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Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional
Iñaki Pastor-Pons1,2, César Hidalgo-García3, María Orosia Lucha-López1
1Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain.
Insights
Pediatric integrative manual therapy (PIMT) significantly improved active rotation range of motion in infants with positional plagiocephaly compared to caregiver education alone. Both groups showed neuromotor development improvements, but PIMT demonstrated superior outcomes for AROM.
Area of Science:
- Pediatrics
- Manual Therapy
- Cranial Deformities
Background:
- Positional plagiocephaly (PP) is a common infant cranial deformity linked to supine positioning and congenital muscular torticollis (CMT).
- Limited research exists on manual therapy's efficacy for PP.
- This study investigates adding manual therapy to caregiver education for PP.
Purpose of the Study:
- To compare the effectiveness of pediatric integrative manual therapy (PIMT) combined with caregiver education versus caregiver education alone.
- To assess the impact on active rotation range of motion (AROM) and neuromotor development in infants with PP.
Main Methods:
- A parallel randomized controlled trial involved 34 infants with PP under 28 weeks old.
- Interventions included PIMT with manual therapy and caregiver education, or caregiver education alone.
- Active rotation range of motion (AROM) and Alberta Infant Motor Scale (AIMS) were measured by a blinded examiner.
Main Results:
- The PIMT group showed a significantly greater increase in AROM (29.68° ± 18.41°) compared to the control group (6.13° ± 17.69°, p=0.001).
- Both groups improved neuromotor development, with no statistically significant difference between them.
- No adverse events were reported during the study.
Conclusions:
- Pediatric integrative manual therapy (PIMT) is more effective than caregiver education alone for improving AROM in infants with PP.
- Caregiver education programs can be enhanced with manual therapy for better outcomes.
- The study is registered under NCT03659032.
Background:
Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample.
Methods:
Thirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen's d.
Results:
All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study.
Conclusion:
The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program. The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032 . Registration date: September 1, 2018.
