ASK THE EXPERT
What is the indicator that you use to determine when a child is ready for discharge with a home program? How frequently do you have these children come in for a recheck?
Answer by Carolyn B. Armstrong, PT, DPT, PCS:
When speaking of cranial deformations, we must remember that we are not truly affecting the shape of the skull with our interventions. We are really looking for the consequences of cranial deformations which often means screening for orthoses and focusing on the developmental delays. The child’s entire program should be based on catching up to age appropriate levels and dealing with the development delays. In this case, I would allow the orthotist to do the rechecks. In cases where the child is not getting orthoses, and we are doing positioning only, I would monitor and do measurements at least once a month. If the plagiocephaly is very severe, I do weekly measurements. I want to be sure that cranial vault asymmetry index values are not getting worse but are instead getting better.
For children with torticollis, I look at the ICF model and first consider the impairment and the impact on activity and participation. I would discharge a child that does not have developmental and movement problems when they approach their typical age performance. But for indicators that a child is ready for discharge based on the impairment measurement, such as the range of motion values that they are getting for their neck into lateral flexion, I would use a percentage value. A goal may be that I would like to have a children within 15 degrees of normal before they get discharged. Usually I am seeing them a little longer than that to try and be sure that they are getting even closer.
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For more information on this topic, view the recorded live webinar Management of Congenital Muscular Torticollis and Cranial Positional Deformation in Infants.