Essence of Life Spinal Care

"Acquired torticollis in children may present a diagnostic challenge as many different underlying causes are possible, ranging from benign mechanical concerns to serious and potentially life-threatening conditions. 

A number of cases describing the conservative treatment of congenital torticollis in children, including with chiropractic care, have been published throughout the years. However, less has been published about acquired torticollis in children and even fewer publications are related to its conservative management. Torticollis is a symptom that can be indicative of a wide range of pathology from benign muscular contractures to severe and possibly life-threatening conditions like tumors or central nervous system (CNS) disorders. Torticollis is a relatively common disorder, and although most cases are considered benign and appear to respond well to conservative therapy, a detailed clinical history and complete physical examination are necessary to rule out more serious etiologies before initiating care. This report presents the case of a 31-month old boy who presented to a chiropractic clinic with acquired torticollis and illustrates the importance of a thorough evaluation as well as the benefits of intra- and inter-professional collaboration and management.

Torticollis is a relatively common pediatric condition and the majority of cases are benign in origin. The most common type of torticollis seen in children is congenital muscular torticollis, with a reported incidence ranging from 0.3 to 2%. Congenital muscular torticollis is typically associated with intrauterine constraint and/or birth trauma, and usually appears within the first month of life, although it may become more apparent in the early childhood years. Most cases either self-resolve within the first year of life or with conservative treatments consisting of various manual therapy approaches including stretching, postural exercises, massage and postural advice. Some cases may require surgical intervention. Contrary to congenital muscular torticollis, acquired torticollis in children can be associated with a myriad of causes. Among those etiologies, the most common are traumatic, infectious, or CNS-related disorders. Other causes include congenital malformations of the cranio-cervical structures, as well as tumoral and inflammatory conditions. It is important to consider these etiologies when evaluating a child with acquired torticollis.

Neck conditions are the second leading reason for patients seeking chiropractic care in Canada and the United States. It is therefore probable that a parent may seek chiropractic care for a child who develops a torticollis. Although manual therapy offered by chiropractors and other health professionals has been shown beneficial in some cases of torticollis, especially the congenital muscular variation, awareness about other types of torticollis is necessary to ensure appropriate management for all patients. In order to ensure that a thorough examination and clinical history are performed prior to initiating treatment, practitioners who are not practiced at performing pediatric evaluations are encouraged to seek advice from colleagues with more expertise in the pediatric population. Although conservative care for pediatric torticollis appears to be effective based on the available publications, more extensive research on a larger scale and with higher methodological quality would be warranted to better document the type of care offered and the outcomes. Finally, it should be expected that clinical information readily be shared between healthcare professionals."

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" Autism spectrum disorders (ASD) are defined as a range of conditions classified as neuro-developmental disorders, including autistic disorder (autism), Asperger syndrome, and pervasive developmental disorder (PDD). Symptoms are quality-related disorders in the areas of social interaction, verbal and non-verbal communication, and a variety of behaviours and learning disorders. Abnormalities in development are apparent already in early childhood and have a high variability. ASD is reported to occur in all racial, ethnic and socioeconomic groups, with about 1 in 68 children being identified with ASD in 2012 in the US. Boys seem to be 4.5 times more often affected than girls.

With respect to the causation of autism, no universally accepted explanations are currently present. The possibility of a genetic component, environmental triggers and imbalances in the neuro-physiological state are all discussed. No specific medication is available to address autism. Medication is generally used to treat accompanying symptoms and modify behaviors of the condition. Current clinical guidelines recommend a combination of behavioral, developmental and educational approaches in order to enhance communication, social and cognitive skills and at the same time minimizing autistic symptomology. Medication is recommended in case of challenging behavior and other accompanying symptoms that justify its use.

Use of complementary and alternative treatments is common among children with autism, 50 to 75% of children with autism may be treated with complementary and alternative medicine (CAM). The use of manipulative or body based therapies, such as Cranio-sacral therapy, osteopathic and chiropractic manipulation were reported by approx 25% of children with ASD. Significant improvements in the symptomology in children with autism are anecdotally reported by chiropractors and other manual therapists, however, the research literature on the effectiveness of manual therapies in ASD is scarce.

In all identified articles of this current review, chiropractic treatment was performed, with all of the studies describing manipulative techniques for the spine, either the cervical or entire spine. Common to all studies is that positive effects, such as improvement in autistic symptoms, were observed in patients with ASD after treatment. 

In four studies, the Autism Treatment Evaluation Checklist (ATEC) was used to assess the severity of autistic symptoms (Table 3). This checklist has been designed to monitor children with autism over time in order to evaluate the potential effects of a given therapy. This simple scoring scale with 77 items is filled in by parents or caregivers. It consists of four subdomains: speech/language, sociability, sensory and cognitive awareness, and health/physical/behavior, providing a possible total score range of 0-180, with a higher score generally indicating a greater degree of impairment in symptoms. Total scores of less than 30 indicate that the child may lead a normal and independent life, scores of less than 50 indicate that the child may lead a semi-independent life, scores between 50 and 104 hint to moderate autistic symptoms, and with scores above 104 the child would be considered severely autistic. Within the scope of this review, the clinical changes after chiropractic treatment were demonstrated by a decrease in the ATEC scores

The authors‘ interpretation of the results of this review indicates that chiropractic intervention to the musculoskeletal system of autistic children and young adults may have the potential to create a positive effect on the severity of their symptoms."

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