Congenital Muscular Torticollis

Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline from the APTA Academy of Pediatric Physical Therapy

A 2018 Evidence-based Clinical Practice Guideline
Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA academy of pediatric physical therapy. Pediatric Physical Therapy. 2018;30:240-290.

Spanish translation of the 2018 CMT CPG by the Spanish Society of Physiotherapy in Pediatrics (www.sefip.org)

USER GUIDE: How to Use Newborn Tips for Positioning and Play

PURPOSE:
The purpose of this document is to provide tips for parents and caregivers of newborns on positioning and play to encourage proper development of posture and movement, and to promote early monitoring for postural difference.

SUGGESTED USE:
This document may be used by healthcare providers (pediatricians, midwives, nurse practitioners, prenatal educators, lactation consultants, physical therapy clinicians) for parent/caregiver education during the prenatal or newborn period as described in Action Statement 1 of the Academy of Pediatric Physical Therapy's Congenital Muscular Torticollis Clinical Practice Guideline.

This document may be used to educate parents and caregivers in a variety of settings. For example, at well baby visitis, during one-to-one meetings with parents, during prenatal/newborn classes, and/or at community health fairs.

POTENTIAL OUTCOME:

• Parents and caregivers will have increased awareness of positioning and play to promote proper posture and development.
• Parents and caregivers will understand signs of CMT (neck muscle tightness and movement preference) to watch for and take appropriate action by alerting their baby's medical provider.
• Following the tips provided in this document may help prevent unequal head shape and movement problems from developing.
• Parents, caregivers and others will be educated about the role of physical therapy in the management of congenital muscular torticollis.
• Reduced episode of care and better outcomes if early monitoring for postural difference results in early detection, referral, and intervention.

USER GUIDE: How to Use 2018 CMT CPG Resource Packet for Parents and Caregivers

2018 CMT CPG Resource Packet for Parents and Caregivers

PURPOSE:
The following resources provide parents and caregivers of infants diagnosed with Congenital Muscular Torticollis (CMT) with information related to the 2018 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG) and how it is used by their physical therapy provider. These resources were designed to be provided by physical therapists and physicians to parents and caregivers. Individual review with recipients is highly recommended for optimal introduction, education, and support.

This Knowledge Translation (KT) Intervention targets the following Knowledge Broker Role Domains:

• Information Management - by packaging educational materials for immediate use
• Capacity Development - by providing educational materials with reminders to follow best practice guidelines
• Linkage and Exchange - by engaging parents and caregivers in their role as a key stakeholder in the management of CMT

SUGGESTED USES:

1. Clinician: Individual clinicians may distribute these handouts to families, caregivers and other health care providers in conjunction with their management of infants with congenital muscular torticollis. The documents should be reviewed with parents and caregivers individually in order to adapt the knowledge to the unique needs of each recipient.
2. Groups and organizations: Groups and organizations may use these resources to guide discussion, education, or to identify opportunities for program development for the care of infants with CMT. These resources may be shared via social media to promote uptake of the CMT CPG.
3. Continuing education providers: Continuing education providers may use these resources as handouts to supplement their presentation.
4. Other health care providers: Referral sources may distribute these resources to parents and caregivers at the point of diagnosis and referral to physical therapy.
5. Caregivers: Parents and caregivers of infants at risk for or diagnosed with CMT may download the handouts directly for reference.

POTENTIAL OUTCOMES:

1. Increased awareness of the CMT CPG content.
2. Earlier referrals to physical therapy for newborns and infants with CMT.
3. Improved communication between all stakeholders in the management of infants with CMT.
4. Identification of needs related to parent education and collaboration during management of infants with CMT.
5. Targeted education for parents and caregivers to improve knowledge, skills and abilities in caring for their infants with CMT.
6. Improved empowerment of parents and caregivers of infants with CMT, resulting in increased parent involvement in all aspects of care and intervention.
7. Ultimately, improved care and outcomes for infants with CMT.

USER GUIDE: How to Use 2018 CMT CPG Discharge Guide

2018 CMT CPG Discharge Guide

PURPOSE:
The purpose of this document is to assist all key stakeholders in the discontinuation and discharge process from physical therapy for infants/children being treated for congenital muscular torticollis (CMT). The document identifies discontinuation and discharge criteria as well as signs of posture and movement differences that may warrant another episode or continuation of direct physical therapy.

SUGGESTED USE:
This document is intended for use by physical therapists when communicating with medical providers and parents/caregivers regarding:

1. Criteria for appropriate discontinuation and/or discharge from physical therapy.
2. Signs indicating necessity for an infant/child to return to physical therapy for additional evaluation/intervention following discharge.

The document may be used at anytime during the episode of care. For example:

• Clinicians may present the document during an initial visit to make parents aware of the path toward discharge and the specific criteria being monitored.
• The document may be presented at the time of discontinuation and/or discharge as a reminder to parents of signs warranting another referral for direct physical therapy.

POTENTIAL OUTCOME:

1. Parents/caregivers, medical providers, and other key stakeholders will:
• Understand the criteria indicating readiness for discontinuation and discharge from physical therapy that include:
  • Passive cervical ROM within 5 degrees of the non-affected side
  • No visible head tilt
  • Age appropriate motor development
  • Equal symmetrical active movement patterns
  • Caregiver's understanding of the exercises and monitoring
• Understand signs warranting another episode of direct physical therapy.
2. Episodes of physical therapy care will be planned efficiently according to specific criteria for discontinuation and discharge.

USER GUIDE: 2018 CMT CPG Resources for Healthcare Providers

2018 CMT CPG Resource Packet for Healthcare Providers

PURPOSE:

The following resources provide physicians and health care providers of infants at risk for or diagnosed with Congenital Muscular Torticollis (CMT) with information based on the 2018 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG) published by the Academy of Pediatric Physical Therapy. These resources were designed to be provided to and reviewed with Pediatricians, Neonatologists, Nurse Practitioners, Physician Assistants and other health care providers who refer infants to physical therapy.

This Knowledge Translation (KT) Intervention targets the following Knowledge Broker Role Domains1:

• Information Management - by packaging educational materials for immediate use
• Capacity Development - by providing educational materials with reminders to follow best practice guidelines
• Linkage and Exchange - by engaging physicians and health care providers in their role as a key stakeholder in the management of CMT

SUGGESTED USES:

1. Clinicians: Clinicians may distribute the handouts to physicians, health care providers and other referral sources. Individual discussions are recommended in order to adapt the knowledge to the unique needs of each recipient and answer relevant questions.
2. Groups and organizations: Groups and organizations may use these resources to guide discussion, education, and/or to identify opportunities for program development for the care of infants with CMT. These resources may be shared via social media to promote uptake of the CMT CPG.
3. Continuing education providers: Continuing education providers may use these resources as handouts to supplement their presentation.
4. Other medical providers: Referral sources may access these resources online for rapid reference and education of relevant key points to support their practice decisions.

POTENTIAL OUTCOMES:

1. Increased awareness of the CMT CPG content.
2. Earlier referrals to physical therapy for newborns and infants with CMT.
3. Improved communication and collaboration between all stakeholders in the management of infants with CMT.
4. Identification of needs related to education and collaboration during management of infants with CMT.
5. Targeted education for health care providers to improve knowledge in caring for their infants with CMT.
6. Ultimately, improved care and outcomes for infants with CMT.

2018 CMT CPG Clinician Self-Assessment

PURPOSE:
The purpose of this document is to provide physical therapy clinicians with a self-assessment tool related to knowledge and use of the 2018 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG). This self-assessment is designed to assist clinicians in gauging knowledge, skills, attitudes, and factors impacting use of the CMT CPG.

The CMT CPG provides 17 action statements within 4 domains including: Education; Identification and Referral; Physical Therapy Examination; Physical Therapy Intervention; Discontinuation; Reassessment, and Discharge.

INSTRUCTIONS FOR USE: When using this self-assessment, individuals may select all or some parts of the tool to meet their need. All parts of the self-assessment may be completed at once or in stages to meet the need of the user(s).

2018 CMT CPG Updates Educational PowerPoint

This resource is meant for use by physical therapy clinicians who work with infants to inform users of the APTA Pediatrics 2018 update of the Congenital Muscular Torticollis (CMT) Clinical Practice Guideline (CPG).