I believe that this publication can help, for the levels of evidence it's good.

It is a very good work they have done, I have read several times (I was one of the first draft reviewers) but it is about infants, exercises for older children is not a part. There are a rather small group of children with CMT that continue having problem at older age, mostly for muscular imbalance, these are the ones I want more exercises for. I have some exercises for older children (http://torticollis.dinstudio.se) but wanted to have some more for variation. Thought maybe someone have some to contribute with.

Neck proprioception exercises. I usually ask the children to walk with a book on the vertex of head in neutral neck position without dropping it. It may be part of your existing program.

BTW do you have any reference regarding the indications for surgery in CMT patients? Can surgery be performed for cosmetic reasons?

Limited range of motion, a muscular string and facial asymmetry are indications for surgery. Facial asymmetry can give earlier surgery, but not as the only indicator, there need to be limited motion also.

I think that some articles by Cheng et al can be used as references.

Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis. Clin Orthop Relat Res. 1999 May;(362):190-200.

Cheng JC, Wong MW, Tang SP, Chen TM, Shum SL, Wong EM.

Cheng JC, Wong MW, Tang SP, Chen TM, Shum SL, Wong EM. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases.J Bone Joint Surg Am. 2001 May;83-A(5):679-87.

I rarely use the exercise to wear something on the head any more, more after exercises for strength, have some but sometimes you need more variation.

As orthopaedic surgeon I would say that conservative treatment should be carried out systematically till the age of 2. If CMT persists then surgery is indicated followed by exersices and physiotherapy. The age of 6-7 is late for surgery and the results are not so good. These cases are also difficult for conservative treatment. So I recommend early surgical treatment (2-3 years of age).

The children I had in mind are older children not in need for surgery, they have good range of motion. However they have muscular imbalance in the lateral flexors of the neck that make them tilt the head.

You may try exercises to strengthen the opposite side muscles, but I believe a better outcome (although the right time for surgery is missed) will be achieved if a selective surgical release is performed on the affected side (m. sternocleidomastoideus, m.scalenus anterior, m. scalenus medius).

I was probably not clear enough in my question

I have met children that have had surgery for torticollis the last 17 years, and followed them over the years, it is not the ones that need surgery I had in mind with my question. But I also have met some children that have had the surgery "to late", with facial asymmetry that not improve enough, that is sad.

I already do strengthening exercises for the opposite side, it is effective if done enough. Of course you also have to add postural training, the brain interpret that tilted head to torticollis side is straight and straight is tilted (at least children above the age of 4-5 years interpret the head posture like this), tilted to opposite side is interpreted as tilted. Mostly the "weaker" side need to be somewhat over trained to achieve a straight posture of the head.

The problem when there is "only" muscular imbalance (strength imbalance) is when the children get tired of doing the same exercises (with little variation).

Wanted to know if somebody had any new/other exercises to suggest.

Hi, though it's late response. Its quite surprising for me I was searching for literature on valid outcome measures to measure progress children with torticollis aging around 7 plus years. Recently I have treated 7yr old girl with SCM release where she still maintain tilt whicg seems to be more of habitual adaptation and she is less interested to do traditional exercises. So I tried doing play based exercises like throwing ball and catching towards affected side as well in multi direction, visual cue exercises and head moving towards affected side to touch the pointed stick and balloon tapping with head ... What I observed is her fatigue is less and she is more interested in doing play based exercises where After 5 sessions in 8 weeks, there is less tilt and increased midline perception with improved functional activities..

@Anna M Ohman

Thank you

I have only done one exercise with ball, good to get something new to try

Best Regards

Anna

Is there any valid outcome measures we can use for those age group with torticollis (around 6+ years)?

Anna, have you used the TOT collar for those older children? I have found it effective in some cases but compliance can be a problem.

Regarding the outcome measure for older children, I had done a systematic review of outcome measures for torticollis, but only in infants. However I came across a few papers involving children. These three were looking at reference values for ROM in children: Argoblast et al 2007; Lewandowski & Szulc 2003; Lynch-Caris et al 2008. There are some authors who have looked at measuring abnormal head posture in ocular torticollis e.g. Hald 2011.

Anthea Seager - thank you very much. I couldnt find any functional outcome measure or social participation measures for children's.. Though most of studies look into ROM as measure in infants /children's.

Anthea

Use tot collar only after surgery, for others I am doubtful about collar