ortopedyczne_postepowanie_z_kreczem.pdf

Orthotic Management of Congential Muscular Torticollis

Presented By: Karl Fillauer, CPO, FAAOP; Fillauer, Inc

Robert R. Madigan, MD; Knoxville Orthopedic Clinic

What is Torticollis?

Torticollis is a condition where the head is bent to one side and

rotated in the opposite direction due to acongenital shortening of the

sternocleidomastoid muscle. This condition becomes apparent shortly

after birth and is also known as “wry neck” syndrome. The causes of

torticollis may be genetic, acquired, or idiopathic (occurring without

a known cause) and may also develop later in childhood or adulthood.

Acquired torticollis, much more dificult to treat, results from damage

to the muscular or nervous system due to trauma or disease. In

most cases surgical release of the tight sternocleidomastoid muscle

is indicated followed by aggressive physical therapy to stretch the

contracture. Often the surgeon is interested in orthotically managing

the deformity by gradually moving the head into the correct position.

The Fillauer Torticollis Orthosis has the advantage of being able to

maintain the head in any position desired with respect to cervical

lexion, abduction, and transverse rotation.

Orthotic Indications and Goals

• Easy to Fabricate • Ease of Donning/Dofing

• Comfortable for patient • Positional Adjustments

• Physiological Positioning • Stability

Recommended Success Factors

• Accurate Measurement and Cast

• Ease in Donning/Dofing and a Comfortable Fit

• Multiplane Positional Adjustments

Orthotic Design

• Height Adjustment

• M-L Angulation Adjustment

• Rotational Adjustment

• A-P Placement

• Right or Left

Components

• Torticollis Joint (A Multiplane Adjustable Connector)

• Helmet/Shoulder Sections

• Elastic Velcro Straps

Materials

• Pe-Lite Interface 3mm

• Velcro Straps

• Copolymer Thermoplastic 1/8 inch - Transfer Paper to Personalize

Diagnosis - Data

• Muscular torticollis is a common congenital musculoskeletal

anomaly after dislocated hip and clubfoot.

• Incidents varying from 0.4% to 1.9%

• No predilection for either sex

• 6.% to 19.% (congenital Muscular Diagnosis 3-12 months) have

incidence of hip dysplasia in direct relation to the severity of

the torticollis.

Types of Treatment

• Physical Therapy - Muscle Stretching, P. T. and Parents

• Surgery Followed with Physical Therapy and Orthosis.

Measurements

Temporal Head A-P

Temporal Head M-L

Base of Neck to Mandible A-P Temporal Head Circumference

Patient Positioning

Stretch and exercise patient to

obtain proper holding position

during plaster impression.

Fillauer ® P.O. Box 5189 • 2710 Amnicola Hwy • Chattanooga, TN 37406 • 800 251 6398 • Fax: 423 629 7936 • Web: www.illauer.com/products/torticollis

Preparation for Plaster Impression

Apply 1st stockinette from base

of neck to include shoulders

Apply 2nd stockinette over-

lapping a minimum of 1 inch

Apply tape to secure

stockinette

Plaster Splint of Head & Neck Impression

Plaster impression of left

Torticollis

Preoperative - Fitting and Delivery

Make needed multiplane

adjustments

Conirm it for contact

at base of neck

Utilize elastic velcro for

comfort and security

Postoperative Management

• Physician can easy adjust alignment and head position.

• Time of wear: three months full time, three months night wear.

• Stretching exercise performed by parents and therapist.

• Patient should be followed by Orthotist in addition to Physician during

initial three months.

Verify head position

Conirm proper it

(lateral view)

Evaluate and adjust elastic

strapping as needed

References

• Binder, H., Eng, G.D. Gaiser, J.F., Koch, B. Congenital Muscular torticollis. Arch Phys Med Rehabil 68:222-225, 1987

• Wolfort, F.G., Kanter, M.A., Miller, L.B. Torticollis. Plast. Reconstr. Surg Sept. 2, pp, 682-692, 1988.

M024/03-01

Plik z chomika:

Inne pliki z tego folderu:

Inne foldery tego chomika: