Evaluation of a Cervical Orthosis for the Correction of Head Tilt in Children with Congenital Muscular Torticollis

SYLVIA COTTRILL-MOSTERMAN, BSc, OT, OTR,DOREEN BARTLETT, BSc, PT,RICHARD BEAUCHAMP, MD, FRCS ANDCAROLE JACQUES, BSR, OT*


Congenital Muscular Torticollis (CMT), if left untreated, may result in restriction of neck range of motion, permanent head tilt, and facial asymmetry. Conservative treatment, incorporating stretching, positioning and facilitation of normal righting reactions, is the treatment of choice for most facilities. Unfortunately, there is often a residual head tilt despite full passive range of motion and normal ocular examination. To ameliorate this problem, a new cervical orthosis has been developed. It provides a slight noxious stimulus (like the Milwaukee brace) to encourage active correction of head tilt. Infants with CMT and no other problems were assessed and treated conservatively. Twelve with a head tilt of greater than 5 degrees at age 4 months were randomized to a orthosis or non-orthosis group. Conservative treatment continued for all. Habitual head tilt and passive range of motion of the neck were measured monthly until one year of age. Initial results have been positive regarding the orthosis's assistance in head-tilt correction, fabrication, fit, tolerance and lack of side effects. Positive results point to the value of constant dynamic feedback for correction of head tilt.

*University of British Columbia, 6136 Nurseries Road, Vancouver, British Columbia V6T 1W5