Mengenai Exercise dan Treatment Neck Torticollis

 
Torticollis, dikenal dengan istilah wry neck/loxia, lyaitu kondisi distonic yang definisikan oleh abnormalnya, asimetris posisi kepala atau leher yang disebabkan oleh berbagai hal.
Torticollis berasal dari bahasa latin yaitu tortus berarti berputar dan collum berarti leher.
 Torticollis yaitu miring dinamis atau tetap atau fleksi kepala atau leher.
Jenis torticollis dapat didefinisikan beradasarkan posisi leher dan kepala
- Laterocollis : kepala ke samping ke arah bahu
- rotational torticollis : kepala berotasi searah axis longitudinal
- anterocollis : fleksi kepala dan leher
 - retrocollis : hiperekstensi kepala dan leher ke belakang

Penyebab
penyebab terjadinya torticollis yaitu:
- Muscular fibrosis
- Bawaan lahir tulang belakang yang abnormal
- Racun atau traumatic brain injury

Secara garis besar terdapat dua penyebab torticolis
1. Kongenital Torticollis
    Trauma lahir atau malposisi intrauterine dapat menyebabkan kerusakan otot sternocleidomastoideus pada
    leher. Akibatnya terjadi pemendekan atau kontraksi berlebihan otot sternocleidomastoideus yang
    menyebabkan ROM antara rotasi dan lateral fleksi terganggu. Posisi kepala lateral fleksi pada otot yang
    bermasalah dan rotasi ke sisi oposit.
2. Aquired Torticollis
    Faktor penyebab luar seperti infeksi telinga, tumor, adenitis, tonsilitis, rhematic, retropharyngeal abses,
    tumor cerebellar.
                                                                                                (sumber wikipedia.com, terjemahan bebas)

Pemeriksaan Torticollis

Examination

The evaluation of an adult with signs or symptoms of torticollis begins with a thorough history followed by a physical examination

History

• Previous episodes of abnormal head posture
• Neck pain
• Headache
• Birth history
• Family history
• Medication history
• Trauma
• Recent infection

Physical Exam

Vitals

• Height
• Body weight
• Blood pressure
• Pulse rate
• Respiration rate
• Temperature (if indicated)

*Establish a baseline for patients overall health status*
Observation in Standing
Posture:

• Head alignment on cervical spine
• Cervico-thoracic spine
• Scapula
• Glenohumeral joint
• Arm & forearm
• Hand

Soft tissue:

• Muscular atrophy
• Muscular spasms
• Mass in tissue
• Phasic jerking of muscle
• Shape/symmetry of structures BIL

The examination also may include a commonly used outcome measure, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). This scale includes an assessment of the dystonic position of the head, neck, and shoulders, the effectiveness of sensory cues, the length of time the patient can keep the head in the midline, and the range of head and neck movements.
*Identify key impairments of the musculoskeletal disorder and establish a global understanding of the involved structures as indicated with posture. Patient will present with head outside of normal alignment, usually rotated and flexed to one side.* 
Neurological Screen

• Reflexes (C5,C6,C7)
• Myotomes (C4-T1)
• Dermatomes (C4-T1)

*Identify if there is any involvement with the CNS, will not find abnormal findings as a result of the torticollis.*
Thoracic Provocation Test

• Seated Rotation BIL

*Rule out thoracic spine*
Ligamentous Instability

• Sharp-Purser
• Alar ligament

*Rule out trauma to ligamentous structures*
Cervical Active Range of Motion Assessment

• Flexion (45 degrees)
• Extension (75 degrees)
• Lateral flexion (40 degrees)
• Rotation (85 degrees)

*Document impairmed ROM's. Patient will likely be unable to rotate head beyond midline toward the affected side.*
Shoulder Active Range of Motion

• Flexion
• Extension
• Abduction
• Adduction
• Internal rotation
• External rotation

*Observe any gross abnormalities in motion BIL, assist to rule out shoulder*
Palpation
Sitting:

• Upper trapezius
• First rib
• Anterior/posterior rib cage

Supine:

• Sternocleidomastoid (STM)
• C7-C1 cervical paravertebral muscles
• Nuchal line and suboccipital muscles
• Mastoid process
• C1 transverse processes
• C2-C7 spinous processes
• C2/3 through C6-7 articular pillars

*Be sure to note any tenderness due to trigger points and/or abnormal masses found in the surrounding tissues. Take notice to localized spasms and/or tightened musculature. Patient's involved musculature (especially SCM), will be especially prominent upon palpation.*
Joint Mobility
Sitting:

• 1st rib (hypo, normal, hyper)

Supine:

• OA (Flexion: 10 degrees, Extension: 25 degrees, Sidebending BIL: 5 degrees)
• AA (Flexion: 8 degrees, Extension: 10 degrees, Rotation: 45 degrees)
• Articular Pillars BIL (Hypo, Normal, Hyper)

Prone:

• Passive Inter-vertebral mobility (bilaterally & unilaterally)

*Assessing the movement that is available within the joint, noting areas of restricted motion and/or pain*
Muscle Length

• Suboccipital muscles
• Trapezius
• Levator scapulae
• Scalenes
• SCM BIL  

 (sumber physio-pedia.com, tanpa terjemahan, pedoman fisioterapist)

Manual stretching untuk torticollis (dipandu fisioterapis anda)

Beberapa hal yang harus ibu lakukan pada bayinya 

- posisikan anak diberikan ASI di arah posisi kepala berlawanan, misalnya torticolis kanan, berikan ASI untuk anak di sebelah kiri payudara ibu

- Berikan stimulasi anak untuk menengok ke arah sebaliknya seperti memberikan rangsangan dengan lonceng, mainan, dan pintu kamar di sebelah berlawanan

- Lakukan stretching dan massage secara teratur untuk mempercepat perbaikan