Turkish Journal of Physical Medicine and Rehabilitation 2010 , Vol 56 , Num 1
The Importance of Rehabilitation in the Treatment of Congenital Muscular Torticollis
Alev Çevikol Demirel 1 ,Ebru Umay 2 ,Sema Noyan 1 ,Aytül Çakcı 3
1 Sağlık Bakanlığı Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara
2 Sağlık Bakanlığı Kütahya Yoncalı Fizik Tedavi ve Rehabilitasyon Hastanesi, Kütahya, Türkiye
3 Sağlık Bakanlığı Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara, Türkiye

Objective: The aim of this study was to determine the effect of time to initiation of rehabilitation on the outcomes of treatment in congenital muscular torticollis (CMT) cases between 0-96 months of age and to evaluate the place of rehabilitation in cases with CMT.

Materials and Methods: In our study, 24 patients with CMT were evaluated retrospectively. The patients were divided into 2 groups according to their age on admission; group 1- between 0-6 months of age and group 2- between 6-96 months of age. The demographic features, deformities and type of CMT were assessed. Passive and active range of motion (ROM) of cervical lateral rotation, passive ROM of cervical flexion and extension and head tilt were measured using a goniometer. The head tilt at 1-15˚ was evaluated as mild, 16-30˚ as moderate, and >30˚ as severe. The difference between the heights of the shoulders was measured in centimeters. The parents of both groups were given training for passive and active positioning, stretching and cervical ROM exercises. The patients were followed bimonthly for total of 6 months. 

Results: Of 24 patients included in the study, 13 (54.2%) were in group 1, 11 (45.8%) were in group 2. According to head tilt degree before treatment, 5 (38.5%) patients were mild, 6 (46.1%) were moderate and 2 (15.4%) were severe in group 1; 3 (27.3%) were moderate, 8 (72.7%) were severe in group 2. After treatment, full cervical ROM and neutral position of head were achieved in all patients in group 1 and in 7 (63.6%) in group 2. 

Conclusion: The necessity for surgery can be decreased in all patients with CMT, even if diagnosed in late childhood, if rehabilitation program is applied at least for six months before planning an operation. 

Keywords : Congenital muscular torticollis, early treatment, late treatment, rehabilitatio