Neural and visceral manipulation in infants with congenital muscular torticollis: a feasibility study.

[Purpose] As an alternative to manual stretching, the aim of this study was to investigate the feasibility of using neural/visceral manipulation as a safe and effective intervention to increase neck range of motion of infants with congenital muscular torticollis. [Participants and Methods] Ten 4-month old infants with congenital muscular torticollis received eight sessions of neural/visceral manipulation administered for 30-50 minutes without observed pain. Specific palpation techniques addressed restricted tissue areas of neck, head, trunk and extremities. Neck rotation and lateral flexion were assessed by still photography and a computer program calculating ROM angles before, immediately following, and 4 months post intervention. Motor development and social competence were monitored over time using the Alberta Infant Motor Scale and Bayley-III Social Emotional Scale. [Results] Results of analysis of variances revealed significant improvements in passive and active neck rotation and lateral flexion. Significant increases were also found on the Alberta Infant Motor Scale and Bayley-III Social-Emotional scale. [Conclusion] Neural/visceral manipulation can be used safely in infants with congenital muscular torticollis to improve neck range of motion.

The Framework of Occupational Gradation (FOG) to Treat Upper Extremity Impairments in Persons With Central Nervous System Impairments.

Occupational therapists providing treatment of persons with central nervous system (CNS) impairments now embrace a motor control approach based on principles of strength training and practice of meaningful occupations. This paper describes the Framework of Occupational Gradation (FOG), which was developed to assist occupational therapists to systematically challenge upper extremity function by manipulating the degrees of freedom of active motion in a person's extremity. Clients may be able to perform occupations under several or all levels within the framework. However, the person, task, or object properties and the environment can also be manipulated by the occupational therapist to optimize or challenge a person's performance at each level. Application of the FOG is presented through case studies.