What is it?

Plagiocephaly or "flat head syndrome" is a very common and treatable disorder.   It develops when an infant’s soft skull becomes flattened in one or more area secondary to constant pressure to that portion of the skull.  Studies show that 20 to 25 percent of infants that sleep on their back develop some degree of plagiocephaly.

Causes of Plagiocephaly

› Position in the womb 

› Prematurity

› Congenital Muscular Torticollis or Positional Torticollis

› Excessive time spent laying on the same portion of the head

Effects of Plagiocephaly

› Misalignment of eyes and/or different eye shapes - possible astigmatism or strabismus can develop as a result

› Asymmetry of the ears - one ear is more positioned forward than the other

› Flattening of the jaw (mandible)

› Flattening of the cheek opposite to the flattened skull

› Trouble with lip closure (assumption of midline) that could result in poor feeding

› Future difficulty with wearing sporting helmets (football, baseball, cycling, etc.)

This little one began physical therapy intervention at Power of Movement PT just before turning 3 months, resulting in the correction of his head shape. We have specific and proven methods that consists of positioning, therapeutic exercises, and a comprehensive carryover exercise program provided to the parents and caregivers.  Six weeks following the initial imaging, the facial asymmetry (flattened left forehead, cheek, and jaw) is no longer present. Additionally, the follow up scans reveal Cranial Vault Asymmetry (CVA) and Cranial Vault Asymmetry Index (CVAI) measurements went from "severe" to "mild," and this child did not require intervention with the helmet!

Before

After

What is Torticollis?

Congenital muscular torticollis

The infant maintains the head tilted to the same side with neck rotation to the opposite side. The affected muscle is the sternocleidomastoid and it is shortened on one side of the neck. This is typically due to intrauterine mal-positioning, such as in breech presentations or intrauterine crowding (seen in multiple births or larger babies).

Positional torticollis

Poor positioning that does not properly support the developing neck muscles creates imbalance of the neck musculature that leads to a persistent head tilt in the same direction. This is often seen in infants placed in inclined positioners without proper neck support or slept in side lie in the same direction.

Signs and Symptoms

The infant may keep the head tilted and/or rotated toward one side of the body and attempting to straighten the neck is difficult. For example, if the muscle on the left side of the neck is shortened, weak, or in spasm—the head may tilt toward the left shoulder and rotate toward the right (this is referred to as a left torticollis).  There may be tightness in the neck or a noticeable lump in the neck muscle.

If left untreated, the following complications may result:

› Flattening of the skull (plagiocephaly) 

› Limited ability to turn the head to see, hear, and interact with surroundings that can lead to delayed cognitive development

› Delayed body awareness, especially to the side side of the body that the head has difficulty turning to

› Movement that favors one side of the body, affecting muscular development of the arms, trunk, and hips. This can lead to strength imbalances

› Developmental hip dysplasia

› Scoliosis

› Difficulty with balance

› Fine motor issues

How will Power of Movement PT help? 

Physical Therapy is the primary treatment for all forms of torticollis.  Our therapists have extensive training in infant development and a thorough understanding on facilitating acquisition of motor milestones while focusing on maintenance of midline head orientation and appropriate muscular balance.  We provide treatment to address the functional impairments and limitations that are caused by torticollis. Early treatment and intervention yields the best outcomes.  We will work with parents and caregivers to develop and reach mutual goals.

This will include an individualized treatment plan to: 

› Gain pain-free movement (range of motion)

› Strengthen neck muscles

› Correct muscle imbalances

› Improve postural control, alignment, and symmetry through the milestones
 

These goals will be addressed through stretching, strengthening, myofascial work, positioning, possible kinesiotaping, and a comprehensive home exercise program. If not treated, torticollis can result in compensatory scoliosis and may require surgical intervention.