I. Pastor-Pons1, O. Lucha-López1, M. Barrau-Lalmolda2, I. Rodes-Pastor2, Á.L. Rodriguez-Fernández3, J.M. Tricas-Moreno1
1Universidad de Zaragoza, Zaragoza, Spain, 2Instituto de Terapias Integrativas, Zaragoza, Spain, 3Universidad San Pablo CEU, Madrid, Spain
Background: Positional plagiocephaly (PP) is a frequent cranial deformation in healthy babies and describes a flattened, asymmetric head shape. PP is linked to excess time in supine and congenital muscular torticollis (CMT). Although physiotherapy has shown efficacy in CMT, few studies have been carried out applying an adapted protocol of manual therapy in a controlled study.
Purpose: Analyse the effect of manual therapy on the active rotation range of movement (AROM) of the cervical spine and on neuromotor development in a sample of infants with PP. As a secondary objective, the study of reliability of the measurement of the AROM was proposed.
Methods: 44 subjects were included for the reliability study, sufficient sample to guarantee a good degree of agreement. For the intervention study, 34 subjects were randomly distributed into two groups. Clinical, demographic and anthropometric values were taken. Dependent variables were cervical AROM and neuromotor development. The AROM was measured in each direction in a sitting position with photogrammetry and angle calculation. The Alberta Infant Motor Scale (AIMS) was used for neuromotor development
The intervention group received 10 sessions, once a week, of an integrative pediatric manual therapy (PIMT) protocol and educational physiotherapy and exercises. PIMT is a conceptual model in pediatric physiotherapy that integrates manual techniques and sensory-motor stimulation with the family’s help to improve the development and functionality. The control group received only educational physiotherapy.
The intervention group received 10 sessions, once a week, of an integrative pediatric manual therapy (PIMT) protocol and educational physiotherapy and exercises. PIMT is a conceptual model in pediatric physiotherapy that integrates manual techniques and sensory-motor stimulation with the family’s help to improve the development and functionality. The control group received only educational physiotherapy.
Results: Reliability study
On right AROM, a difference of 3.86º was observed. Without a normal distribution, Bland-Altman graph was used to assess reliability. The mean of the differences was -0.3, so the systematic error is low. In addition it obtained a good agreement. On left AROM, a difference of 1.46º was observed. Bland-Altman graph showed an average difference of -0.3, so the systematic error is low. Furthermore, good agreement was obtained.
Intervention study
Of 34 subjects, 2 were lost so the final analysis covered 15 subjects in the intervention group and 17 in control group. Demographic, anthropometric and development characteristics were comparable in both groups. At the end, the right AROM improved significantly in the PIMT group, from 66.44º to 79.95º while it worsened in a non-significant way in control group, from 76.51º to 74.91º. The left AROM improved significantly in the PIMT group, from 68.36º to 80.44º. In control group, the improvement was also significant, from 62.95º to 70.67º. The improvement index was significantly much better in the right AROM and better in the left AROM in the PIMT group.
Total AROM increased in both groups, significantly in PIMT group. Improvement index was significantly much better in PIMT group. The AIMS improved significantly in both groups, without differences in improvement index.
On right AROM, a difference of 3.86º was observed. Without a normal distribution, Bland-Altman graph was used to assess reliability. The mean of the differences was -0.3, so the systematic error is low. In addition it obtained a good agreement. On left AROM, a difference of 1.46º was observed. Bland-Altman graph showed an average difference of -0.3, so the systematic error is low. Furthermore, good agreement was obtained.
Intervention study
Of 34 subjects, 2 were lost so the final analysis covered 15 subjects in the intervention group and 17 in control group. Demographic, anthropometric and development characteristics were comparable in both groups. At the end, the right AROM improved significantly in the PIMT group, from 66.44º to 79.95º while it worsened in a non-significant way in control group, from 76.51º to 74.91º. The left AROM improved significantly in the PIMT group, from 68.36º to 80.44º. In control group, the improvement was also significant, from 62.95º to 70.67º. The improvement index was significantly much better in the right AROM and better in the left AROM in the PIMT group.
Total AROM increased in both groups, significantly in PIMT group. Improvement index was significantly much better in PIMT group. The AIMS improved significantly in both groups, without differences in improvement index.
Conclusion(s): A specific pediatric manual therapy protocol plus education showed more efficacy in improving cervical active mobility than educational physiotherapy alone. The active cervical rotation ROM appears to be a reliable measurement system in infants with PP.
Implications: This may offer new treatment safely routes for congenital muscular torticollis associated with positional plagiocephaly. Cervical AROM may be a reliable and complementary assessment system in infants.
Funding, acknowledgements: There is no funding source.
Keywords: Congenital muscular torticollis, Positional plagiocephaly, Manual therapy
Topic: Paediatrics
Did this work require ethics approval? Yes
Institution: Aragon Government
Committee: Ethics Committee at the Aragon Health Sciences Institute
Ethics number: No. C.P. - C.I. PI16/0275
All authors, affiliations and abstracts have been published as submitted.
