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The TOT Collar for Torticollis Treatment

Torticollis Treatment Brace

The TOT Collar (Tubular Orthosis for Torticollis) is the best treatment for Congenital Muscular Torticollis when combined with stretching.

Designed as a treatment for Congenital Muscular Torticolllis, the TOT Collar is a simple, effective and inexpensive therapy to correct head position and prevent further health problems. It is used for infant torticollis as well as for older patients. When combined with stretching of the muscle, the TOT Collar offers better results for torticollis than stretching alone.

About Torticollis
Congenital Muscular Torticollis is usually discovered in the first 6 to 8 weeks of an infant's life. It is characterized by a contracture of the sternocleidomastoid muscle, causing the head to be laterally flexed to the affected side and rotated to the opposite shoulder. If uncorrected, this posture may lead to plagiocephaly and a high thoracic scoliosis. There is further information about Congenital Muscular Torticollis towards the bottom of the page.

How the TOT Collar works

The TOT Collar for Torticollis Treatment is designed to provide a noxious stimulus to the lateral aspect of the skull. The user moves away from this stimulus towards a new, central corrected position. Adoption of a new, normal head position provides the ability to reset perception of horizontal and so maintain the corrected head position. The TOT Collar is preassembled and ready to fit.

Specifications of the TOT Collar

The TOT Collar is made of a loop of soft PVC tubing that is bridged by two short nylon tubes. Varying sizes of tubes are packaged with the TOT Collar. These tubes are positioned anterior and posterior to the crest of the trapezius. The PVC tubing is fastened with a Velcro strap. The TOT Collar is non-toxic and washable. It can be cleaned with soap and water.

Indications for use
TOT Collar use is added to the conservative torticollis treatment of infants with congenital muscular torticollis if they are 4 months of age or older and show a consistent head tilt of 5 degrees or more. The infant must have adequate ROM and lateral head righting reaction (head control and strength) to lift his or her head away from the side of the TOT Collar.

Features and Benefits of the TOT Collar

For the Fitter:

-simple to fit

-easy adjustment using interchangeable tubes

-longer tubes can be inserted to accomodate improved alignment No Image

For the wearer and/or caregiver

-a cool comfortable collar

-easy to put on and remove

-easy to keep clean

-low profile, unobtrusive appearance

-amount of support set to wearer needs

Fitting the TOT Collar

SIZES:
TOT 01 Child: fits a four-month to 10-year-old child (for infant torticollis)
TOT 02 Adult: fits an average 10-year-old to adult

1. The Collar is pre-assembled and ready to fit. If necessary, change the white nylon tubes for the correct size. TOT Collar pulled apart

2. Place the TOT Collar around the neck and connect it. If you find the height of the support tubing is incorrect, you can change the tubes for other lengths, which are included with the Collar.

Avoid undue pressure.

Cut Tubing

3. To adjust the length of the Collar, remove the Collar from the wearer. Pull the clear p.v.c. tubing through the support tubes. Trim the clear tubing to the correct length with scissors.
Please be careful not to cut off too much of the clear tubing as it cannot be reconnected once it is cut.

4. Once you have sized and fitted the Collar:
Torticollis Treatment Brace

-Ensure the nylon support tubes are anterior and posterior to the crest of the trapezius;
-and make sure any caregiver can position the Collar correctly. If required, the top of the Collar can be marked to show positioning.

When placed in the position, the Collar should be checked for any undue pressure points. Longer tubes can be inserted when the head alignment improves.

WARNING
-The Collar must be removed when the wearer is asleep.
-Do not leave a child unattended while wearing this collar.

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What is congenital muscular torticollis?
Congenital muscular torticollis is a condition in which an infant's neck muscle is shortened causing the neck to twist. Congenital means present at birth and torticollis means twisted neck. The condition is sometimes called "wryneck."
What causes congenital muscular torticollis?
Congenital muscular torticollis may occur following a difficult birth, especially if the infant is very large or is delivered breech. During the delivery, if the sternocleidomastoid muscle, the neck muscle that extends from the jawbone (mastoid) to the clavicle (collarbone) and sternum (breastbone), is stretched or pulled, it may tear, causing bleeding and bruising within the muscle. The injured muscle develops fibrosis (scar tissue) which causes the muscle to shorten and tighten, pulling the infant's head to one side. The fibrosis forms a mass or lump that sometimes can be felt on the side of the neck.
Occasionally, congenital muscular torticollis occurs because of a defect in the development of the sternocleidomastoid muscle, or because of an abnormal fetal position in the uterus.
What are the symptoms of congenital muscular torticollis?
Congenital muscular torticollis may be visible at birth or it may not become evident until several weeks later. The following are the most common symptoms of congenital muscular torticollis. However, each child may experience symptoms differently. Symptoms may include:

tilting of the infant's head to one side
the infant's chin turns toward the opposite side
firm, small, one to two centimeter mass in the middle of the sternocleidomastoid muscle

The symptoms of congenital muscular torticollis may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.
How is congenital muscular torticollis diagnosed?
Generally, physical examination of the infant may show the characteristic tilting of the head and tension of the sternocleidomastoid muscle, as well as presence of a mass in the middle portion of the muscle. In addition to a complete medical history and physical examination, diagnostic procedures for congenital muscular torticollis may include the following:
-x-rays - to check for abnormalities in the bones of the neck and shoulders; a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
-ultrasound examination - to evaluate the muscle around the mass; a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Treatment of congenital muscular torticollis:
If the condition is not corrected, the infant will be unable to move his/her head properly. Permanent muscle tightening with asymmetry (uneven development) of the neck and face can result. Specific treatment of congenital muscular torticollis will be determined by your child's physician based on:

your child's age, overall health, and medical history
extent of the condition
your child's tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

Treatment may include:

gentle stretching exercise program (to help relieve the tension and lengthen the sternocleidomastoid muscle)
infant stimulation (to help the infant learn to move and stretch the muscle)
surgery (to correct the shortened muscle)

The neck mass may enlarge during the first month of life, then gradually get smaller, usually disappearing by age 5 to 8 months.

Check out our Article Library for more information on Congenital Muscular Torticollis as well as studies and papers on treatment.

References

1. Tubular Orthosis for Torticollis (TOT): A new approach to the Correction of Head Tilt in Congenital Muscular Torticollis, Mosterman et all, B.C.H.R.F. Study, 1985 - 1986. Abstract copies available. Article in PDF format.

2. The Determinants of Treatment Duration for Congenital Muscular Torticollis, Emery, C., Physical Therapy - Vol. 74, #10, October 1994, pp 921 - 929. Article in PDF format.

3. TORTICOLLIS: Differential Diagnosis, Assessment and Treatment, Surgical Management and Bracing, ISBN 0-7890-0317-1, Karen Karmel-Ross: Published by Haworth Press. Article in PDF format.

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