behind
  • In ventral decubitus, the head is in the I-II Gesell zone
  • He bring his hands under the chest, especially the left one
  • Postural reactions corresponding to the first quarter
  • Maintains himself in sub-axillary suspension, at the contact of the feet with the examination table, they move in equinus (at birth he had a cast for equinus varus predominantly left)
  • In crouching position he has no anti-gravity response
  • Active return from dorsal decubitus to lateral decubitus.

 

DIAGNOSIS:

Global development disorder (motor developmental age – 1-2 months, psychological development – 3 months)

Left torticollis.
Vojta therapy starts at the age of 3 months and a week – 4 sessions per day.

The first Vojta session:

  • spontaneous motility in supine position
  • spontaneous motility in prone position

After four days of Vojta therapy:

  • spontaneous motility in supine position before therapy
  • Vojta stimulation – the first phase of reflex rolling.
  • Vojta stimulation – the second phase of reflex rolling.
  • spontaneous motility prone position after therapy.
  • spontaneous motility in supine position after therapy.

Consultation for functional recovery at the age of 4 months and 3 weeks – the second admission to our clinic

  • Posture in supine position with arching of the spine with convexity to the right
  • Head and neck tilted to the left, with slight rotation of the face to the right
  • At the active rotation of the head, a slight resistance to the rotation to the left is perceived
  • At the traction from supine position, the head is in the trunk axis
  • In prone position, the head is in Gesell II zone, without proper support of the doll type posture
  • At Collis horizontal reaction: hand is put on the examination table with the fist closed (especially on the right)
  • He maintains himself in sub-axillary suspension
  • In crouching position, supports his own weight
  • Does not have anti-gravity response
  • Mild tension in the triceps surae muscles
  • Does not stretch out his hands sideways to catch a toy
  • Motor Age – 3 months
  • Continues Vojta therapy – 4 sessions per day.

Evaluation and therapy at the age of 4 months and 3 weeks – the second hospitalization in our clinic

a. evaluation

  • In prone position
    • support in the forearms
    • pelvis in ventral flexion
    • hyperlordosis
    • fingers flexed, toes flexed, thumb adducted to the palm.
  • In supine position
    • follows a toy with the eyes that is offered from the lateral side
    • does not catch a toy that is offered from the lateral side
    • hand mouth contact.
  • Postural reactions
    • At the reaction of traction, head aligns with the trunk axix (slight tendency to retroduction)
    • The response to the Landau reaction – the cervical spine start s to extend
    • The reaction to the sub-axillary suspension, the legs are slightly bent
    • At Vojta reaction of lateral rolling – the child performs no abduction in the upper thigh
    • At Collis horizontal reaction – tendency to support the fist on the examination table
    • At Peiper reaction – arms are moving in adduction + opistotonus
    • At Collis vertical reaction – the child is flexing the free leg + tendency to hyperextension at the level of the cervical spine.

b. Therapy

  • spontaneous motility in supine position before therapy
  • spontaneous motility in prone position before therapy
  • Vojta stimulation – the second phase of reflex rolling
  • Vojta stimulation – crawling reflex
  • Vojta stimulation – crawling reflex
  • Vojta stimulation – the first phase of reflex rolling
  • spontaneous motility in supine position after therapy
  • spontaneous motility prone position after therapy

Functional recovery consultation at the age of six months – the third hospitalization in our clinic

  • Right parietal-occipital plagiocephaly with facial asymmetry, head rotated clockwise, virtually equal right-left passive rotation of the head
  • The child sits with anterior support of hands, he rolls
  • Possible prehension in the midline
  • Motor age: 5-6 months
  • Diagnostic – left laterocollis (possibly KISS syndrome)
  • Continues Vojta therapy – 4 sessions per day.
  • Evaluation at the age of six months – the third hospitalization in our clinic
    • in prone position
      • support on the elbows
      • making active head rotation left and right.
    • in supine position
      • hand-knee contact
      • lateral grip with the right hand.
      • can be positioned in sitting (sits with dorsal kyphosis)
      • rolls from supine to prone position
    • Postural reactions
      • corresponding to the second quarter
      • at Collis horizontal reaction – support on the examination table with the left palm; right upper limb in the flexion phase
      • At Peiper reaction – limited abduction of the upper limbs.

Functional recovery consultation at the age of 8 months – the fourth hospitalization in our clinic

  • The child maintains himself in sub-axillary suspension
  • In crouching position, he has anti-gravity response
  • Equal head rotation right and left
  • Laterocollis no longer present
  • The right parietal-occipital plagiocephaly is more subdued
  • The child rolls over
  • He sits in balance – only positioned
  • Tries to crawl
  • Parachute reflex is absent
  • Prehension grasp – present
  • Motor age – 6 ½ months

The evolution was favourable, so that the patient will continue the intensive physical therapy in the territory.

  • It will focus on – crawling exercises
    • lifting to the sitting position
    • positioning and moving on the four limbs.

 

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