Cheng Chun-yiu, Jack. / Thesis (M.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 254-265). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Photocopy. Ann Arbor, Mich. : Bell & Howell Information and Learning, 2000. 267, [41] p. : ill. ; 22 cm.

Chen Mui Kwan. / Publication date from spine. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 138-145). / Acknowledgment --- p.1 / List of Abbreviations --- p.2 / Abstract --- p.3 / Chapter Chapter 1 --- Introduction --- p.5 / Chapter Chapter 2 --- Terminology and Classification --- p.7 / Chapter Chapter 3 --- Review of Literature on Infantile Muscular Torticollis --- p.9 / Chapter 3.1 --- Anatomy --- p.9 / Chapter 3.2 --- Pathology --- p.12 / Chapter 3.3 --- Etiology --- p.14 / Chapter 3.4 --- Epidemiology --- p.23 / Chapter 3.5 --- Natural History --- p.30 / Chapter 3.6 --- Associated Deformities --- p.32 / Chapter 3.7 --- Differential Diagnosis --- p.35 / Chapter 3.8 --- Diagnostic Methods --- p.37 / Chapter 3.9 --- Treatment: / Chapter 3.9.1 --- Conservative Treatment --- p.40 / Chapter 3.9.2 --- Surgical Intervention --- p.46 / Chapter 3.10 --- Postural Torticollis --- p.52 / Chapter Chapter 4 --- A Pilot Study on the Measurement of Passive Rotation of the Neck --- p.53 / Chapter 4.1 --- Need of a New Design --- p.54 / Chapter 4.2 --- Materials and Method --- p.55 / Chapter 4.3 --- Results --- p.63 / Chapter 4.4 --- Discussion and Conclusion --- p.69 / Chapter 4.5 --- Clinical Adaptation --- p.71 / Chapter Chapter 5 --- Physiological Rationale of Conservative Treatment --- p.73 / Chapter 5.1 --- Positioning Programme --- p.73 / Chapter 5.2 --- Massage --- p.77 / Chapter 5.3 --- Active Stimulation --- p.78 / Chapter 5.4 --- Manual Stretching --- p.79 / Chapter Chapter 6 --- Experiment 1: A Comparative Study to Evaluate the Effectiveness of Active Home Treatment Programme versus Manual Stretching in Treatment of Moderate IMT --- p.82 / Chapter 6.1 --- Background --- p.82 / Chapter 6.2 --- Method and Materials --- p.84 / Chapter 6.3 --- Results --- p.93 / Chapter 6.4 --- Discussion --- p.111 / Chapter 6.5 --- Conclusion --- p.112 / Chapter Chapter 7 --- Experiment 2: A Prospective Study on the Role of Manual Stretching in Treatment of Moderate and Severe IMT --- p.113 / Chapter 7.1 --- Background --- p.113 / Chapter 7.2 --- Method and Materials --- p.113 / Chapter 7.3 --- Results --- p.114 / Chapter 7.4 --- Discussion --- p.128 / Chapter 7.5 --- Conclusion --- p.131 / Chapter Chapter 8 --- Overview --- p.133 / Chapter 8.1 --- Results of Medium Term Follow-up --- p.133 / Chapter 8.2 --- Overall Results --- p.134 / Chapter 8.3 --- Strengths and Limitations of the Studies --- p.135 / Chapter 8.4 --- Conclusion --- p.135 / Chapter 8.5 --- Suggestion for Future Study --- p.136 / References --- p.138 / Appendix1 --- p.146 / Appendix2 --- p.147 / List of Figures --- p.148 / List of Tables --- p.151

ABSTRACT Introduction The parents involvement in the physical therapy treatment of their child diagnosed with congenital muscular torticollis is crucial for a positive outcome. The parents’ role has been mentioned as valuable in many studies, but there is a lack of studies that solely focus on the parents. Purpose The purpose was to interview Vietnamese parents at Ho Chi Minh City Children's Hospital in Vietnam, focusing on what the parents believe to be their role in the treatment of their child with congenital muscular torticollis. Design and method This study had a qualitative and exploratory research design with eight semi-structured interviews. To process the data a qualitative inductive content analysis were used. Results There were a will from the participants to be involved in the physical therapy treatment but there were also a need and desire for more knowledge. The participants experienced role in the treatment were regarding knowledge, trust, support and involvement. Conclusion All of the participants saw their importance to the treatment and wanted to be involved in the intervention. Despite the will to be involved there are a need of more support from the hospital. / SAMMANFATTNING Bakgrund I den fysioterapeutiska behandlingen för barn med kongenital muskulär torticollis är det viktigt att föräldrarna involveras. Föräldrarnas delaktighet i behandlingen är avgörande för att uppnå positiv effekt. I ett flertal studier tas föräldrarnas roll i behandlingen upp som viktig, trots detta finns det i nuläget ingen studie som enbart ser till föräldrarnas roll. Syfte Syftet med studien var att intervjua vietnamesiska föräldrar på Ho Chi Minh Children’s Hospital i Vietnam angående deras upplevda roll i behandlingen som deras barn med kongenital muskulär torticollis genomgår. Design Studien hade en kvalitativ explorativ forskningsdesign med 8 semistrukturerade intervjuer. I analysprocessen användes en kvalitativ induktiv innehållsanalys. Resultat Resultatet delades in i 4 kategorier och 14 subkategorier. Resultatet visade att det fanns en vilja från deltagarnas sida att vara involverad i den fysioterapeutiska behandlingen men det fanns också ett behov och en önskan av att få en ökad kunskap. Konklusion Alla deltagarna såg sig själva som en viktig del i behandlingen och ville vara involverade. Trots viljan att vara delaktig så finns det ett behov av ökat stöd från sjukhuset.

Introdução: A distonia cervical (DC) é a distonia focal mais comum no mundo, cujas manifestações clínicas e consequências vão muito além dos movimentos involuntários cervicais. A doença causa significativo impacto sobre a vida profissional e social dos indivíduos acometidos, com acentuado comprometimento da qualidade de vida, além de dor cervical. Uma avaliação clínica completa é necessária para um manejo adequado desta enfermidade. Não há, no Brasil, escala validada que permita uma avaliação holística dos pacientes portadores de DC. A escala Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) é um instrumento de avaliação conhecido em todo o mundo, tendo sido utilizado em inúmeros estudos de avaliação de DC, e sua validação é o objetivo deste estudo. Casuística e métodos: A adaptação transcultural foi realizada segundo critérios já publicados. Após o pré-teste com 30 pacientes, observou-se que a escala era de difícil entendimento para pessoas com escolaridade abaixo de 8 anos, e a escala foi novamente submetida a um processo de adaptação, com modificações sugeridas por juízes, produzindo a escala adaptada. A validação do instrumento seguiu orientações padrão: comparação com instrumento de medida de qualidade de vida (WHOQOL-Bref); realização de teste-reteste por meio de três avaliações separadas entre si por 2 semanas; cálculo do alfa de Cronbach para os itens da escala; medida do coeficiente de correlação intraclasse e intervalo de confiança de 95%; e cálculo dos gráficos de concordância/dispersão de BlandAltman. Resultados: A escala final foi de fácil entendimento por pessoas de todos os níveis educacionais. A consistência interna foi boa a excelente (0,599 para o domínio Intensidade, 0,860 para o domínio Incapacidade, e 0,878 para o domínio Dor). Houve boa correlação com a escala padrão e concordância entre examinadores. A confiabilidade e reprodutibilidade da escala, conforme cálculo do ICC e IC95%, alcançaram níveis aceitáveis. Os gráficos de Bland-Altman produziram dados dispersos de forma aleatória, sugerindo ausência de tendência nas avaliações. Conclusão: A versão em Português da TWSTRS é válida para a avaliação de pacientes brasileiros portadores de DC possui boa consistência interna e apresenta boa reprodutibilidade entre examinadores / Background: Cervical dystonia (CD) is the most common focal dystonia, its clinical picture and outcome going far beyond the involuntary muscle contractions. This illness has a significant impact over the social and professional lives of affected individuals, leading to severe compromise of quality of life (QoL), and cervical pain. A complete clinical assessment is of utmost importance to an adequate management of this disease. There is no validated clinical tool in Brazil devised to a holistic evaluation of CD patients. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) is a world famous scale used in several studies of CD evaluation, and its validation is the objective of this study. Patients and methods: The transcultural adaptation was performed according to published criteria. After the initial pre-test with 30 patients, it was observed that patients with schooling under 8 years could not understand the whole scale, and the tool underwent a new adaptation process after modifications suggested by the judges, producing the adapted scale. The validation followed standard methods: comparison with a QoL instrument (WHOQOL-Bref); test-retest with three examinations 2-weeks apart from each other; Cronbach\'s ? calculation of the items of the scale; intraclass correlation coefficient (CCI) and 95% confidence interval (95%CI) determination; and production of the Bland-Altman graphs. Results: The final version of the scale was easy to understand by all patients examined. The internal consistency was good to excellent (0.599 for domain Intensity, 0.860 for the domain Disability, and 0.878 for domain Pain). There was a good correlation between the adapted scale and the QoL instrument and good concordance between examiners. The reliability and reproducibility according to CCI and 95% CI reached acceptable values. The Bland-Altman graphs displayed randomly dispersed data, suggesting no tendency in the evaluations. Conclusions: The Portuguese version of the TWSTRS is valid for evaluation of Brazilian CD patients, has good internal consistency, and is reproducible between examiners

Tyrimo objektas: kūdikių kreivakaklystės požymių išreikštumo kitimas taikant kineziterapiją. Tyrimo problema. Įgimta raumeninė kreivakaklystė yra labiausiai paplitusi kreivakaklystės forma vaikų amžiuje. Tai yra laikysenos deformacija nustatoma gimimo metu ar iškart po gimimo, pasireiškianti vienos kūno pusės galvos sukamojo raumens sutrumpėjimu ir fibroze. Esant įgimtai raumeninei kreivakaklystei kūdikiai galvą laiko pakreipę į vieną pusę, be to, dažnai stebima galvos rotacija į priešingą pusę. Yra daroma prielaida, kad kuo anksčiau pastebimi kreivakaklystės požymiai, tuo anksčiau pradedamas gydymas ir geresnių gydymo rezultatų galima tikėtis. Hipotezė. Manome, kad 18 kineziterapijos procedūrų taikomų du–tris kartus savaitėje kartu su kūdikių tėvų instruktavimu, kaip skatinti norimų judesių išgavimą, turėtų sumažinti kreivakaklystės požymių išreikštumą ir padidinti kūdikių galvos judesių amplitudes. Todėl šio tyrimo tikslas buvo: nustatyti kineziterapijos poveikį gydant dviejų–keturių mėn. kūdikių įgimtą raumeninę kreivakaklystę. Tyrimo uždaviniai: įvertinti kūdikių kreivakaklystės požymių išreikštumą prieš kineziterapiją; įvertinti kūdikių kineziterapijos požymių išreikštumą po kineziterapijos taikymo; išsiaiškinti kineziterapijos poveikį kreivakaklystės gydymui amžiaus aspektu; išsiaiškinti kineziterapijos poveikį kreivakaklystės gydymui lyties aspektu. Tiriamąją imtį sudarė 40 (2–4 mėn. amžiaus) kūdikių. Kūdikių amžiaus vidurkis buvo 3,3±0,4 mėn. Tiriamųjų grupėje buvo 22... [toliau žr. visą tekstą] / Subject of research: resolving of torticollis features in infants under the influence of physiotherapy. Problem of research: Congenital muscular torticollis is the most common form of torticollis in children. It is a postural deformity detected at birth or shortly after birth, primarily resulting from unilateral shortening and fibrosis of the sternocleidomastoid muscle. Infants with congenital muscular torticollis display head tilt to one side and often rotation of the head to the opposite side. It has been hypothesized that the earlier is diagnosed torticollis, the earlier starts treatment the better results can be expected. Hypothesis: 18 procedures of physiotherapy applied 2–3 times per week with the guidelines for parents should decrease signs of congenital muscular torticollis and increase range of head motion. The aim of this research was to evaluate impact of physiotherapy treating congenital muscular torticollis in 2–4 months infants. The tasks were: to evaluate signs of torticollis before applying physiotherapy; to evaluate signs of torticollis after applying physiotherapy; to find out relationship between impact of physiotherapy and age of infants; to find out relationship between impact of physiotherapy and gender of infants Methods: 40 (2–4 months) infants (22 males (55%) and 18 females (45%) were evaluated. Left side torticollis was diagnosed in 15 infants (37.5%), right side — in 25 infants (62.5%). In the center of early rehabilitation 18 procedures were... [to full text]

Introdução: A distonia cervical (DC) é a distonia focal mais comum no mundo, cujas manifestações clínicas e consequências vão muito além dos movimentos involuntários cervicais. A doença causa significativo impacto sobre a vida profissional e social dos indivíduos acometidos, com acentuado comprometimento da qualidade de vida, além de dor cervical. Uma avaliação clínica completa é necessária para um manejo adequado desta enfermidade. Não há, no Brasil, escala validada que permita uma avaliação holística dos pacientes portadores de DC. A escala Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) é um instrumento de avaliação conhecido em todo o mundo, tendo sido utilizado em inúmeros estudos de avaliação de DC, e sua validação é o objetivo deste estudo. Casuística e métodos: A adaptação transcultural foi realizada segundo critérios já publicados. Após o pré-teste com 30 pacientes, observou-se que a escala era de difícil entendimento para pessoas com escolaridade abaixo de 8 anos, e a escala foi novamente submetida a um processo de adaptação, com modificações sugeridas por juízes, produzindo a escala adaptada. A validação do instrumento seguiu orientações padrão: comparação com instrumento de medida de qualidade de vida (WHOQOL-Bref); realização de teste-reteste por meio de três avaliações separadas entre si por 2 semanas; cálculo do alfa de Cronbach para os itens da escala; medida do coeficiente de correlação intraclasse e intervalo de confiança de 95%; e cálculo dos gráficos de concordância/dispersão de BlandAltman. Resultados: A escala final foi de fácil entendimento por pessoas de todos os níveis educacionais. A consistência interna foi boa a excelente (0,599 para o domínio Intensidade, 0,860 para o domínio Incapacidade, e 0,878 para o domínio Dor). Houve boa correlação com a escala padrão e concordância entre examinadores. A confiabilidade e reprodutibilidade da escala, conforme cálculo do ICC e IC95%, alcançaram níveis aceitáveis. Os gráficos de Bland-Altman produziram dados dispersos de forma aleatória, sugerindo ausência de tendência nas avaliações. Conclusão: A versão em Português da TWSTRS é válida para a avaliação de pacientes brasileiros portadores de DC possui boa consistência interna e apresenta boa reprodutibilidade entre examinadores / Background: Cervical dystonia (CD) is the most common focal dystonia, its clinical picture and outcome going far beyond the involuntary muscle contractions. This illness has a significant impact over the social and professional lives of affected individuals, leading to severe compromise of quality of life (QoL), and cervical pain. A complete clinical assessment is of utmost importance to an adequate management of this disease. There is no validated clinical tool in Brazil devised to a holistic evaluation of CD patients. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) is a world famous scale used in several studies of CD evaluation, and its validation is the objective of this study. Patients and methods: The transcultural adaptation was performed according to published criteria. After the initial pre-test with 30 patients, it was observed that patients with schooling under 8 years could not understand the whole scale, and the tool underwent a new adaptation process after modifications suggested by the judges, producing the adapted scale. The validation followed standard methods: comparison with a QoL instrument (WHOQOL-Bref); test-retest with three examinations 2-weeks apart from each other; Cronbach\'s ? calculation of the items of the scale; intraclass correlation coefficient (CCI) and 95% confidence interval (95%CI) determination; and production of the Bland-Altman graphs. Results: The final version of the scale was easy to understand by all patients examined. The internal consistency was good to excellent (0.599 for domain Intensity, 0.860 for the domain Disability, and 0.878 for domain Pain). There was a good correlation between the adapted scale and the QoL instrument and good concordance between examiners. The reliability and reproducibility according to CCI and 95% CI reached acceptable values. The Bland-Altman graphs displayed randomly dispersed data, suggesting no tendency in the evaluations. Conclusions: The Portuguese version of the TWSTRS is valid for evaluation of Brazilian CD patients, has good internal consistency, and is reproducible between examiners

Le torticolis postural est une affection courante dans le milieu pédiatrique en particulier depuis que les parents ont adopté les lignes directrices de la campagne « Back to Sleep ». Habituellement, un programme d’exercices à domicile est présenté aux parents afin de promouvoir une récupération optimale toutefois, peu d’outils existent pour les accompagner dans la réalisation de ces exercices. L'objectif de cette étude était d'évaluer l'impact de l'addition du nouveau livret d’intervention pour le torticolis (LIT) sur la résolution du torticolis (restitution de l’amplitude passive du cou), le stress parental et la satisfaction à l’égard du traitement reçu et sur l'observance des parents au traitement à domicile. Cinquante-huit nourrissons référés en physiothérapie pour un torticolis postural ont été recrutés et randomisés au cours de leur première visite à l’un ou l’autre de ces 2 groupes: Physiothérapie + LIT (n = 29) ou Physiothérapie + traitement standard (n = 29). Des évaluateurs ont évalué à l’aveugle les patients 1 et 3 mois après leur visite initiale, 30 minutes avant leur consultation en physiothérapie. L’amplitude articulaire passive du cou en rotation était mesurée à l’aide d’un goniomètre arthrodial. Le niveau de stress parental a été évalué en utilisant l’Indice de Stress Parental (ISP). Les parents ont reçu l’ISP à la fin de la visite initiale et ont été invités à le compléter à la maison et le retourner à la visite suivante en physiothérapie ou à la visite de 1 mois. La satisfaction des parents à l’égard du traitement reçu a été évaluée en utilisant la Mesure du Processus de Soins (MPOC-56) à 3 mois. L'observance au traitement a été estimée en demandant aux parents de rapporter la durée quotidienne de positionnement des nourrissons sur le ventre pendant la semaine dernière à l’évaluation. L’analyse de nos données consista à d’abord décrire les performances des 2 groupes à l’aide de statistiques descriptives. Ensuite, des tests de t ont permis de comparer le changement à la rotation passive cervicale, entre la visite de 1 mois et la visite initiale ainsi qu’entre la visite de 3 mois et la visite initiale. Des tests de t ont aussi été calculés pour comparer les scores de chaque sous-échelle du ISP (stress parental) et du MPOC-56 (satisfaction des soins) entre les groupes. Le test du chi carré a été réalisé pour comparer l'adhérence entre les deux groupes à 1 et 3-mois. Les résultats ont montré une tendance à un plus grand changement de la rotation passive du cou à 1-mois dans le groupe LIT (Intervalle de Confiance à 95% = 95% IC= 1,97-8,77 ; p = 0, 17) mais pas à 3 mois. Les parents du groupe LIT ont obtenu des scores de stress plus faibles après avoir reçu l'outil d'intervention (95%IC= 49,20-57,94 ; p = 0, 01) et ont déclaré être plus satisfaits que les parents du groupe témoin pour le traitement reçu (95%IC= 6,7-6,8 ; p=0,03) e o partenariat avec les thérapeutes (95%IC= 6,3-6,9 ; p<0,001). Enfin, l'observance au traitement a été plus élevée dans le groupe LIT que dans le groupe contrôle en particulier à 3-mois (p = 0.01). Le nouveau livret d'intervention pour le torticolis accompagné d'un traitement de physiothérapie a tendance à contribuer à une restitution plus rapide de l’amplitude passive du cou en rotation, peut aider à diminuer le niveau de stress parental, contribuer à une plus grande satisfaction à l’égard du traitement et améliorer l’observance au traitement à domicile. / Postural Torticollis is a common condition in pediatric practices especially since parents have adopted “Back to Sleep” campaign’s guidelines. Parents are often instructed to carry out a home program of exercises; however there are few educational tools with comprehensive information about postural torticollis exercises. The main objective of this study was to evaluate the impact of the addition of the new Torticollis Intervention Booklet (TIB) on torticollis resolution (attainment of full passive neck range of motion), parental stress level, parental satisfaction and adherence to treatment received. Fifty-eight infants referred to physiotherapy for a postural torticollis were recruited and randomized during their initial visit to two groups: Physiotherapy + TIB (n=29) or Physiotherapy + Standard Care (n=29). Blinded evaluators assessed the patients at 1 and 3 months after their initial visit, thirty minutes before their physiotherapy consultation. Passive neck rotation range of motion (ROM) was measured by an arthrodial goniometer. Parental stress level was evaluated using the Parenting Stress Index- Short Form (PSI-SF). Parents received the PSI-SF at the end of the baseline visit and were requested to complete it at home and return it at their subsequent physical therapy appointment or at the second scheduled study assessment time. Parental satisfaction was evaluated using the Measure of Processes of Care (MPOC-56) at 3-months. Adherence to treatment was evaluated as the length of time per day parents reported having their children in the prone awake position in the week before follow-up visits. Analysis consisted of descriptive analyses for each group; t-tests to compare passive neck rotation ROM change scores between the baseline and 1-month visits and baseline and 3-month visits; and to compare subscale scores for PSI-SF (parental stress) and MPOC-56 (satisfaction with care) between the two groups. The Chi-square test was performed to compare adherence between the two groups at 1 and 3-months. The results showed a tendency to greater passive neck rotation (ROM) change at 1-month in the TIB group (95% Confidence Interval = 95%CI = 1.97- 8.77; p=0.17) but not at 3-months. Parents in the the TIB group showed lower global stress scores after receiving the intervention tool (95%CI= 49.20- 57.94; p = 0.01) and reported greater satisfaction than controls in the “coordinated and comprehensive care” (95%CI= 6.7-6.8; p=0.03) and « enabling and partnership » subscales (95%CI= 6.3-6.9; p<0.001). Finally, adherence was higher in the TIB group than controls especially at 3-months (p=0.01). The new Torticollis Intervention Booklet accompanied by physical therapy treatment has a tendency to lead to an earlier restitution of passive neck rotation ROM, may help decrease stress levels, increase satisfaction with treatment, and improve adherence.

Le torticolis postural est une affection courante dans le milieu pédiatrique en particulier depuis que les parents ont adopté les lignes directrices de la campagne « Back to Sleep ». Habituellement, un programme d’exercices à domicile est présenté aux parents afin de promouvoir une récupération optimale toutefois, peu d’outils existent pour les accompagner dans la réalisation de ces exercices. L'objectif de cette étude était d'évaluer l'impact de l'addition du nouveau livret d’intervention pour le torticolis (LIT) sur la résolution du torticolis (restitution de l’amplitude passive du cou), le stress parental et la satisfaction à l’égard du traitement reçu et sur l'observance des parents au traitement à domicile. Cinquante-huit nourrissons référés en physiothérapie pour un torticolis postural ont été recrutés et randomisés au cours de leur première visite à l’un ou l’autre de ces 2 groupes: Physiothérapie + LIT (n = 29) ou Physiothérapie + traitement standard (n = 29). Des évaluateurs ont évalué à l’aveugle les patients 1 et 3 mois après leur visite initiale, 30 minutes avant leur consultation en physiothérapie. L’amplitude articulaire passive du cou en rotation était mesurée à l’aide d’un goniomètre arthrodial. Le niveau de stress parental a été évalué en utilisant l’Indice de Stress Parental (ISP). Les parents ont reçu l’ISP à la fin de la visite initiale et ont été invités à le compléter à la maison et le retourner à la visite suivante en physiothérapie ou à la visite de 1 mois. La satisfaction des parents à l’égard du traitement reçu a été évaluée en utilisant la Mesure du Processus de Soins (MPOC-56) à 3 mois. L'observance au traitement a été estimée en demandant aux parents de rapporter la durée quotidienne de positionnement des nourrissons sur le ventre pendant la semaine dernière à l’évaluation. L’analyse de nos données consista à d’abord décrire les performances des 2 groupes à l’aide de statistiques descriptives. Ensuite, des tests de t ont permis de comparer le changement à la rotation passive cervicale, entre la visite de 1 mois et la visite initiale ainsi qu’entre la visite de 3 mois et la visite initiale. Des tests de t ont aussi été calculés pour comparer les scores de chaque sous-échelle du ISP (stress parental) et du MPOC-56 (satisfaction des soins) entre les groupes. Le test du chi carré a été réalisé pour comparer l'adhérence entre les deux groupes à 1 et 3-mois. Les résultats ont montré une tendance à un plus grand changement de la rotation passive du cou à 1-mois dans le groupe LIT (Intervalle de Confiance à 95% = 95% IC= 1,97-8,77 ; p = 0, 17) mais pas à 3 mois. Les parents du groupe LIT ont obtenu des scores de stress plus faibles après avoir reçu l'outil d'intervention (95%IC= 49,20-57,94 ; p = 0, 01) et ont déclaré être plus satisfaits que les parents du groupe témoin pour le traitement reçu (95%IC= 6,7-6,8 ; p=0,03) e o partenariat avec les thérapeutes (95%IC= 6,3-6,9 ; p<0,001). Enfin, l'observance au traitement a été plus élevée dans le groupe LIT que dans le groupe contrôle en particulier à 3-mois (p = 0.01). Le nouveau livret d'intervention pour le torticolis accompagné d'un traitement de physiothérapie a tendance à contribuer à une restitution plus rapide de l’amplitude passive du cou en rotation, peut aider à diminuer le niveau de stress parental, contribuer à une plus grande satisfaction à l’égard du traitement et améliorer l’observance au traitement à domicile. / Postural Torticollis is a common condition in pediatric practices especially since parents have adopted “Back to Sleep” campaign’s guidelines. Parents are often instructed to carry out a home program of exercises; however there are few educational tools with comprehensive information about postural torticollis exercises. The main objective of this study was to evaluate the impact of the addition of the new Torticollis Intervention Booklet (TIB) on torticollis resolution (attainment of full passive neck range of motion), parental stress level, parental satisfaction and adherence to treatment received. Fifty-eight infants referred to physiotherapy for a postural torticollis were recruited and randomized during their initial visit to two groups: Physiotherapy + TIB (n=29) or Physiotherapy + Standard Care (n=29). Blinded evaluators assessed the patients at 1 and 3 months after their initial visit, thirty minutes before their physiotherapy consultation. Passive neck rotation range of motion (ROM) was measured by an arthrodial goniometer. Parental stress level was evaluated using the Parenting Stress Index- Short Form (PSI-SF). Parents received the PSI-SF at the end of the baseline visit and were requested to complete it at home and return it at their subsequent physical therapy appointment or at the second scheduled study assessment time. Parental satisfaction was evaluated using the Measure of Processes of Care (MPOC-56) at 3-months. Adherence to treatment was evaluated as the length of time per day parents reported having their children in the prone awake position in the week before follow-up visits. Analysis consisted of descriptive analyses for each group; t-tests to compare passive neck rotation ROM change scores between the baseline and 1-month visits and baseline and 3-month visits; and to compare subscale scores for PSI-SF (parental stress) and MPOC-56 (satisfaction with care) between the two groups. The Chi-square test was performed to compare adherence between the two groups at 1 and 3-months. The results showed a tendency to greater passive neck rotation (ROM) change at 1-month in the TIB group (95% Confidence Interval = 95%CI = 1.97- 8.77; p=0.17) but not at 3-months. Parents in the the TIB group showed lower global stress scores after receiving the intervention tool (95%CI= 49.20- 57.94; p = 0.01) and reported greater satisfaction than controls in the “coordinated and comprehensive care” (95%CI= 6.7-6.8; p=0.03) and « enabling and partnership » subscales (95%CI= 6.3-6.9; p<0.001). Finally, adherence was higher in the TIB group than controls especially at 3-months (p=0.01). The new Torticollis Intervention Booklet accompanied by physical therapy treatment has a tendency to lead to an earlier restitution of passive neck rotation ROM, may help decrease stress levels, increase satisfaction with treatment, and improve adherence.

Abstract The recommendation for infants to sleep supine has decreased the incidence of sudden infant death syndrome by more than a half, but as another consequence, a dramatic rise has been observed in the incidence of acquired cranial asymmetry (deformational plagiocephaly, DP). According to recent data, almost half of otherwise healthy infants are affected by some degree of DP at 7 to 12 weeks of age, and especially in the USA and some Central European countries, major effort is put into treatment of severe DP. However, little is known of the prognosis of DP in the absence of intervention, and although primary preventive strategies are often recommended, a lack of evidence on the effectiveness of such measures persists. Furthermore, although 3D imaging is nowadays frequently used on infants with DP, no data is available on the accuracy of the measurements used to quantify cranial asymmetry. In the present study, the efficacy of a primary preventive program in reducing the incidence of DP was tested in a randomized, controlled trial. The course of DP in the absence of active treatment was studied throughout the first year of life, and factors impacting the prognosis of DP were investigated. The diagnostic accuracy of four 3D stereophotogrammetry-based measurements was also analyzed and compared, with a goal of determining their optimal cut-off values for DP. DP was less prevalent and less severe in the intervention group infants at the end of the RCT (3 months). The point prevalence of DP peaked at 3 months, whereafter spontaneous improvement in DP was seen throughout the follow-up period until 12 months of age. A preferential infant head position at 3 months was the strongest predictor of a subsequently unfavorable course of DP. Cranial asymmetry seen at birth was transient, and none of the older infants with torticollis had presented neck imbalance at birth, but rather appeared to develop the condition postnatally concomitantly with DP. Although all studied asymmetry-related measurements performed well regarding diagnostic accuracy, OCLR produced the most accurate classification of DP. In conclusion, primary preventive guidelines would likely aid in reducing the burden from both DP itself and associated healthcare costs, although substantial spontaneous improvement from DP can usually be expected. The cut-off values defined for the asymmetry-related measurements have clinical implication in both making the diagnosis of DP and determining the target outcomes for treatment. / Tiivistelmä Imeväisten nukuttaminen selällään on vähentänyt kätkytkuolemien määrää alle puoleen aiemmasta, mutta käytäntö on myös huomattavasti lisännyt asentoperäisen, ei-synostoottisen vinokalloisuuden esiintyvyyttä; tuoreen tutkimustiedon mukaan jopa lähes joka toisella imeväisellä on nähtävissä jonkinasteista asentovinokalloisuutta 7–12 viikon iässä. Etenkin USA:ssa ja muutamissa Keski-Euroopan maissa vaikea-asteista asentovinokalloisuutta hoidetaan aktiivisesti kypäräortoosein, mutta samanaikaisesti tietämys tilan luonnollisesta kulusta on vähäistä. Vaikka riskitekijöitä tunnetaan ja ehkäiseviä toimenpiteitä usein suositellaan, ei niiden tehosta ole juuri näyttöä. Nykyään 3D-pintakuvantamista käytetään usein vinokalloisten imeväisten seurannassa, mutta epäsymmetrian mittaamiseen käytettyjen muuttujien osuvuudesta ei ole tietoa. Tämän tutkimuksen tarkoituksena oli selvittää vastasyntyneiden vanhemmille annettavan vauvan käsittelyohjeistuksen vaikutusta asentovinokalloisuuden ilmaantuvuuteen satunnaistetussa, kontrolloidussa asetelmassa. Lisäksi pitkäaikaisseurannassa kartoitettiin asentovinokalloisuuden luonnollista kulkua ja ennusteeseen vaikuttavia tekijöitä suomalaisilla imeväisillä. Tutkimuksessa myös analysoitiin ja vertailtiin 3D-kuvista laskettavien epäsymmetriaa mittaavien muuttujien diagnostista osuvuutta. Käsittelyohjeita saaneiden lapsilla oli 3 kuukauden iässä merkittävästi vähemmän asentovinokalloisuutta ja kalloasymmetria oli lievempää kuin verrokkiryhmässä. Asentovinokalloisuuden esiintyvyys oli korkeimmillaan juuri 3 kuukauden iässä, jonka jälkeen merkittävää spontaania palautumista oli havaittavissa koko 12 kuukauden ikään jatkuneen seurannan ajan. Vastasyntyneillä nähty kalloasymmetria oli puolestaan ohimenevää, eikä myöskään vastasyntyneenä dokumentoitu kaulan liikerajoitus lisännyt myöhemmän vinokalloisuuden riskiä, vaan vinokalloisilla usein tavattava torticollis (kierokaula) näytti kehittyvän ensimmäisten elinviikkojen aikana yhdessä vinokalloisuuden kanssa. 3 kuukauden iässä havaittu imeväisen halu pitää päätään aina samaan suuntaan käännettynä oli yhteydessä kalloasymmetrian huonompaan spontaaniin palautumiseen. Tutkituista epäsymmetriaa mittaavista muuttujista OCLR erotteli vinokalloiset parhaiten. Yhteenvetona voidaan todeta, että ennaltaehkäisevä ohjeistus voisi vähentää vinokalloisuutta ja siitä aiheutuvia hoitokuluja kustannustehokkaasti, mutta vinokalloisuudelta on lupa odottaa myös merkittävää spontaania palautumista. Tutkimuksessa määritellyillä epäsymmetriaa mittaavien muuttujien raja-arvoilla on käyttöä sekä diagnostiikan että hoidon tavoitteiden määrittelemisen saroilla.