Motor and cognitive development at one-year follow-up in infants with torticollis☆

https://doi.org/10.1016/j.earlhumdev.2007.02.001Get rights and content

Abstract

Background

Clinical experience suggests infants with torticollis are at risk for developmental delay.

Aims

To examine gross motor (GM) skills at presentation in infants with torticollis; report first-year GM and cognitive outcomes; examine relationship between types of torticollis and above outcomes.

Study design

Prospective follow-up study.

Subjects

Infants referred to 2 regional child development centers from April 2001–December 2002 with torticollis/head tilt and no perinatal complications syndromes were studied.

Outcome measures

GM function was measured using the Alberta Infant Motor Scale and classified as normal (> 10%), suspect (5–10% inclusive), or abnormal (< 5%). Cognitive function was measured at follow-up using CAT-CLAMS-r Developmental Assessment. Follow-up data obtained between 8 and 15 months of age.

Results

One hundred and one infants with torticollis were seen for initial assessment at mean age 2.9 (SD 1.5) months. Eighteen had sternomastoid tumor, 47 muscular torticollis and 36 postural torticollis. At presentation, 35 (35%) of the 101 infants had suspect or abnormal GM function. 19/66 children with normal GM and 17/35 with suspect or abnormal GM function had postural torticollis (p = 0.054). All children received physical theraphy. Follow-up assessment of 83 participants, mean age 12.8 (SD 3.6) months, showed 75 had normal GM function and 8 had suspect or abnormal GM function; 11/83 still had torticollis. Cognitive assessment on 66 infants, mean age 14.4 (SD 4.8) months, revealed 57 (87%) had normal cognitive function and 9 (13%) were either delayed or significantly delayed.

Conclusions

Infants with torticollis are at increased risk for early GM delay but most normalize by one year. Torticollis is not associated with delays in early cognitive function.

Section snippets

Background

Congenital Muscular Torticollis (CMT) is a common condition in infancy warranting referral for evaluation and treatment. Cheng et al. [1], in reviewing the literature, reported a prevalence of congenital muscular torticollis between 0.3 and 2.0% and classified infants with CMT into three groups based on clinical examination: a palpable sternomastoid tumor (SMT), muscle tightness on passive head flexion or rotation but without sternomastoid tumor (MUSCULAR), and all the clinical features of

Objectives

The objectives of this work were to examine:

  • 1)

    the gross motor skills of infants referred with torticollis at presentation and one-year follow-up;

  • 2)

    the cognitive skills of infants referred with torticollis at one-year follow-up; and

  • 3)

    the relationship between the types of torticollis and the above outcomes.

Design

Prospective follow-up study. The Director of the Medical Section of the HMO approved this study and written parental consent was obtained.

Setting

Two regional child development centers in central Israel, which are the primary referral sites in their respective locations for infants with torticollis who belong to the Kupat Holim Meuhedet Health Maintenance Organization, one of four in the country.

Patients

Infants were referred by physicians or public health nurses for evaluation and were not solicited for this

Referral and perinatal data

One hundred and one infants, (67 male, 34 female), with a mean referral age of 2.8 (SD 1.5) months were diagnosed with torticollis. The referring sources were primary care physicians or well baby care clinics (83.2%) or orthopedists (16.8%). Forty infants were reported by the mothers to have onset of torticollis within the first week of life; the latest reported onset was at 5 months of age. Mean gestational age was 39.7 (SD 1.3) weeks, and mean birth weight was 3272 (SD 491) g. Seventy-three

Discussion

Congenital muscular torticollis including postural torticollis is a localized asymmetry in infancy with preferential posture of the head and asymmetric cervical movements [21]. Etiology remains unclear though in most cases of CMT it appears to involve damage to the SCM. This study found that infants with CMT were generally at increased risk for concomitant early gross motor delay, and those with the postural torticollis subtype appeared to be at greatest risk. Follow-up data indicate that most

Acknowledgments

Special thanks to Anat Ortner BP, Kirsi Hadad PT, Pam Freedman PT and Michal Noiman BPT of the physical therapy staff and to Chava Iluz, Nili Raz, Shoshi Levi, Sigal Shmul, Oshrat Eyal, Rika Taub and Suzi Amit of the secretarial staff for assisting in the data collection.

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    ☆

    Part of this work was presented as a poster at the 56th Annual Meeting of the American Academy for Cerebral Palsy and Developmental Medicine, September 11–14, 2002. New Orleans, Louisiana and at the 57th Annual Meeting of the American Academy for Cerebral Palsy and Developmental Medicine, September 10–13, 2003. Montreal, Quebec, Canada.

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