Program Development for the Treatment of Torticollis and Plagiocephaly

1. Program Development for the Treatment of Torticollis and Plagiocephaly LAURA FLYNN, PT, PCS AMY L. ROSEN, MPT, CLT

2. What is Torticollis? • Torticollis literally means “twisted neck”. It can occur cogenitally (in utero) or be acquired (due to prolonged positioning of the infant’s head to one side). Torticollis occurs when muscles on one side of the infant’s neck become tighter than the same muscles on the opposite side of the neck, pulling the head toward the tighter side. Because this muscle performs two motions (tilting the head in one direction and turning the head in the opposite direction), often the infant will rest with the head tilted toward the tightness and rotated in the opposite direction.

3. What is Plagiocephaly? • Plagiocephaly refers to the condition in which the shape of the skull is asymmetrical. There may be a flattened area at the back of the skull as well as a forward protrusion on one side of the forehead. Plagiocephaly is often seen in children with Torticollis as a result of preferred head rotation to one side causing uneven weight bearing through the skull.

4. THE QUESTIONS… • Children diagnosed with torticollis continue to be a significant referral to pediatric rehabilitation. Are we currently providing the most comprehensive, efficient, and effective treatment program? • Can we better educate families in the clinic and in the community in torticollis prevention and treatment? • Can we improve home exercise program compliance for better outcomes and parent satisfaction? • Can we better communicate with physicians to create a strong team approach to the treatment of torticollis and plagiocephaly?

5. THE EVIDENCE THAT LACK OF A COMPREHENSIVE TREATMENT PROGRAM IS A PROBLEM IMPACTING TREATMENT QUALITY, OUTCOMES, EFFICIENCY, AND SATISFACTION… • Inconsistent treatment between therapists. No written HEP available for torticollis patients. Each training therapist creates own program. • It is inefficient to create individual HEP • Lack of photos for proper demonstration of HEP • Decreased efficiency with torticollis documentation. • Parents often verbalize lack of education re: torticollis at initial evaluation. Decreased awareness due to lack of brochure/information in pediatrician office. • Children are often referred for treatment at 4-6 months of age, generally increasing treatment duration.

6. PROJECT IMPACT ON CLINICAL AREA… • Improve quality of care, consistency between therapists, and efficiency of care • Improve compliance and parent commitment to HEP, providing thorough written and web-based education. • Improve communication with referring physicians. • Increase torticollis awareness for early diagnosis and referral, improving outcomes. • Market our clinic through website link and educational brochure.

7. OUR PLAN… • Literature , peer, and internet review • Create and implement comprehensive HEP utilizing written description and photographs • Create written educational brochure to be available in pediatrician offices • Create website/link to VCH • Meet/talk with referring physicians to create team approach to treatment. • Collaborate with staff and educate through in-service.

8. THE RESULTS… • Created brochure for Torticollis Treatment Program at VCH Pediatric Rehabilitation. To be distributed to local pediatrician offices upon approval from marketing team. • Website link to MCJCH at Vanderbilt re: Torticollis and Plagiocephaly, to be completed upon brochure approval. • Consulted with Dr. Kevin Kelly re: plagiocephaly assessment and referral for molding helmet therapy. • Assessed current documentation template and decided changes not necessary.

9. …RESULTS CONTINUED • Created and implemented comprehensive home activities program, staff in-service scheduled July 2009 : • Stretching/ROM exercise • Midline positioning in car seat/carrier • Tummy time! • Carrying positions • Playtime positions • Diaper changes and feeding • Plagiocephaly • TOT collar

10. Thank you!