A. M. Öhman / Open Journal of Therapy and Rehabilitation 1 (2013) 31-35
34
limited direction, this is more than adult PROM for rota-
tion. For children in need of surgery there is often also a
muscular band that limits the motion. There may not be a
problem if a child has asymmetric but large PROM and
no muscular band, but it may still be important to ob-
serve the child for possible long-term effects. Chang et al.
found that ROM in lateral flexion is limited in those
cases that need surgery. Unfortunately, in the studies that
were found about long-term follow-up [2,5,11,12], there
is a lack of information about raw data and how the
measurements were performed. This makes it difficult to
compare with the current study. Later gestation week and
higher birth weight may be risk factors for later problems
with asymmetric PROM for children with CMT. Chen et
al. screened 1021 newborn infants for CMT with sono-
graphy and found that the infants with CMT were statis-
tically significantly longer and heavier than the norma-
tive group [13]. It is common that mothers of infants
with CMT state that the infant was in the birth canal for a
rather long time before birth. Intrauterine malposition is
one possible cause for CMT; both old and recent studies
support this theory [4,5,14,15].
In the current study 21% still had obvious muscular
imbalance in the lateral flexors of the neck. For those
children with head tilt it was more common with muscu-
lar imbalance than with asymmetric PROM. There is a
need for strategies of how to best prevent later problems
due to muscular imbalance. At the time of the study six
children had minor tilt that was not a problem. However,
the parents have to be observant to notice if it becomes
worse as the child gets older. For the child who had sur-
gery after the study, the parents were not aware of the
problem before the study, but could after the assessment
not understand how they could have missed the obvious
head tilt and muscular band. This reflects that the parents
can become blind to flaws and miss a very obvious head
tilt. We usually tell the parents to observe the child’s
head position once or twice a year until the child stops
growing; they also receive this information in writing.
We have to consider how we can further improve the
information. Chang et al. suggest that infants with CMT
ought to be followed up until four years of age [5].
6. LIMITATIONS
MFS are developed for infants and are not adjusted for
children of an older age. To use it in a modified version
demands experience when assessing children at this age
for this diagnosis. An alternative would be a handheld
dynamometer, but clinical experience has shown that it is
less reliable in younger ages. However for older children,
from about 6 years, the dynamometer seems to function
well [2,8].
7. CONCLUSION
The PROM for rotation as infants, gender and also
birth weight and gestation week may be risk factors for
later asymmetric PROM in lateral flexion and rotation of
the neck. Muscular imbalance in the lateral flexors of the
neck but not necessary asymmetric PROM seems to be a
risk factor for a later tendency of head tilt. This ought to
be taken into consideration when developing guidelines
for long-term follow-up.
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