Week 4 Entry

Situation
Right classical torticollis client with severe plagiocephaly and facial asymmetries. Developmental delay secondary to the torticollis and plagiocephaly. Mother is of aboriginal heritage with the department of child protections constantly checking up on her and the baby. Father is not known.

Task
The task is to stretch the right SCM muscles using activities that the mother can easily do and continue with in her daily routine and teach them to her.

Action
Explaination to mother of the importance of the intervention and the consequences of the skull fusing and staying that shape, not allowing the brain to grow properly and facial asymmetry.
Stretching of the childs neck by side flexing the left ear to the left shoulder, and activites to encourage active right rotation of the baby's head. Advice was given to the mother regarding managing plagiocephaly, encouraging tummy time for play when she is watching her child, making sure to still follow the SIDS guidelines.
Because the plagiocephaly looked quite severe, my supervisor asked one of the paediatrician to quickly come and have a look. We then referred her to the craniofacial clinic at PMH to get an X-ray of the baby's skull.

Result
The mother was eager to continue with exercises but is very anxious as she doesn't want child protective services to take her child away and she stated she will try her best.
The following week we recieved the results of the X-ray from PMH which shows sclerosis of one of the skull sutures indicating premature closure. So it was lucky that the referral was made, so that they can now have surgery to stop the sutures closing prematurely and help with the plagiocephaly.

Evaluation
It was evident that the mother was very anxious throughout the session and because of this may not have understood or took in a lot of the information and exercises for her child.
With torticollis you can't evaluate anything there until the next session, because the effects of stretching aren't evident straight away so i will have to wait till the next session to see how effective the stretches and the explaination of the exercises to the mother were to see if there has been any gain in neck range.

Strategies
We gave the mother handouts with excellent pictures and explainations on them so that she can have them with her when she is performing the exercises. We will also check with social work to see if she is attending and how she is coping and maybe ask a social worker or a clinical pyschologist to come and sit in on one of the sessions.
An idea is to maybe do regular phone reviews between sessions to see how she is coping and whether she is keeping up with the exercises.