Lisa8
23 posts
Feb 13, 2010
1:36 PM
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I have been treating a left torticollis baby for 3 months now. He is now 8 months old. He has made gains but is now left with a mild left head tilt that is not getting better. In the session, the trunk twist and side bend improve but the head tilt remains. Until now I have been concentrating on trunk/pelvis. He does not want anyone around his neck but there is no range restriction, just weakness on right side. When I return next session I have to re-do all the exercises to get back to where the previous session ended. He still dislikes weight bearing/elongation of trunk onto the left side. Mom tries to do activities but he is so active and mobile, she has difficulty.
1. When is it time to practice weight shifts to bad side. It seems like he is too used to weight shifts to the right and I keep reinforcing that.
2. I am thinking the main restriction is in the C-spine so I told mom to weight shift trunk to the right while holding right arm in a raise so she isolates that area. Because long periods of very active positioning in right side lying or any position that encourages right trunk elongation is not working enough to change the head tilt. Any sugguestions on what I am doing wrong. Or am I just not patient. Susan help please.
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SusanPEDPT
77 posts
Feb 14, 2010
3:39 PM
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Please always feel free to call me to discuss challenges! 717 309-1354. There could be many factors here. For one just to clarify I always have the child work on weight shift on the bad side in the new available range immediately after doing the release. This is accomplished by doing butt rocking either on parent's lap pretending they are in a rocking boar or on a ball etc, but never ever past the end of the new easy range.
I may have him laterally bend against gravity on the good side after the release followed by sitting weight shifts. It's use it or lose it - just don't push the bad side only explore with it. Does this make sense? If we challenge the child to move a lot he will be given opportunities to strengthen himself. Again I never push the bad side, but do gentle work in it by doing lots of weight shifting. Let him do something where he has to work hard and use his body within a comfortable range
Second thing. When a kiddo plateaus it is often because the parent isn't being aggressive enough (and often the therapist) I CRANK the child into the good range EG: in twist to the left the right shoulder is at 11:00! In the past I used to be too gentle, but realized that it feels good to go deep into the good side. Don't be afraid to twist The number one reason for delayed progress is need for more INTENSITY, We toss kids in an out of car seats but are afraid of a little twist!
Next are the parents doing Rx 3-5 x per day? It might take that for a while to make a dent in this. I have children w/ tort that I'm seeing for over a year that have related issues (eg: gait delay due to one leg turned out) some of the kiddos are really stuck and it's a very slow process. When they look like they aren't going anywhere and I look at the old videos I do see changes though.
If the pelvis resolves quickly the children have only need between 5-10 visits to get parents totally handling this issue, but if the pelvis is really stuck you are in for the long haul as it isn't going to be just the neck that is an issue.
Finally there is a % of children that have severe upper cervical issues related to vestibular stuff. They may not respond fast w/ TMR, but they did even less with stretching and other typical approaches. Some may need CranioSacral work from someone qualified to treat this area directly. They have benefited from either a therapist or an osteopath that specializes in Cranio to get a jump start on direct treatment at this level. In my discussion with one of the osteopaths he suggested that TMR would ultimately help this indirectly, but the direct approach would get right to it He is fully in favor of TMR as the perfect compliment to what he does
(and he teaches cranio at the med school! ).
I don't do direct treatment at those segments myself but have done some gentle holds at the cranial base or LS decompression tractioning the sacrum myself to complement the TMR.
There may be other factors as well such as visual that are interfering
with your progress. The first thing I'd do is make sure I'm being aggressive enough. Can't comment on a particular child as these are just examples of what I've seen, but I'm happy to discuss further if you'd like to call me or if anyone else with questions would like to as well.
Susan
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Lisa8
24 posts
Apr 01, 2010
2:59 PM
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Susan,
I was getting more results after becoming more aggressive and asking mom to do so as well. Now he is left with a slight lean to the left and I do not know how much more aggressive I can get. He is 9 months and does not tolerate the exercises very well. I tried to call but I keep getting a wrong number message. Is there another number you have?? IF not could you call me at 516-526-6823 and then I can call you right back. I would really like to talk on the phone about this case. Thanks, Lisa
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SusanPEDPT
80 posts
Apr 06, 2010
9:50 PM
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Lisa my phone is ok now. I was out of the country and calls weren't forwarded as they should hVe been but am now back and will call you asap.
Just to add that I have seen much less plateauing with children with torticollis since TMR where as before it
was not unusual to get incomplete correction. Sometimes there is a localized restriction needing extra attention or advanced techniques
We can discss. Susan
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SusanPEDPT
81 posts
Apr 07, 2010
4:33 PM
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Just a follow up after phone call to refresh suggestions.
-Always check all motions - just because ankle dorsiflexion was balanced the last 10 times it may in fact be the key to slower progress.
-Look at the imbalance in arm raise in a baby from the standpoint of tight fascia pulling down into the groin and not as a shoulder joint issue. Looking for restrictions in the tissues in the lower abdomen as chunking in parts and helping the arm raise by treating the good side of the anterior trunk.
(TMR 1 fixes 85% of the issues - we are now talking about the fine tuning needed for the other 15%)
- I do not exercise the neck in artificial positions to lift the head against gravity. Once the rest of the body is balanced you will see things stack up so the neck should be neutral and the child will get strong without extreme positions. Keep in touch! Susan
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13 posts
Jul 16, 2010
5:11 PM
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