Il torcicollo muscolare congenito è un atteggiamento viziato della testa e del collo, legato ad un’anomala contrattura o all’accorciamento del muscolo sternocleidomastoideo, presente al momento della nascita. Le cause di tale alterazione sono per lo più sconosciute, anche se si ipotizza che il malposizionamento all’interno dell’utero giochi un ruolo importante. In ogni caso, al momento della diagnosi, sarà necessaria un’attenta valutazione medica del neonato per verificare possibili cause e intraprendere la terapia più adeguata.
Nella struttura di Cadoneghe si esegue il trattamento del torcicollo congenito.
Non sempre è facile identificare un torcicollo congenito nei primissimi giorni di vita. È possibile, anzi, che rimanga celato fino alle prime settimane di vita.
I genitori sono, in genere, i primi a rendersi conto che il neonato tende a mantenere la testa ruotata ed inclinata sempre da un lato, accettando mal volentieri di girare il capo verso una direzione dello sguardo. Naturalmente non sempre questo tipo di ‘pigrizia’ sarà associata ad un torcicollo congenito:
la diagnosi, al minimo sospetto, dovrà essere confermata dalla visita del pediatra, dell’ortopedico o del fisiatra dell’infanzia. Accanto ad un esame clinico, lo specialista si potrà avvalere di alcune tecniche di diagnostica strumentale, in particolare dell’ecografia, indolore e sicura per il neonato, affidabile per i medico.
La prognosi del torcicollo congenito è generalmente favorevole: si arriva ad una guarigione completa fra l’87 ed il 99% dei casi in cui una fisioterapia sia iniziata precocemente e protratta per almeno i primi 12 mesi di vita. A nostro avviso, infatti, è importante iniziare da subito un programma fisioterapico, non appena la diagnosi venga confermata. Il neonato dovrà essere affidato ad un fisioterapista esperto nel trattamento di questi problemi, il quale provvederà ad allungare il muscolo contratto ed a stimolare il bambino a ruotare il capo ed il collo in tutte le direzioni.
In ogni caso, nel caso in cui si sospetti una qualsiasi anomalia nel movimento della testa e del collo del neonato, è bene consultare il proprio pediatra di fiducia, per dirimere qualsiasi dubbio.
Le responsabilità del fisioterapista includono la valutazione del bambino e la famiglia per determinare le cause del disturbo del movimento del bambino, seguito dall’attuazione di un programma di gestione. Il programma a casa dovrebbero essere incorporate nella routine della famiglia e comprendono: ile modalità di gestire, nutrire, trasportare e posizionare il bambino, attività per favorire la posizione della testa sulla linea mediana e posture del tronco. La collaborazione dei genitori è obbligatoria per ottenere un pieno recupero.
Trattamento
Obiettivo del trattamento del torcicollo congenito è l’allungamento del muscolo sternocleidomastoideo accorciato. Nei neonati e nei bambini piccoli, ciò si ottiene con lo stretching passivo, cioè tentando una correzione con delicate manipolazioni in senso contrario alla deformità (inclinando il capo verso la spalla dal lato opposto a quello della lesione e ruotando il mento verso la spalla dal lato leso). Gli esercizi debbono essere eseguiti cautamente e ripetuti più volte nell’arco della giornata. Tali
trattamenti hanno spesso successo, soprattutto se iniziati entro 3 mesi dalla nascita.
Il trattamento riabilitativo, eseguito dal terapista consiste :
Mobilizzazioni e allungamento passivo e attivo del muscolo sterno-cleido-mastoideo.(SCOM)
Cura posturale: indicare ai genitori le posture che spontaneamente favoriscono l’allungamento del muscolo e che agiscono correggendo le deformazioni cranio-facciali determinate dal torcicollo.
E’ indicato cominciare molto presto la terapia, che dovrebbe essere svolta almeno tre giorni a settimana con il terapista e poi a casa, con le indicazioni fornite ai genitori.
Nei casi di torcicollo congenito lieve, i miglioramenti sono spesso visibili dopo pochi giorni e la prognosi è favorevole, ma i genitori devono essere informati del fatto che si possono ripresentare delle “ricadute”, in alcuni casi:
• nel momento in cui il bambino acquisisce una nuova postura antigravitaria ( postura seduta, in piedi…);
• quando il bambino è malato;
• quando il bambino è particolarmente stanco.
Questi fenomeni dovrebbero scomparire, mano a mano che il bambino diventa più grande. Inoltre è importante sottolineare, nonostante non vi siano ancora studi scientifici al riguardo, che molto spesso nei bambini con torcicollo miogeno congenito, si evidenzia un lieve ritardo nello sviluppo motorio.
Sono spesso bambini, poco reattivi, che dormono molto (anche tutta la notte) già da piccolissimi, che presentano spesso un tono muscolare lievemente diminuito e che presentano una motricità spontanea poco ricca.
E’ importante quindi fornire indicazioni ai genitori, su come stimolare adeguatamente il bambino e seguirlo nelle fasi dello sviluppo. Il trattamento conservativo dei neonati con TCM consiste nel posizionamento, recupero del range di movimento e guidare il bambino ad acquisire il controllo della postura corretta. Nel complesso gli
obiettivi del fisioterapista nella gestione dei bambini con TCM sono:
• recupero della mobilità articolare;
• prevenzione di contratture o di ulteriore perdita di movimento;
• mantenere o recuperare la simmetria della forma del viso, testa e collo;
• lo sviluppo di reazioni posturali in tutte le direzioni;
• postura corretta della testa e del collo senza inclinazione persistente verso lato interessato;
• simmetria di schemi motori durante lo sviluppo.
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The main number which is used to assess the value of the bond is the gross redemption yield.
The last word objective of traders in such trading is to earn a revenue by purchasing a commodity at a lower worth and selling at a higher worth.
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Choices may be extra versatile but this additionally signifies that it’s more sophisticated than different forms of trading.
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