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Torticollis and Plagiocephaly: What is it? How can it affect your baby?

Baby in White OnesieTorticollis is a turning and/or tilting of the neck causing restriction in the available range of motion. This can cause the neck to be turned or tilted away from midline and difficult to move the head to a particular side. For example, the neck at rest can be turned towards the right and tilted towards the left, giving the appearance of a “twisted” position. Torticollis with this alignment can make it difficult to move the head in the opposite directions: rotating left and tilting right. The causes of torticollis can be from pain, stiffness, head/neck injury, or muscle spasm.
Torticollis can occur across the lifespan from newborns to adulthood. The difference for newborns and infants is that their skulls are largely cartilaginous and can be shaped. This combination of malleable shaping of the head and torticollis can result in a progressive flattening of a particular side or portion of the head due to any constant turning to a side, away from midline at rest. This flattening is referred to as plagiocephaly. Flattening can be congenital, developed in utero, or can be related to head position (i.e. with toricollis); in the latter case, the flattening is termed positional plagiocephaly and is often linked with torticollis. It is important to note that although toricollis and plagiocephaly affect the shape of the head, there are no direct affects on brain development or function.
If there are concerns with the baby’s neck range of motion or positioning, physiotherapy can help guide stretches and exercises to restore full range of motion. There are additional concerns with plagiocephaly, physiotherapy can help with establishing exercises are strategies to counteract this shaping.
Questions or concerns regarding your child? Book your 15 minute free consultation today! 

Paediatric Milestone series: Activities in Supported Standing

Before we discuss independent standing and standing up without using support, it would be appropriate to consider simple exercises when the child is standing at the couch, ottoman, coffee table, etc. In fact, this is quite a critical period for the child to master their body in space when trying to stand and balance at their support surface.

 

Once the child is up and standing at their preferred support surface, placing toys or any other item of interest just out of reach on the couch is an excellent activity to practice weight shifting and challenging the boundaries of their balance while they are well supported. During a single lateral reach, the child will shift their body and take more weight on the same-sided leg and foot. This simple and subtle movement is so important because this allows the child to unweight the opposite leg and foot. With progression and strengthening, complete lifting of the opposite foot from the ground will be achieved to reach even further. Mastery of this combination of weight shifting and balancing is incredibly important because this skill is absolutely necessary for walking; weight shifting onto a single leg, lifting the opposite leg, and progressing the unweighted leg and foot forward to walk.

 

For continued balance and strength development, encourage rotation and reaching away from their support. Start by using a toy on the couch or table and slowly pull the toy out of reach along the surface and more towards the side of the child to encourage reaching away from their support. Continue to repeat this to both sides and within their tolerance, ensuring to give breaks as needed. Gradually increase how far the child reaches in an arc around their reaching radius until they can almost reach behind by rotating at the trunk and waist with a hand still on their support. Again, this exercise is working their ability to weight shift and balance at the same time; however, with rotating and balancing as well, we are working on trunk strengthening with movement to build strong core muscles to support the trunk and upper body when it is time for standing and walking independently.

 

Of course, during these activities it is important to give plenty of positive reinforcement and feedback to demonstrate the importance and excitement of standing, reaching, rotating, and moving.

 

We will take another detour before we get to independent standing up; we will first discuss cruising along their support on the next blog post.

 

By: Chris Dahiroc, PT.

 

Questions or concerns regarding your child’s development? Contact us for your free 15 minute meet and greet today!

Reaching the next milestone: ground to standing

Getting into a standing position independently is a massive and exciting milestone for a developing child. The progression of developing this important skill goes from the child pulling to stand at support with their hands, to standing up with support at the hips, to standing up independently and hands-free. In this post, we will cover pulling to stand.

The height level of the support surface that a child pulls to stand is a big factor in determining successful standing. Generally, the higher the surface, the more support that it will provide, making it easier to pull into standing. Using the couch (with the seat cushions in place) is a common place to start. Place toys of interest at the elevated surface to draw the child’s attention. Ideally, this should draw the child towards the couch and crawl up the face of the couch and place them in a kneeling position with their hands on-top of the couch. From here, encourage the child to take a step forward with a foot into a half kneeling position, then stand up from this position. Hands-on support can be provided throughout these movements to help the child along. As this transition becomes easier, lower the support surface; this can be easily done by removing the couch cushions, and progressing to even lower support like a step stool. As the support decreases, there is more demand on the legs and balance to stand up, driving the strengthening process.

Once the child is up and standing at support, the previous activities discussed in the previous post can be easily practiced to bring together all of their skills. After they have spent some time standing and need a rest, the transition to the floor is essentially reversed: standing to half kneeling, and half kneeling to high kneeling.

Next post will continue with the theme of standing up, but this time without using the hands to pull for help.

By: Chris Dahiroc PT.

 

Questions or concerns regarding your child’s development? Contact us for your free 15 minute meet and greet today!

#MilestoneMonday / Walking Part II

As previously discussed, standing is a critical piece to a baby’s gross motor skill and physical development. Perhaps above all, its an additional means that allows a baby to explore and interact with their environment. This week, we will discuss activities that standing with support and independent standing can be facilitated.baby standingpart

Early on, (i.e. in the first months of life) prone positioning, or ‘tummy time’ is an important strengthening activity to practice. Although at this point, standing is not a short term goal to learn, it is valuable to emphasize the importance for spending some time in prone. This is because laying on the abdomen gives babies a chance to work on the strength of their extensor muscles through their hips, back, and neck. This is so important because these muscle groups are essentially their ‘anti-gravity’ muscles that will provide the necessary strength to achieve and maintain standing. Given this, I realize that tolerance for ‘tummy time’ for some children is limited. In this case, it is important to gradually build their tolerance for this position and present them with activities, toys, and faces they can interact and explore to create a positive experience. Additionally, providing support at around chest level can be used to reduce the strength requirements for prone positioning. This can be done with hands at the chest level and under the arms or a rolled up towel or soft stuffed toy in the same position.

For early standing activities to encourage weight to be taken on the feet, support should be provided at the chest and under the arms. In this position, it should feel as though the child is providing resistance at their legs to remain standing, but cannot quite take their full weight. In this position, you can be facing each other or in the same direction, depending on the baby’s attention and interest. While working on this standing with high support position, you can sustain a stand for longer if they are playing with a toy, or if they enjoy movement, you can work on bouncing on this position with your hands guiding the movement, but allowing them to participate by pushing through their feet. As their strength and balance improve, the goal is to reduce the amount of support that is provided by moving the hands from the chest to the waist, and then to the hips. This way, the amount of weight that they must manage is increased, in addition to balancing their trunk above your hands to maintain standing.

standingagainstfenceAlso, a great way to get more weight bearing on a baby’s legs to play in a kneeling position at a support surface such as a couch. This position gives significant input into the hips, namely, the gluteal muscles that are powerful extensors of the hip. When performing this activity, you may find that the infant may alternate between high kneeling and low kneeling (on the knees, but the buttocks resting on their heels). This is a great activity because they are actively using their hip extensors to bring themselves into an elevated position, thus working on anti-gravity strength at their hips.

As the baby develops their strength and they are looking to become more independent, standing at a support surface may be an activity that would be appropriate. This is significant step, because again, this promotes the independence of the child to allow them to be more explorative. Initially, their positioning will be square to their supportive surface (as previously discussed in the previous post). Here, we want to work on the ability to manage small weight shifts left and right and ultimately master movement in the frontal plane. This can be facilitated by providing support at the hips, and guiding their weight to shift left and right; combine this with toys or objects the child likes just within their reaching range, and they will begin to learn the value to weight shifting to extend their exploration abilities.

As with all activities that involve strengthening, be sure to monitor the infant’s tolerance closely. If you find that new activities require a big effort, then short and frequent bouts of activities may be more tolerable.

For the next post, we will talk about strategies for transitioning into a standing position from the ground.

By: Chris Dahiroc P.T.

If you have any concerns or questions contact us to book your free 15 minute meet & greet today!

#MilestoneMonday / Standing

Gaining verticality is an exciting perspective for your developing baby. Like sitting up, this opens up more possibilities for interaction and discovery. Weight bearing on their feet against gravity is also a major stimulus for babies’ musculoskeletal development. Additionally, standing can be viewed as a precursor to stepping and walking. Independent standing is usually learned near 12 months; however, the work towards standing alone begins with standing with support, which is much earlier. Standing at a supportive surface is typically learned at 6 months.

baby standingBefore one can learn how to stand independently they must first master their base of support, and how their centre of balance interacts with their movements within this area. To simplify this relatively complex interaction, it is best to minimize the number of degrees of freedom of movement that the baby has to account for when trying to stand. For reference, we can move in three planes; they are the sagittal (front and back), frontal (side to side) and transverse (rotation) planes. This is achieved by the supportive surface. For an early stander, they would be facing squarely to the surface, with both hands firmly placed on the support. This position removes the balance requirements that the baby is required to account for moving forwards and backwards (in the sagittal plane), and rotating left and right (in the transverse plane).  This leaves only lateral weight shifting movements to the sides relatively “free” (in the frontal plane). Yet, as we will learn, babies seem to be built to have some inherent stability in the frontal plane to facilitate learning movement in this plane.

When a baby is attempting to stand at a surface, one may notice that the baby’s feet are quite widely spread. Early in the baby’s skeletal development, their alignment through their legs are actually biased to have to be wider to be more stable when weight bearing.  In fact, a baby may appear to be “bowlegged” early in their alignment, but this is to be expected, because as they physically mature, this alignment is expected to resolve into a more neutral alignment where their feet are narrower and legs have a straight appearance. However, this immature alignment effectively widens the base of support and lowers the centre of gravity, thus making the child more stable. Thus, this developmental stability allows for slight weight shifting standing2movements left and right that the child can explore when standing at support. As a result, the first component of standing that a baby will learn is mastery of the frontal plane in standing, or, weight shifting left and right in standing. Yet, this makes a lot of sense that they would achieve this first, because weight shifting left and right is a critical component of walking; taking the full weight on one foot is necessary to unweight the other foot for movement. Mastery of weight shifting allows the baby to learn and explore cruising steps left and right, and ultimately culminates in taking steps forward.

Also, when learning how to stand at a support, there is the additional layer of the strength that is needed to support their bodies in a position where they are weight bearing on their feet. This means that their anti-gravity muscles through their legs and trunk must work in synergy to achieve standing. Early on, when standing at support, their arms must also work in unison with the rest of their body to maintain standing. It will be difficult early on to maintain standing, so babies tend to hold on to their support surface with everything they have; they will hold on with their arms, and may lean their trunk against the supportive surface. For some with gross motor delays, this tends to persist well passed 12 months, where they prefer to rest their bodies against a support surface. Although this may be a functional position, this eliminates the use of their trunk and leg muscles to provide them with balance when they are standing. Thus, an important strengthening opportunity is missed.

MILESTONEMONDA

In the next post, we will discuss activities that can be performed to facilitate standing at support and standing.

By: Chris Dahiroc P.T.

If you have any concerns or questions contact us to book your free 15 minute meet & greet today!

#MilestoneMonday / Crawling

crawl postCrawling is a milestone that babies typically learn between the ages of 7 and 9 months. As with any milestone, there is variability around when infants master this skill. Nonetheless, crawling is a tremendously important gross motor skill to learn because it gives your child a means of transportation to continue their interaction with their environment. This is also a very significant strengthening opportunity because the child will be bearing significant weight on their hands. Thus, this is facilitating hand strength, which builds the foundation for in-hand and fine motor skills.

 

Included in this weeks entry of #MilestoneMonday is an article that highlights the importance of crawling. You can be redirected here: http://www.babble.com/baby/crawling-is-crucial/

keepcalmandcrawl

If you have any concerns or questions contact us to book your free 15 minute meet & greet today!

#MilestoneMonday / Sitting

Sitting up is a crucial component for an infant’s development; this is because this gives the child a completely new perspective of their environment. Also, and perhaps more importantly, sitting allows your infant to use their hands for purposeful play and interaction (i.e. with toys, parents, etc.). As a milestone, independent sitting is expected at around the 6 month mark. But, as with all milestones, this age is an average age, and variability is to be expected.

Before one can sit independently, they must have the necessary neck and trunk control to be able to control their posture in a vertical position. This is where those sessions of ‘tummy time’ yield their results to build the neck strength that allows a child to control their head against gravity. Sitting must also be practiced safely and with support. Support can be provided by a parent or with a pillow; to start, provide this support near the chest level to allow the child to remain upright and play with their hands. As their posture control improves, allow the level of support to fall lower on their trunk, until your support is at their pelvis. When the child is able to sustain this position confidently (with your hand on their pelvis), begin encouraging weight shifting on their pelvis by placing toys within their reach to the side, behind and in front as they are sitting. As they are reaching out to a side, guide them to weight bear onto the arm that is on the same side of the object, promote them to reach with the opposite hand and allow the opposite buttocks to lift by relaxing the support on their pelvis on that side; then return to a sitting position. This task will allow the child to begin to understand how their pelvis interacts with the ground. As they continue to refine these skills and become stronger, try removing support but remain close-by in case of any falls. Or, better yet, perform these practice sits on a soft surface to allow for safe falling.

After sitting is mastered, you can expect more play in this position, transitions into and out of sitting, and continued progression for verticality, namely weight bearing on their feet with support.

For any concerns with your childs development, call us to book your free 15 minute meet & greet today!

By: Chris Dahiroc P.T

#MilestoneMonday / Rolling

November 30,2015

For the first ever entry of #MilestoneMonday, we have decided to post a video on rolling. I think that this video is particularly effective because it emphasizes the importance of the necessary (baby) steps that all contribute meaningfully to completing a given skill; in this case, rolling. Additionally, this video highlights the need for continued practice to refine and master skills, regardless if it is learning early floor mobility, or perfecting a jump shot. Too often, especially for skills appear to be ‘automatic’, we ignore the practice that is required for these skills to become more or less automatic. For future posts on #MilestoneMonday expect some insight from a therapist’s perspective on gross motor skill acquisition and infant development. For now, enjoy the video.

By: Chris Dahiroc P.T.

For any concerns with your childs development, call us to book your free 15 minute consultation today!