Alexandra's P.H.A.T.E. (Plagiocephaly, Helmet And Torticollis Education)

Plagiocephaly? Whats That?

noreply@blogger.com (www.alexandrasphate.org) — Sat, 25 Feb 2012 14:52:00 +0000

What is positional plagiocephaly?

Positional plagiocephaly (play-gee-oh-seff-a-lee) is the term used to describe a flattened or misshapen head that may result from crowding within the womb or from an infant being placed in the same position (such as on the back) for long periods of time.

Health care providers also use the term brachycephaly (bray-kee-seff-a-lee) to describe the flattening of the back of the skull. Positional plagiocephaly and brachycephaly often occur together.

The general term plagiocephaly refers to a head that is abnormally shaped from a variety of causes. Positional plagiocephaly is only one type of plagiocephaly. Other types can result from: skull sutures closing too soon (called craniosynostosis); twisted neck present at birth (called congenital muscular torticolis); and fluid around the brain (called hydrocephaly). Plagiocephaly can sometimes be severe and may require surgical treatments.

What causes positional plagiocephaly?

Positional plagiocephaly usually results from an infant being placed in the same position, such as on the back, for long periods of time.

Babies' skulls are soft and are made up of several skull plates. These movable plates have space between them, called sutures, that allow the head to be flexible so that the brain can grow. If the head is left in the same position for long periods of time, the plates move in a way that leaves a flat spot.

The most common causes of positional plagiocephaly include:

Too little time spent upright—sometimes called "cuddle" time
Too little "Tummy Time" when the baby is awake and supervised
Too much time in car seats, carriers, and bouncy seats

Preterm babies are more likely to get flats spots on their heads because their heads are softer than those of full-term babies.

How can I help prevent positional plagiocephaly?

Most cases of positional plagiocephaly can be prevented (and sometimes corrected) by repositioning, which relieves pressure from the back of an infant’s head. Techniques for repositioning include:

Providing "Tummy Time" when your baby is awake and someone is watching. Tummy Time not only helps prevent flat spots, but it also helps the baby's head, neck, and shoulder muscles get stronger as part of normal development. Parents and caregivers can try Tummy Time 2 or 3 times a day, for short periods of time, until the baby gets used to being on the tummy. Once the baby begins to enjoy the position, parents can try longer periods of time or increase frequency of Tummy Time. [link to http://www.nichd.nih.gov/health/topics/Tummy_Time.cfm]
Changing the direction that your baby lies in the crib from one week to the next. For example, have the baby's feet point toward one end of the crib for a few days, and then change the position so his or her feet point toward the other end of the crib. This change will encourage the baby to turn his or her head in different directions to avoid resting in the same position all the time.
Avoiding too much time in car seats, carriers, and bouncers while the infant is awake.
Getting "cuddle time" with the baby by holding him or her upright over one shoulder often during the day.
Changing the location of the baby's crib in the room so that he or she has to look in different directions to see the door or the window.

Healthy babies should be placed on their backs to sleep for naps and at night to reduce the risk of Sudden Infant Death Syndrome (SIDS). It is important to note that even though back sleeping may affect the risk of flat spots on the head, flat spots are much less serious than SIDS and can often be prevented and treated. Parents should not stop placing babies on their backs to sleep, but rather should be sure to offer Tummy Time while awake and use repositioning techniques.

What are the treatments for positional plagiocephaly?

In most cases, flat spots on the head go away on their own once an infant starts sitting up and crawling. Repositioning (described above) can also successfully correct positional plagiocephaly.
If the problem is detected early, more severe positional plagiocephaly can usually be treated successfully under a health care provider's direction. Some options for this treatment include:

A custom helmet that prevents the baby's head from always falling to one side when lying down. Most importantly, it allows the baby’s skull to expand into a more rounded shape as the brain and skull grow.
Custom bands can also be used to help reshape a baby's head. Bands place a small amount of pressure on the baby's skull in the areas that need reshaping. A health care provider adjusts the band regularly as the baby’s head grows.

Using these treatments, the flat spots typically go away in about 2 months to 4 months.
If the abnormal shape is the result of some other disorder, and is not related to position, a health care provider may also recommend helmets and bands. Or, if the head is severely misshapen or the result of craniosynostosis, surgery may be required to correct the problem.

Talk to your health care provider about your baby’s head shape at each well-baby checkup.

Source: Eunice Kennedy Shriver | Nat'l Institute of Child Health and Human Development

If you would like more information on Plagiocephaly, Torticollis or Cranial Remolding Helmets, please feel free to conact us here.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
http://draft.blogger.com/gary@alexandrasphate.org

Stretches for Torticollis

noreply@blogger.com (www.alexandrasphate.org) — Fri, 24 Feb 2012 17:07:00 +0000

Torticollis (wry neck) is a symptom that causes a child's chin to be rotated to one side and his head to the other side. Disorders that can cause torticollis include congenital muscular torticollis, acquired torticollis, atlanto-axial rotary subluxation, and spasmus nutans (head tilt, nystagmus and head nodding).

Congenital muscular torticollis occurs when the sternocleidomastoid muscle on one side of your infant's neck becomes tighter than the other, pulling the head and neck to that side. This can occur when scar tissue forms in this muscle so that it can't grow properly. Congenital torticollis is sometimes the consequence of injury to the muscle during delivery, although it is also thought that it may occur prior to delivery and be a contributing cause to a difficult birth and not its consequence. It can also be caused by congenital abnormalities of the cervical spine, so sometimes xrays are required in evaluating newborns with torticollis.

If the right sternocleiomastoid muscle is affected, the infant will hold his head with his chin rotated to the left and his head rotated to the right. In addition to the head posture, you may be able to feel a lump in the affected muscle, which is usually most noticable between 2 and 8 weeks of age. Unlike acquired toticollis, congenital muscular torticollis is usually painless.

Congenital muscular torticollis usually improves with range of motion and stretching exercises and massage, but it can lead to positional plagiocephaly and facial asymmetry if your child's head lies in the same position all of the time. If it isn't quickly improving, then your child may need to be evaluated by a physical therapist. In cases that aren't improving by 12-18 months, a surgical release/lengthening of the sternoidcleidomastoid muscle may be required.

Here are some stretching exercises recommended to help with Torticollis. These exercises are provided by KeepKidsHealthy.com:

Instructions for Stretching and Positioning Left Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.
Instructions for Stretching and Positioning Right Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.

If you have any questions or need more information regarding torticollis, please fill out the "contact me" form below or call 412-860-4557.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
gary@alexandrasphate.org

What does torticollis look like??

noreply@blogger.com (www.alexandrasphate.org) — Fri, 24 Feb 2012 16:57:00 +0000

This lack of movement, caused the sternocleidomastoid muscle to be tight on her left side(Torticollis or Wry Neck). We have created a video to show parents the signs of Torticollis in infants. Initially, most won't see any issue with the photos, but it is plain as day. If you know what Torticollis looks like. Had we been able to view this early on in Alexandra's life, we would have know right away, what Tortcollis looks like. You can link directly to the video by clicking here.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557

mailto:412-860-4557Gary@alexandrasphate.org

Meet Cazzy!

noreply@blogger.com (www.alexandrasphate.org) — Fri, 24 Feb 2012 00:56:00 +0000

Meet Cazzy. He received his helmet in January of 2012. His journey has just begun, but he still has a big, big smile on that cute little face. Best of Luck Cazzy! See our other STARband kids by visiting our website at www.alexandrasphate.org/

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
http://www.blogger.com/gary@alexandrasphate.org

Welcome Emily to our STARband blog family!

noreply@blogger.com (www.alexandrasphate.org) — Fri, 24 Feb 2012 00:25:00 +0000

Please check out our newest blogging family. Emily has just started her STARband journey and has invited us along for the ride. You can follow her journey here.

You can also visit her blog by visiting http://myhelmetbabysquared.wordpress.com/

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.

Pittsburgh, PA
412-860-4557
http://www.blogger.com/gary@alexandrasphate.org

Alexandra's P.H.A.T.E. --Welcome Natalie to our STARband Family!

noreply@blogger.com (www.alexandrasphate.org) — Tue, 01 Nov 2011 23:17:00 +0000

Hi Friends. Meet Natalie. She is our newest addition to our STARband family. We were able to make a donation of a STARband to Natalie and her family. Special thanks to Blake at Orthomerica, Inc. and Level Four Orthotics. Without their help, we wouldn't have been able to assist this family in need. Kudos to everyone involved.

Natalie's family will be blogging on our website HERE . Check it out and stop back often for updates on her progress.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Do you know what Torticollis Looks Like? We didn't either!

noreply@blogger.com (www.alexandrasphate.org) — Fri, 28 Oct 2011 15:49:00 +0000

Gary Tate Jr. President and Founder Alexandra's P.H.A.T.E. Pittsburgh, PA 412-860-4557

gary@alexandrasphate.org

How Is Plagiocephaly Different From Craniosynostosis?

noreply@blogger.com (www.alexandrasphate.org) — Mon, 24 Oct 2011 23:05:00 +0000

What is deformational plagiocephaly?

Deformational (or positional) plagiocephaly refers to a misshapen (asymmetrical) shape of the head (cranium) from repeated pressure to the same area of the head. Plagiocephaly literally means "oblique head" (from the Greek words "plagio" for oblique and "cephale" for head).

How is deformational plagiocephaly different from craniosynostosis?

Craniosynostosis is premature fusion of one or more of the sutures in the skull. True synostosis may limit the size of the cranial vault (skull) and therefore impair brain growth. The diagnosis is made after a clinical evaluation by a craniofacial surgeon and/or a neurosurgeon. X-rays and CT scans of the head may be performed to confirm the diagnosis of craniosynostosis. Surgery is usually the recommended treatment.

In deformational plagiocephaly, there is no fusion of the skull sutures. It is a clinical diagnosis made after a thorough medical history and physical examination by a craniofacial surgeon or neurosurgeon. X-rays and/or CT scans are usually not necessary. Treatment of deformational plagiocephaly generally includes positioning and/or helmeting.

The major differences between craniosynostosis and deformational plagiocephaly are summarized in the chart below:

	craniosynostosis	deformational plagiocephaly
head shape:	asymmetrical head	asymmetrical head
results from:	internal events	external molding
fusion of cranial sutures:	premature fusion of cranial suture(s)	normal cranial sutures
diagnosis:	made with x-rays and CT scans	usually made without x-rays and other imaging studies
treatment:	surgery	positioning and/or helmeting
causes:	unknown	may include back sleeping, restrictive intrauterine environment, muscular torticollis, prematurity

What causes deformational plagiocephaly?

By keeping an infant's head in one position for long periods of time, the skull flattens (external pressure). Occasionally, a baby is born with this flattening because of a tight intrauterine environment (i.e., in multiple births, small maternal pelvis, or with a breech position). Other factors which may increase the risk of deformational plagiocephaly include the following:

muscular torticollisOne cause of deformational plagiocephaly may be muscular torticollis. Muscular torticollis is a congenital (present at birth) finding in which one or more of the neck muscles is extremely tight, causing the head to tilt and/or turn in the same direction. Torticollis is often associated with the development of plagiocephaly since the infant holds his/her head against the mattress in the same position repeatedly.
prematurityPremature infants are at a higher risk for plagiocephaly since the cranial bones become stronger and harder in the last 10 weeks of pregnancy. Also, since many premature infants spend extended periods of time in the neonatal intensive care (NICU) unit on a respirator, their heads are maintained in a fixed position, increasing the risk for this condition.
back sleepingInfants who sleep on their backs or in car seats without alternating positions for extended periods of time are also at a higher risk for deformational plagiocephaly.

Treatment for deformational plagiocephaly:

Specific treatment will be determined by your child's physician based on the severity of the deformational plagiocephaly. Frequent rotation of your child's head would be the first recommendation once your infant has been diagnosed with plagiocephaly. Alternating your infant's sleep position from the back to the sides, and not putting infants on their backs when they are awake may also help prevent and treat positional plagiocephaly. Some cases do not require any treatment and the condition may resolve spontaneously when the infant begins to sit.

If the deformity is moderate to severe and a trial of re-positioning has failed, your child's physician may recommend a cranial remodeling band or helmet.

How does helmeting correct deformational plagiocephaly?

Helmets are usually made of an outer hard shell with a foam lining. Gentle, persistent pressures are applied to capture the natural growth of an infant's head, while inhibiting growth in the prominent areas and allowing for growth in the flat regions. As the head grows, adjustments are made frequently. The helmet essentially provides a tight, round space for the head to grow into.

How long will my child wear a helmet?

The average treatment with a helmet is usually three to six months, depending on the age of the infant and the severity of the condition. Careful and frequent monitoring is required. Helmets must be prescribed by a licensed physician with craniofacial experience.

Source: Lucile Packard's Childrens Hospital at Stanford

If you have any questions, or need more information, please fill out the "contact me" for below or call 412-860-4557.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
gary@alexandrasphate.org

Pay It Forward! 10th Annual Children's Hospital Toy Drive in Memory of Sammy Tennyson.

noreply@blogger.com (www.alexandrasphate.org) — Fri, 21 Oct 2011 16:31:00 +0000

Hi PHATE friends. We know this is early, but we really wanted to help The Tennyson's with the Chidren's Hospital Toy Drive this year. In Memory of Sammy Tennyson.

It is time for us to PAY IT FORWARD and we are hoping you can help.

For more information, contact us at gary@alexandrasphate.org

LOOKING FOR A GOOD CAUSE OR CHARITY TO GIVE TO THIS HOLIDAY SEASON?

10th Annual Children’s Hospital Toy Drive in Memory of Sammy Tennyson

Our family is getting ready to load up the U-Haul and play Santa once again!

We are collecting new toys and donations to be hand delivered to Children's Hospital of Pittsburgh before Christmas.

This will be our 10th Annual toy collection drive in loving memory of our son Sammy Tennyson who passed away 4 days before Christmas in 2001. We decided that year to donate all of his Christmas presents to Children's Hospital in Pittsburgh since he spent so much time there. Sammy had a very rare Metabolic disorder called Carnitine Acylcarnitine Translocase Deficiency (CACT), where your body is unable to absorb certain fats for energy. He is only 1 of 30 cases ever reported. Each year we will continue this tradition in loving memory of our son.

So, if anyone is interested in donating, we are accepting any kind of new toy from: books, videos, board games, puzzles, Barbie's, stuffed animals and toys for teenage kids too! All toys must be new but books, DVD’s and video games may be used if they are still in good shape. We will also accept monetary donations that will be combined to purchase items such as Playstations, XBOX, video games, DVD players, etc for the play rooms. Checks can be made payable to Lisa Tennyson and they will be combined together to purchase gifts donated in the name of our son, Sammy Tennyson.

The purpose of our toy drive is to brighten a child's life and let them forget about their pain even if it is only for a little while. Toy donations will be given to the Child Life Department, Children’s Hospital of Pittsburgh. This department provides activities, toys, movies, and other special projects for the in-house patients. (Any and all donations that are not given out at Christmas will be used throughout the year for prizes such as Bingo or other games, birthdays, etc.)

All toys must be "UNWRAPPED" due to security reasons and this also gives the opportunity for the staff to give each child an age-appropriate toy.

Toys or donation can be mailed to:

Lisa Tennyson
25 Fayette Ave
Oakdale, PA 15071
Email: douglas.tennyson@verizon.net
Phone # 724-693-2705

We would be more than happy to come pick it up! We are taking donations up to Monday December 19th and will be delivering them to Children’s Hospital on Wednesday, December 21st.

We’d like to thank everyone in advance and wish all of you a happy and healthy Holiday Season!

Happy Holidays!

Doug, Lisa, Brad & Lucas Tennyson

If you would like to make a donation to Sammy's Children's Hospital Toy Drive via Alexandra's PHATE, please visit our website at http://www.alexandrasphate.org/donate_phate.html. Please designate your donation as being for the toy drive, so that we can distribute the funds, accordingly.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
http://www.blogger.com/gary@alexandrasphate.org

New Additions to Alexandra's PHATE's STARband Journey Blogs!

noreply@blogger.com (www.alexandrasphate.org) — Wed, 19 Oct 2011 17:10:00 +0000

Hi Alexandra's PHATE friends and fans. We have two new family Journey Blogs starting this week.

1. Aiden's STARband Journey
2. Mirick's STARband Journey

These new blogs will allow you to follow these family's and their children's paths in dealing with Plagiocephaly, Torticollis and Helmet Remolding Therapy.

If there are any other families interested in participating in the blogging program. We would be appreciative in you allowing us to follow your journey. Your input will assist families to come with some of the obstacles and issues during the treatment process. Please feel free to contact us by filling out the "contact me" form below. You can also visit our website at www.alexandrasphate.org

Best Regards,

Gary Tate Jr.
President and Founder

Alexandra's P.H.A.T.E.

Pittsburgh, PA

412-860-4557

Gary@alexandrasphate.org

Stretching Excercises for Torticollis.

noreply@blogger.com (www.alexandrasphate.org) — Wed, 19 Oct 2011 00:48:00 +0000

Torticollis (wry neck) is a symptom that causes a child's chin to be rotated to one side and his head to the other side. Disorders that can cause torticollis include congenital muscular torticollis, acquired torticollis, atlanto-axial rotary subluxation, and spasmus nutans (head tilt, nystagmus and head nodding).

Congenital muscular torticollis occurs when the sternocleidomastoid muscle on one side of your infant's neck becomes tighter than the other, pulling the head and neck to that side. This can occur when scar tissue forms in this muscle so that it can't grow properly. Congenital torticollis is sometimes the consequence of injury to the muscle during delivery, although it is also thought that it may occur prior to delivery and be a contributing cause to a difficult birth and not its consequence. It can also be caused by congenital abnormalities of the cervical spine, so sometimes xrays are required in evaluating newborns with torticollis.

If the right sternocleiomastoid muscle is affected, the infant will hold his head with his chin rotated to the left and his head rotated to the right. In addition to the head posture, you may be able to feel a lump in the affected muscle, which is usually most noticable between 2 and 8 weeks of age. Unlike acquired toticollis, congenital muscular torticollis is usually painless.

Congenital muscular torticollis usually improves with range of motion and stretching exercises and massage, but it can lead to positional plagiocephaly and facial asymmetry if your child's head lies in the same position all of the time. If it isn't quickly improving, then your child may need to be evaluated by a physical therapist. In cases that aren't improving by 12-18 months, a surgical release/lengthening of the sternoidcleidomastoid muscle may be required.

Here are some stretching exercises recommended to help with Torticollis. These exercises are provided by orthoseek.com:

Instructions for Stretching and Positioning Left Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.

Instructions for Stretching and Positioning Right Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.

If you have any questions or need more information regarding torticollis, please fill out the "contact me" form below or call 412-860-4557.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
gary@alexandrasphate.org

It's A Great Day at Alexandra's P.H.A.T.E.

noreply@blogger.com (www.alexandrasphate.org) — Tue, 18 Oct 2011 21:37:00 +0000

It's A Great Day At Alexandra's P.H.A.T.E.. Today we were able to help another family in need with the donation of a STARband. With the help of the Davis Family, Family Orthotics in Kearney, NE and Blake at Orthomerica, we were able to come through and make the donation. We couldnt have done it without your endless cooperation.

Thanks to everyone involved.

For more information visit www.alexandrasphate.org

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Everything Plagiocephaly and Torticollis. Long Read, but very informative.

noreply@blogger.com (www.alexandrasphate.org) — Mon, 17 Oct 2011 21:45:00 +0000

In 1992, the American Academy of Pediatrics initiated the “Back to Sleep” campaign recommending that infants be placed to sleep in the supine position to reduce the incidence of sudden infant death syndrome (SIDS). Although there was a significant decrease of approximately 40% in the occurrence of SIDS, the practice creates a condition of flattening of the occipital area referred to as positional plagiocephaly, which has increased sixfold. Plagiocephaly is derived from the Greek word meaning “oblique head”. In addition to the asymmetrical head shape, infants present with a head tilt, reduced range of cervical motion, and a form of torticollis apparently associated with positional plagiocephaly. The significant increase of plagiocephaly, is as high as 48%. The associated increase in muscular torticollis is 84%. Positional plagiocephaly and secondary muscular torticollis increased in incidence is a concern because it has a strong influence on the effects of child development. Evidence-based practice identifies that an infant needs to receive early assessment and treatment to correct these conditions that are acquired in the first several weeks of life. A plethora of research is available on the internet, as well as accessible in medical journals regarding the prevention, care, assessment and rehabilitation of these musculoskeletal injuries. Parental support sites are available for additional information on these subjects.

A variety of developmental problems exist that could be interesting to research to gain more knowledge that would be beneficial in treating children. It is a con to isolate the resources to such a concentration on one subject. The negative aspect of focusing just on positional plagiocephaly and secondary muscular torticollis is that the two conditions have multiple causes and different versions of injury that may be attributed to more than just supine positional compression.

Positional head deformities are caused by external pressures placed on a quickly developing skull. The infant’s head becomes deformed as the result of external modeling forces applied prenatally, postnatally or both. The increased use of car seats and carriers has been an attributing factor to positional plagiocephaly. Sleeping in the supine position and feedings always offered from the same side correlate with a positional head deformity. Plagiocephaly occurs first and predisposes other forms of neck imbalance. Torticollis may occur in association with plagiocephaly; each condition exacerbates the other or, successful treatment of one demands recognition and then treatment of the other condition. Plagiocephaly associated torticollis; the onset is immediate and appears to be related to the infant adopting a favored sleeping position usually lying supine with the head turned to one side. Ipsilateral sternocleidomastoid (SCM) muscle shortens resting in a torticollis position because the head rotates and tilts initiating the side preference and the occiput flattens correspondingly. Risk Factors for plagiocephaly and torticollis include but are not limited to intrauterine development, prematurity, multiple births, congenital anomalies, neurological injury, tumors, cervical defects, muscular, bony, and restrictive condition development. The key to the successful management of infants with deformational plagiocephaly is to prevent the occurrence of injury, however early diagnosis and treatment is extremely important.

The infant’s head shape and neck range of motion must be assessed first as a newborn and again evaluated at two months. Approximately one out of 300 healthy birth infants have a noticeable flattening of the head, asymmetry of the skull base and face, or both. Plagiocephalic deformity may be perpetuated or worsened by gravitational forces, so the supine position creates a higher likelihood for deformation. Early recognition of positional head deformity is crucial with the rapid growth of an infant’s skull. Deformational plagiocephaly has been described as a parallelogram shaped head when looking from a vertex view or when observed from a top down analysis of the skull. There is asymmetry that may cause deformation of the facial features when severe and an ipsilateral ear shift and a contralateral forehead flattening. Some degree of facial distortion is usually apparent, but it also may be minimal, however it becomes more noticeable when the infant is held up to a mirror. The mirror reflection can be checked for asymmetry without distraction of the babies’ response.

Dysfunction of the neck musculature is almost a universal finding in patients with deformational plagiocephaly.6 Torticollis has some limitations of active rotation of their heads away from the flattened side of the occiput Neck dysfunction can be diagnosed by the rotating stool test, which can be used in children 3 months or older. Torticollis can effect vertical eye movements or strabismus secondary to the head tilt created by the SCM muscle shortening. The number of affected patients can be reduced by early screening, identifying patients at risk, educating parents about the importance of rotating infants, and supervised “tummy time”.

The most important treatments for plagiocephaly and torticollis are prevention and awareness. Educating the infant’s caregiver related to supervised tummy time and how it promotes development of the trunk musculature and improves both gross and fine motor skills is the first line of defense. Prone positioning while the infant is awake and being observed is crucial to prevent the development of flat spots on the occiput and to facilitate development of shoulder girdle strength, necessary for motor milestones. Encouraging and implementing a nightly alternating head position, changing the supine head position during sleep and periodically changing the orientation of the infant to outside activity can make all the difference. The preventative interventions are also part of the solution to reducing the plagiocephaly and torticollis in existing conditions.

Parents must be involved to make a difference in the infant’s condition. All patients under the age of 18 months should be given active and passive neck stretching exercises as the first line of treatment. Most forms of intervention rely on redirecting symmetrical growth of the skull during the first year of life when 80% of growth occurs. Additionally, in the first 6 to 18 months of life there is an attempt to use remaining brain growth to redirect head shape. It is critical that parents be taught a home exercise program since physical therapy at one hour visits three times a week will be insufficient to make a difference in plagiocephaly and torticollis alone. A regiment that includes repetitive passive stretches of the affected SCM muscle and strengthening exercises for the contralateral side needs to be done regularly. In addition, positioning and handling skills will aid in resolution, allowing the infant to alter head orientation more freely. Neck exercises should be done with each diaper change, three repetitions of 10 second stretches of the SCM, upper trapezius, and the ipsilateral trunk muscles need to be performed. Caregivers must reposition their child frequently by alternating the arm in which the child is carried and fed. Parents can subsequently relieve pressure sites on the skull by rotating the position of toys in the crib, stroller, swing and car seat, which will in turn improve the range of motion of the neck. Parents need to approach feeding to the side opposite of the flattened area to encourage head turning and lengthening of the SCM muscle. A cranial orthoses, in addition to a stretching program, are a viable option to aid in the recovery from plagiocephaly and decrease the secondary torticollis. Significant improvements in overall symmetry are found with use of a cranial remolding orthosis.

Helmet therapy or an external orthotic device is an effective treatment option that has similar results to using repositioning and stretching. The theory is based on the mechanism that pressure from a rapidly growing brain against a concave surface should round flattened areas caused by earlier pressure against a flat surface. The best response for helmets occurs in the age range of 4-12 months because at the greater malleability of the young infant skull bone and the normalizing effect of the rapid growth of the brain.10 Using slight alterations in design, all cranial orthoses, bands and caps attempt to achieve a more normalized skull through strategically placed forces and directing new growth. The orthosis may need to be kept on for approximately 20 hours out of the day. Therapeutic physical adjustments of the orthosis is necessary to correct for positional changes. Also, a cervical collar can be used to block lateral flexion to the involved side to decrease range of motion deficits. When conservative treatment has been exhausted, surgery is a viable option.

The earlier the treatment begins for plagiocephaly and torticollis, the greater the likelihood of a successful outcome. Immediately after diagnosis, the majority of the literature suggests that conservative treatment should be started. This initial intervention suggests proper positioning, followed by a rigorous stretching program, both implemented by the parents. It has been identified that 95 percent of congenital muscular torticollis resolves within 1 year with manual stretching. A cranial orthoses or helmet therapy has also been used with positive results with patients under 3 months of age. However, 25 percent of the 3 to 6 months old infants, 70 percent of 6-18 month old infants and 100 percent of the older children required surgery. Surgical management of torticollis is rare. Therefore, a craniofacial surgeon should only be considered if there is a progression of the condition or a lack of improvement following a trial of mechanical adjustments. There were long-term problems noted related to subtle cerebral dysfunction during the school-age years involving language disorders, learning disability, and attention deficits in this population. This may be due to compression in certain areas of the brain that are manifested as the child grows into their deficits. Disruption of the head in the midline position through trauma or deformation such as torticollis can also affect the processing of sensory stimulation and lead to visual disturbances.5 The visual deficits if not resolved are the major reason torticollis is surgically corrected. Other factors should not be over-looked, psychosocial issues such as depression and self image problems may occur if the deformities are not corrected. Social interactions may be avoided by a child that looks different. For example, there may be fear avoidance of being singled out by their peers.

In conclusion, I agree with the rationale for prevention, care, assessment, and rehabilitation of plagiocephaly and torticollis as seen in the current literature. The inherent symmetrical brain growth and the skull’s natural flexibility and plasticity in the early months create dynamic correction and improve cranial shape.5 The skull undergoes approximately 80 percent of its postnatal growth with the first year of life. Awareness of the condition and its causes may decrease the occurrence of positional plagiocephaly and torticollis. Currently, approximately 25 percent of parents never place their infants prone, even for play. It is essential to encourage prone playing and teach parents how to alter eating positions to diminish the side preference of their child. Stretching is the most effective intervention for a parent to perform regularly, however other options like the cranial orthosis exist. The majority of infants referred to neurosurgeons with occipital plagiocephaly can be successfully managed nonsurgically. My conclusions are supported by a sizeable amount of research that is available in reputable journals and online.

Several of my articles are from the Journal of Pediatrics and the American Academy of Pediatrics (AAP). These studies varied in the size of the subjects tested. There was a 15 year retrospective study of 82 infants with non-surgical interventions and 18 with surgery. A clinical report regarding guidance for rendering care by the AAP with recent citations was also available. There was a case study and a clinical report that were small sample subject sizes, however the information quoted in these articles was recent and noteworthy. There was not a preponderance of evidence with in the case study research given their prospective size. The clinical report and several other articles were funded by the company that made the cranial orthoses as were two other articles, which made me question if the papers were indeed unbiased. Luther had a population of 821 with muscular torticollis and stretching exercises, 90 percent had positive outcomes for non-surgical intervention. Another well written article by de Chalain had 159 infants from three out-patient facilities giving some diversity to the population. There were also a couple of articles such as BNI quarterly in 2001; that released a well researched management guide. However, an actual study was not performed. It seemed that there was more guideline and background information available than actual studies with large population sizes with good research formats that are unbiased. In quite a few articles the follow-up decreased the number of subjects analyzed by almost half of the total subjects available. Further research is needed to help identify prevention, assessment, and management of these conditions.

Future research is essential to evidence-based practice. It would be interesting to have a study of caregivers who are given information and prevention methods on positional plagiocephaly and torticollis. Research conducted prenatally will be followed-up at three months, six months and a year to identify how many of these children develop this condition in comparison to controls that do not receive training. There seemed to be a lot of studies that were created by the cranial orthosis companies. I believe to legitimize the use of these devices it is essential to have independent unbiased research comparing both stretching/ positioning and helmet use in the first year of life after diagnosis of positional plagiocephaly and associated torticollis. There should be one group that only uses cranial orthoses, a second group that only uses stretching/positioning and a third group that is a combination of the two groups. Finally, I would like to see a population of positional plagiocephaly and secondary torticollis in the second year of life comparing the non-surgical interventions effectiveness. It seemed as though surgical intervention was the primary option during this time because of the decrease in brain and cranial growth. I would like a study to perform non-surgical interventions in the second year toddler. Similar studies with the use of all intervention strategies should be analyzed with larger subject samples and different patient demographics. A power analysis should be done to identify appropriate sample sizes for this population in future studies.

Works Cited

1) Academy of Pediatrics. (2002). While in Utero, One Twin More Likely to Develop Misshapen

Head. Pediatrics.140.1.

2) Biggs, Wendy S. MD. (2003). Diagnosis and Management of Positional Head Deformity.

American Family Physician.67.1953-60.

3) de Chalain TM and Parak S. (2004). Torticollis Associated with Positional Plagiocephaly: A Growing Epidemic. Journal of Orthotics and Prosthetics.16(4S).28-30.

4) Emery, C. (1994). The Determinants of Treatment Duration for Congenital Muscular Toticollis.

Pediatrics.74 (10).921-9.

5) Lima D. and Fish D. (2003) Acquiring Craniofacial Symmetry and Proportion Through

Repositioning, Therapy, and Cranial Remolding Orthoses. Journal of Orthotics & Prosthetics.15 (1S) 1-8.

6) Littlefield TR, Reiff JL, and Rekate HL. (2001) Diagnosis and Management of Deformational

Plagiocephaly. BNI Quarterly.17 (4).1-9.

7) Luther, Brenda L. (2002) Congenital Muscular Torticollis and Placiocephaly. National

Association of Orthopaedic Nurses.21 (3).21-29.

8) Miller RI and Sterling CK. (2000) Long-Term Developmental Outcomes in Patients with Deformational Plagiocephaly. Pediatrics.105 (2).E26-30.

9) National Institute of Neurological Disorders and Stroke, National Institute of Health. (Oct. 13, 2005). Dystonias. Retrieved November 22, 2005, from

http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm.

10) Persing, John MD.etal. (2003) Prevention and Management of Positional Skull Deformities In Infants. Pediatrics.112.199-202.

Source: Dr. Julie C.
Epinions.com

If you would like more information on Torticollis, Plagiocephaly or Cranial Remolding Orthosis, please visit our website at www.alexandrasphate.org or fill out the "contact me" form below.

Best Regards,

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Torticollis? What's That?

noreply@blogger.com (www.alexandrasphate.org) — Sat, 15 Oct 2011 16:56:00 +0000

Torticollis is a condition which affects the neck and spine in many infants. A common name for Torticollis is "wry neck". The literal translation is "crooked neck". It is a very treatable condition, but should be taken seriously and treated by your child's pediatrician.

The first signs of Torticollis may not appear until the infant is 2-3 months old. You may notice that your child stares into one direction. Your child may seem to hold his neck to the side, and you may even notice a sizable lump just above the infant's collar bone.

The condition affects the sternocleidomastoid muscle which connects the base of the skull to the collar bone. This muscle is the main muscle that is used to move the head from side to side. In an infant with Torticollis, the muscle is shorter on the side that the head is tilted to. With treatment, the muscle will grow and stretch; but if left untreated the condition may cause a permanent limitation of the infant's neck movement. If action is not taken, the infant's head may flatten on one side and the face may become mis-formed.

There are several theories as to what causes Torticollis in infants, but the main theory is the limitation of space inside the mother's uterus. The infant may be stuck in one position for a period of time and not able to move its neck, which in turn will affect how the muscle is formed. If the infant has had a limited amount of mobility of the neck in the womb, the muscle will be very stiff and tight.
Once diagnosed, you will want to start a serious of stretching exercises with your infant. The most basic stretch consists of laying the infant on his or her back and rotating the head away from the tilt. This will
stretch the sternocleidomastoid muscle and relieve the tightness. One other very simple but extremely affective stretch involves laying the infant on its back and tilting the head gently to the side opposite of the tilt. Be sure to only stretch small amounts so that the muscle does not tear or become stressed. Watch your infant for any signs of discomfort, and never stretch past a comfortable pull. Repeat these exercises several times through out the day to lengthen and loosen the muscle.

It is also important to reposition your child's head. If the infant sleeps with its head turned one way a flat spot may shape on the side of the skull. To prevent this you will just need to keep repositioning the head to face the other way. Try to position the infant's bouncy seat or car seat so that the child will want to face the way against the tilt of the head. This will cause the child to reposition its head naturally and learn to turn their head to both sides.

The most common concern with Torticollis is a flat spot on the skull and abnormal face formations. Both of these can be easily prevented by exercise and repositioning. If your infant does develop a flat spot on its skull or face a helmet may be necessary to reform the skull. These helmets are fitted and checked weekly to assure they are working. The infant generally become very comfortable in the helmet, but they are expensive.

If you think your infant has Torticollis schedule an appointment with your pediatrician soon. If your pediatrician confirms your worries you will be set up with a physical therapist to learn the proper techniques and stretches tailored to your son or daughter. You will probably have a check up every 2 weeks to see how your child is progressing.

Although Torticollis can be worrisome to any parent, it is highly treatable. If your infant seems to be uncomfortable or in pain a trip to the doctor is necessary! With a little bit of stretching and exercise your infant can have a straight neck once again!

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Alexandra's P.H.A.T.E. Spaghetti Dinner Fundraiser and Chinese Auction

noreply@blogger.com (www.alexandrasphate.org) — Thu, 20 Jan 2011 15:18:00 +0000

Hello Alexandra's P.H.A.T.E. Friends,

Alexandra's P.H.A.T.E. will be holding a Spaghetti Dinner Fundraiser and Chinese Auction on 3/12/2011 from 12:00 pm to 5:00 pm at the Findlay Township Activity Center in Imperial, PA. 100% of the proceeds will go to the foundation.

If anyone would like to donate items for the Chinese Auction, please let us know. We could use all of the donations that we can get.

If you would like more information on Alexandra's P.H.A.T.E. or would like to make a donation, please visit our website at www.alexandrasphate.org or contact Gary at 412-860-4557.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Strecthing Excercises For Torticollis

noreply@blogger.com (www.alexandrasphate.org) — Fri, 14 Jan 2011 14:45:00 +0000

Instructions for Stretching and Positioning Left Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.
Instructions for Stretching and Positioning Right Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.

If you have any questions or need more information regarding torticollis, please fill out the "contact me" form below or call 412-860-4557.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Everything Plagiocephaly and Torticollis! Long Read, But Very Informative!

noreply@blogger.com (www.alexandrasphate.org) — Wed, 12 Jan 2011 15:57:00 +0000

In 1992, the American Academy of Pediatrics initiated the “Back to Sleep” campaign recommending that infants be placed to sleep in the supine position to reduce the incidence of sudden infant death syndrome (SIDS). Although there was a significant decrease of approximately 40% in the occurrence of SIDS, the practice creates a condition of flattening of the occipital area referred to as positional plagiocephaly, which has increased sixfold. Plagiocephaly is derived from the Greek word meaning “oblique head”. In addition to the asymmetrical head shape, infants present with a head tilt, reduced range of cervical motion, and a form of torticollis apparently associated with positional plagiocephaly. The significant increase of plagiocephaly, is as high as 48%. The associated increase in muscular torticollis is 84%. Positional plagiocephaly and secondary muscular torticollis increased in incidence is a concern because it has a strong influence on the effects of child development. Evidence-based practice identifies that an infant needs to receive early assessment and treatment to correct these conditions that are acquired in the first several weeks of life. A plethora of research is available on the internet, as well as accessible in medical journals regarding the prevention, care, assessment and rehabilitation of these musculoskeletal injuries. Parental support sites are available for additional information on these subjects.

A variety of developmental problems exist that could be interesting to research to gain more knowledge that would be beneficial in treating children. It is a con to isolate the resources to such a concentration on one subject. The negative aspect of focusing just on positional plagiocephaly and secondary muscular torticollis is that the two conditions have multiple causes and different versions of injury that may be attributed to more than just supine positional compression.

Positional head deformities are caused by external pressures placed on a quickly developing skull. The infant’s head becomes deformed as the result of external modeling forces applied prenatally, postnatally or both. The increased use of car seats and carriers has been an attributing factor to positional plagiocephaly. Sleeping in the supine position and feedings always offered from the same side correlate with a positional head deformity. Plagiocephaly occurs first and predisposes other forms of neck imbalance. Torticollis may occur in association with plagiocephaly; each condition exacerbates the other or, successful treatment of one demands recognition and then treatment of the other condition. Plagiocephaly associated torticollis; the onset is immediate and appears to be related to the infant adopting a favored sleeping position usually lying supine with the head turned to one side. Ipsilateral sternocleidomastoid (SCM) muscle shortens resting in a torticollis position because the head rotates and tilts initiating the side preference and the occiput flattens correspondingly. Risk Factors for plagiocephaly and torticollis include but are not limited to intrauterine development, prematurity, multiple births, congenital anomalies, neurological injury, tumors, cervical defects, muscular, bony, and restrictive condition development. The key to the successful management of infants with deformational plagiocephaly is to prevent the occurrence of injury, however early diagnosis and treatment is extremely important.

The infant’s head shape and neck range of motion must be assessed first as a newborn and again evaluated at two months. Approximately one out of 300 healthy birth infants have a noticeable flattening of the head, asymmetry of the skull base and face, or both. Plagiocephalic deformity may be perpetuated or worsened by gravitational forces, so the supine position creates a higher likelihood for deformation. Early recognition of positional head deformity is crucial with the rapid growth of an infant’s skull. Deformational plagiocephaly has been described as a parallelogram shaped head when looking from a vertex view or when observed from a top down analysis of the skull. There is asymmetry that may cause deformation of the facial features when severe and an ipsilateral ear shift and a contralateral forehead flattening. Some degree of facial distortion is usually apparent, but it also may be minimal, however it becomes more noticeable when the infant is held up to a mirror. The mirror reflection can be checked for asymmetry without distraction of the babies’ response.

Dysfunction of the neck musculature is almost a universal finding in patients with deformational plagiocephaly.6 Torticollis has some limitations of active rotation of their heads away from the flattened side of the occiput Neck dysfunction can be diagnosed by the rotating stool test, which can be used in children 3 months or older. Torticollis can effect vertical eye movements or strabismus secondary to the head tilt created by the SCM muscle shortening. The number of affected patients can be reduced by early screening, identifying patients at risk, educating parents about the importance of rotating infants, and supervised “tummy time”.

The most important treatments for plagiocephaly and torticollis are prevention and awareness. Educating the infant’s caregiver related to supervised tummy time and how it promotes development of the trunk musculature and improves both gross and fine motor skills is the first line of defense. Prone positioning while the infant is awake and being observed is crucial to prevent the development of flat spots on the occiput and to facilitate development of shoulder girdle strength, necessary for motor milestones. Encouraging and implementing a nightly alternating head position, changing the supine head position during sleep and periodically changing the orientation of the infant to outside activity can make all the difference. The preventative interventions are also part of the solution to reducing the plagiocephaly and torticollis in existing conditions.

Parents must be involved to make a difference in the infant’s condition. All patients under the age of 18 months should be given active and passive neck stretching exercises as the first line of treatment. Most forms of intervention rely on redirecting symmetrical growth of the skull during the first year of life when 80% of growth occurs. Additionally, in the first 6 to 18 months of life there is an attempt to use remaining brain growth to redirect head shape. It is critical that parents be taught a home exercise program since physical therapy at one hour visits three times a week will be insufficient to make a difference in plagiocephaly and torticollis alone. A regiment that includes repetitive passive stretches of the affected SCM muscle and strengthening exercises for the contralateral side needs to be done regularly. In addition, positioning and handling skills will aid in resolution, allowing the infant to alter head orientation more freely. Neck exercises should be done with each diaper change, three repetitions of 10 second stretches of the SCM, upper trapezius, and the ipsilateral trunk muscles need to be performed. Caregivers must reposition their child frequently by alternating the arm in which the child is carried and fed. Parents can subsequently relieve pressure sites on the skull by rotating the position of toys in the crib, stroller, swing and car seat, which will in turn improve the range of motion of the neck. Parents need to approach feeding to the side opposite of the flattened area to encourage head turning and lengthening of the SCM muscle. A cranial orthoses, in addition to a stretching program, are a viable option to aid in the recovery from plagiocephaly and decrease the secondary torticollis. Significant improvements in overall symmetry are found with use of a cranial remolding orthosis.

Helmet therapy or an external orthotic device is an effective treatment option that has similar results to using repositioning and stretching. The theory is based on the mechanism that pressure from a rapidly growing brain against a concave surface should round flattened areas caused by earlier pressure against a flat surface. The best response for helmets occurs in the age range of 4-12 months because at the greater malleability of the young infant skull bone and the normalizing effect of the rapid growth of the brain.10 Using slight alterations in design, all cranial orthoses, bands and caps attempt to achieve a more normalized skull through strategically placed forces and directing new growth. The orthosis may need to be kept on for approximately 20 hours out of the day. Therapeutic physical adjustments of the orthosis is necessary to correct for positional changes. Also, a cervical collar can be used to block lateral flexion to the involved side to decrease range of motion deficits. When conservative treatment has been exhausted, surgery is a viable option.

The earlier the treatment begins for plagiocephaly and torticollis, the greater the likelihood of a successful outcome. Immediately after diagnosis, the majority of the literature suggests that conservative treatment should be started. This initial intervention suggests proper positioning, followed by a rigorous stretching program, both implemented by the parents. It has been identified that 95 percent of congenital muscular torticollis resolves within 1 year with manual stretching. A cranial orthoses or helmet therapy has also been used with positive results with patients under 3 months of age. However, 25 percent of the 3 to 6 months old infants, 70 percent of 6-18 month old infants and 100 percent of the older children required surgery. Surgical management of torticollis is rare. Therefore, a craniofacial surgeon should only be considered if there is a progression of the condition or a lack of improvement following a trial of mechanical adjustments. There were long-term problems noted related to subtle cerebral dysfunction during the school-age years involving language disorders, learning disability, and attention deficits in this population. This may be due to compression in certain areas of the brain that are manifested as the child grows into their deficits. Disruption of the head in the midline position through trauma or deformation such as torticollis can also affect the processing of sensory stimulation and lead to visual disturbances.5 The visual deficits if not resolved are the major reason torticollis is surgically corrected. Other factors should not be over-looked, psychosocial issues such as depression and self image problems may occur if the deformities are not corrected. Social interactions may be avoided by a child that looks different. For example, there may be fear avoidance of being singled out by their peers.

In conclusion, I agree with the rationale for prevention, care, assessment, and rehabilitation of plagiocephaly and torticollis as seen in the current literature. The inherent symmetrical brain growth and the skull’s natural flexibility and plasticity in the early months create dynamic correction and improve cranial shape.5 The skull undergoes approximately 80 percent of its postnatal growth with the first year of life. Awareness of the condition and its causes may decrease the occurrence of positional plagiocephaly and torticollis. Currently, approximately 25 percent of parents never place their infants prone, even for play. It is essential to encourage prone playing and teach parents how to alter eating positions to diminish the side preference of their child. Stretching is the most effective intervention for a parent to perform regularly, however other options like the cranial orthosis exist. The majority of infants referred to neurosurgeons with occipital plagiocephaly can be successfully managed nonsurgically. My conclusions are supported by a sizeable amount of research that is available in reputable journals and online.

Several of my articles are from the Journal of Pediatrics and the American Academy of Pediatrics (AAP). These studies varied in the size of the subjects tested. There was a 15 year retrospective study of 82 infants with non-surgical interventions and 18 with surgery. A clinical report regarding guidance for rendering care by the AAP with recent citations was also available. There was a case study and a clinical report that were small sample subject sizes, however the information quoted in these articles was recent and noteworthy. There was not a preponderance of evidence with in the case study research given their prospective size. The clinical report and several other articles were funded by the company that made the cranial orthoses as were two other articles, which made me question if the papers were indeed unbiased. Luther had a population of 821 with muscular torticollis and stretching exercises, 90 percent had positive outcomes for non-surgical intervention. Another well written article by de Chalain had 159 infants from three out-patient facilities giving some diversity to the population. There were also a couple of articles such as BNI quarterly in 2001; that released a well researched management guide. However, an actual study was not performed. It seemed that there was more guideline and background information available than actual studies with large population sizes with good research formats that are unbiased. In quite a few articles the follow-up decreased the number of subjects analyzed by almost half of the total subjects available. Further research is needed to help identify prevention, assessment, and management of these conditions.

Future research is essential to evidence-based practice. It would be interesting to have a study of caregivers who are given information and prevention methods on positional plagiocephaly and torticollis. Research conducted prenatally will be followed-up at three months, six months and a year to identify how many of these children develop this condition in comparison to controls that do not receive training. There seemed to be a lot of studies that were created by the cranial orthosis companies. I believe to legitimize the use of these devices it is essential to have independent unbiased research comparing both stretching/ positioning and helmet use in the first year of life after diagnosis of positional plagiocephaly and associated torticollis. There should be one group that only uses cranial orthoses, a second group that only uses stretching/positioning and a third group that is a combination of the two groups. Finally, I would like to see a population of positional plagiocephaly and secondary torticollis in the second year of life comparing the non-surgical interventions effectiveness. It seemed as though surgical intervention was the primary option during this time because of the decrease in brain and cranial growth. I would like a study to perform non-surgical interventions in the second year toddler. Similar studies with the use of all intervention strategies should be analyzed with larger subject samples and different patient demographics. A power analysis should be done to identify appropriate sample sizes for this population in future studies.

Works Cited

1) Academy of Pediatrics. (2002). While in Utero, One Twin More Likely to Develop Misshapen
Head. Pediatrics.140.1.

2) Biggs, Wendy S. MD. (2003). Diagnosis and Management of Positional Head Deformity.
American Family Physician.67.1953-60.

3) de Chalain TM and Parak S. (2004). Torticollis Associated with Positional Plagiocephaly: A Growing Epidemic. Journal of Orthotics and Prosthetics.16(4S).28-30.

4) Emery, C. (1994). The Determinants of Treatment Duration for Congenital Muscular Toticollis.
Pediatrics.74 (10).921-9.

5) Lima D. and Fish D. (2003) Acquiring Craniofacial Symmetry and Proportion Through
Repositioning, Therapy, and Cranial Remolding Orthoses. Journal of Orthotics & Prosthetics.15 (1S) 1-8.

6) Littlefield TR, Reiff JL, and Rekate HL. (2001) Diagnosis and Management of Deformational
Plagiocephaly. BNI Quarterly.17 (4).1-9.

7) Luther, Brenda L. (2002) Congenital Muscular Torticollis and Placiocephaly. National
Association of Orthopaedic Nurses.21 (3).21-29.

8) Miller RI and Sterling CK. (2000) Long-Term Developmental Outcomes in Patients with Deformational Plagiocephaly. Pediatrics.105 (2).E26-30.

9) National Institute of Neurological Disorders and Stroke, National Institute of Health. (Oct. 13, 2005). Dystonias. Retrieved November 22, 2005, from
http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm.

10) Persing, John MD.etal. (2003) Prevention and Management of Positional Skull Deformities In Infants. Pediatrics.112.199-202.

Source: Dr. Julie C. | Epinions.com

If you would like more information on Torticollis, Plagiocephaly or Cranial Remolding Orthosis, please visit our website at www.alexandrasphate.org or fill out the "contact me" form below.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

HELP--Alexandra's P.H.A.T.E. Spaghetti Dinner Fundraiser and Chinese Auction

noreply@blogger.com (www.alexandrasphate.org) — Fri, 07 Jan 2011 14:25:00 +0000

Alexandra's P.H.A.T.E. will be holding a Spaghetti Dinner Fundraiser and Chinese Auction on 3/12/2011 from 12:00 pm to 5:00 pm at the Findlay Township Activity Center in Imperial, PA. 100% of the proceeds will go to the foundation.

If anyone would like to donate items for the Chinese Auction, or be a volunteer to help in the planning of this event please let us know. Also, if anyone could assist with getting some local sports memorabilia it would be greatly appreciated. We could use all of the donations that we can get.

If you would like more information on Alexandra's P.H.A.T.E. or would like to make a donation, please visit our website at www.alexandrasphate.org or contact Gary at 412-860-4557.

You can google us too AlexandrasPHATE!

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Do You Know What Torticollis Looks Like? We Didn't Either

noreply@blogger.com (www.alexandrasphate.org) — Fri, 07 Jan 2011 14:15:00 +0000

Isn't This picture adorable? We thought so too. However, it was trying to tell us something, but we couldn't see the forest through the trees.

What Does Torticollis Look Like? Hmm, the first question people usually ask is, What is torticollis? Most new parents are completely unaware of what to look for when they bring their newborn home from the hospital. If during your pregnancy, you had low amniotic fluid, or your baby was breech there is a higher possibility of torticollis. In our case, low amniotic fluid caused our baby's head to be held in the same position because of lack of room to move. This lack of movement, caused the sternocleidomastoid muscle to be tight on her left side(Torticollis or Wry Neck).

We have created a video to show parents the signs of Torticollis in infants. Initially, most won't see any issue with the photos, but it is plain as day. If you know what Torticollis looks like. Had we been able to view this early on in Alexandra's life, we would have know right away, what Tortcollis looks like.

You can link directly to the video by clicking here.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

We Could Have Prevented Our Plagiocephaly? How?

noreply@blogger.com (www.alexandrasphate.org) — Thu, 06 Jan 2011 13:46:00 +0000

A few words, from our peditrician, could have helped us and many other families to avoid plagiocephaly. One of the key words, that was left out of our early visits, is repositioning.

What is "repositioning"?

"Techniques to encourage your child to alter the resting position of his/her head."

Why is "repositioning" important?

"Careful attention to repositioning while your child is awake can prevent or reduce positional cranial deformities."

From the American Academy of Pediatrics:

"To prevent the [deformational plagiocephaly], parents should be counseled during the newborn period (by 2 to 4 weeks of age) when the skull is maximally deformable. Parents should be instructed to lay the infant down to sleep in the supine position, alternating positions (i.e., left and right occiputs). When awake and being observed, the infant should spend time in the prone position. The infant should spend minimal time in car seats (when not a passenger in a vehicle) or other seating that maintains supine positioning....

Once deformational plagiocephaly is diagnosed, parents should be made aware of the condition and the mechanical adjustments that can be instituted. In general, most infants improve if the appropriate measures are conducted for a 2- to 3-month period. These include positioning the infant so that the rounded side of the head is placed dependent against the mattress.

Additionally, the position of the crib in the room may be changed to require the child to look away from the flattened side to see the parents and others in his or her room..."

Source: Persing J, James H, Swanson J, Kattwinkel J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics 2003 Jul;112(1 Pt 1):199-202.

Key points:

Infants should always be placed on their backs to sleep.

However to avoid positional plagiocephaly:

change the child's sleeping position by placing the child's head at opposite ends of the crib on alternate nights
turn the crib around every few days -- babies will turn their head away from the wall
change the position of toys (for mobiles) and other objects to encourage head movement.

Include supervised "tummy time" in your child's day. In addition to removing pressure on the back/side of the head, playing on his/her tummy is good for development.

Alternate the arm in which the infant is held for bottle and/or breast feeding.

During diaper changes, alternate the side from which you approach the infants. This will encourage the child to turn his/her head to look at the caregiver.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Meet Noah In Our PHATE's Kids Gallery

noreply@blogger.com (www.alexandrasphate.org) — Wed, 05 Jan 2011 22:00:00 +0000

Say Hello To Noah. An adorable little boy, that had to wear a helmet because of sagittal craniosynostosis. How very cute. If you would like to see other adorable children in their helmets, please visit our gallery by clicking here

If you have a great photo of your child in a helmet. Please send us a picture. We would love to add it to our gallery. You can send your photos to photos@alexandrasphate.org.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Alexandra's P.H.A.T.E. Spaghetti Dinner Fundraiser and Chinese Auction

noreply@blogger.com (www.alexandrasphate.org) — Wed, 05 Jan 2011 17:30:00 +0000

Hello Facebook Friends,

Alexandra's P.H.A.T.E. will be holding a Spaghetti Dinner Fundraiser and Chinese Auction on 3/12/2011 from 12:00 pm to 5:00 pm at the Findlay Township Activity Center in Imperial, PA. 100% of the proceeds will go to the foundation.

If anyone would like to donate items for the Chinese Auction, please let us know. We could use all of the donations that we can get.

If you would like more information on Alexandra's P.H.A.T.E. or would like to make a donation, please visit our website at www.alexandrasphate.org or contact Gary at 412-860-4557.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Cranial Remolding Orthosis? What's That?

noreply@blogger.com (www.alexandrasphate.org) — Wed, 05 Jan 2011 14:44:00 +0000

A cranial remolding orthosis or helmet, is a device used to treat head shape deformities such as plagiocephaly, brachycephaly and scaphocephaly. The helmet treatment is effective in infants from 3-18 months of age. The earlier treatment is initiated, the better the outcome due to the decrease in growth rate as the child ages. The first cranial remolding orthosis was developed by Dr. Clarren in 1979. Thousands of infants have been treated with the STARband, which is the first cranial remolding device with FDA clearance and availability to pracitioners across the world. The STARfamily of cranial remolding orthoses are manufactured by Orthomerica.

The improvements in head shape are achieved by providing contact in the bossed areas and reliefs in the flattened areas. As the skull continue to grow, the reliefs are filled out and the skull rounds out. The amount of improvement is directly related to the amount of growth during their time in the helmet. The younger the infant, the faster the rate of skull growth. The ideal age for initiation of helmet treatment is 4-7 months.

The most common cause of head shape deformation is supine sleep positioning. An infant's head triples in size in the first 12 months of life. During this time, their head is susceptible to external pressure that may influence it's shape such as supine sleep position, inutero constraint, car seats, baby carriers etc. Increased risk factors include, multiple births, premturity and torticollis. Torticollis is a condition in which a tight neck muscle on one side causes the head to tilt and turn. Physical therapy is recommended to stretch, strengthen and improve range of motion at the neck.

Repostitioning should be attempted in all cases as early as possible. If two months of repositioning does not improve head shape, a helmet may be necessary. Repositioning and tummy time is important for ALL infants. Since infants spend the majority of time on their backs, spending waking hours on their tummy is critical in strengthening for normal physical development. Click here for handouts on repositioning.

Once any skull flatness or asymmetries are noticed, it is advised to ask your pediatrician to refer you to a craniofacial specialist. The specialist will evaluate the infant to rule out potentially more serious causes such as craniosynostosis(premature fusing of a cranial suture), assess head shape and determine if a helmet and/or any other treatment are needed. Pediatricians can prescribe a cranial remolding orthosis, but it is advised to see a specialist in order to rule out other potential, more serious issues. The earlier the infant is evaluated the better the overall outcome. Repositioning efforts must be attempted for at least two months. If these efforts fail to improve the head shape, a helmet may be required.

We see coverage from 0% to 100%. It is best to call your insurance and see if there are any exclusions in your specific plan. Cranial remolding orthoses fall under a sub category of orthotics and prosthetics which are under the category durable medical equipment. The device code is S1040. Contact us for more information

To read more about the STARscanner data acquisition system information click here.

If you would like more information regarding cranial remolding orthosis, or need assistance with an insurance appeal, please click here to fill out our contact form.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Torticollis? Whats That?

noreply@blogger.com (www.alexandrasphate.org) — Tue, 04 Jan 2011 14:15:00 +0000

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org

Plagiocephaly? What's That?

noreply@blogger.com (www.alexandrasphate.org) — Mon, 03 Jan 2011 17:10:00 +0000

What is positional plagiocephaly?

Health care providers also use the term brachycephaly (bray-kee-seff-a-lee) to describe the flattening of the back of the skull. Positional plagiocephaly and brachycephaly often occur together.
The general term plagiocephaly refers to a head that is abnormally shaped from a variety of causes. Positional plagiocephaly is only one type of plagiocephaly. Other types can result from: skull sutures closing too soon (called craniosynostosis); twisted neck present at birth (called congenital muscular torticolis); and fluid around the brain (called hydrocephaly). Plagiocephaly can sometimes be severe and may require surgical treatments.

What causes positional plagiocephaly?

Positional plagiocephaly usually results from an infant being placed in the same position, such as on the back, for long periods of time.

Too little time spent upright—sometimes called "cuddle" time
Too little "Tummy Time" when the baby is awake and supervised
Too much time in car seats, carriers, and bouncy seats

Preterm babies are more likely to get flats spots on their heads because their heads are softer than those of full-term babies.

How can I help prevent positional plagiocephaly?

Providing "Tummy Time" when your baby is awake and someone is watching. Tummy Time not only helps prevent flat spots, but it also helps the baby's head, neck, and shoulder muscles get stronger as part of normal development. Parents and caregivers can try Tummy Time 2 or 3 times a day, for short periods of time, until the baby gets used to being on the tummy. Once the baby begins to enjoy the position, parents can try longer periods of time or increase frequency of Tummy Time. [link to http://www.nichd.nih.gov/health/topics/Tummy_Time.cfm]
Changing the direction that your baby lies in the crib from one week to the next. For example, have the baby's feet point toward one end of the crib for a few days, and then change the position so his or her feet point toward the other end of the crib. This change will encourage the baby to turn his or her head in different directions to avoid resting in the same position all the time.
Avoiding too much time in car seats, carriers, and bouncers while the infant is awake.
Getting "cuddle time" with the baby by holding him or her upright over one shoulder often during the day.
Changing the location of the baby's crib in the room so that he or she has to look in different directions to see the door or the window.

What are the treatments for positional plagiocephaly?

A custom helmet that prevents the baby's head from always falling to one side when lying down. Most importantly, it allows the baby’s skull to expand into a more rounded shape as the brain and skull grow.
Custom bands can also be used to help reshape a baby's head. Bands place a small amount of pressure on the baby's skull in the areas that need reshaping. A health care provider adjusts the band regularly as the baby’s head grows.

If you would like more information on Plagiocephaly, Torticollis or Cranial Remolding Helmets, please feel free to conact us.

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
Gary@alexandrasphate.org