Topics in pediatricsDevelopment of a Symmetry Score for Infantile Postural and Movement Asymmetries: Preliminary Results of a Pilot Study
Introduction
Although variable positional, postural, and movement asymmetries are considered to be indications of a developing physiological postural motor system, constant early childhood asymmetries of head or body posture, spontaneous movement, or muscle tone are mostly expressions of abnormal sensory-motor coordination and require diagnosis and, if necessary, treatment.1, 2, 3, 4, 5, 6, 7, 8 In pediatric practice in Germany, the term “kinematic imbalance due to suboccipital strain (KISS)” is widely accepted.1, 7, 9 The concept ascribes a decisive importance to segmental dysfunctions in the craniocervical junction in the pathogenetic occurrence of development of asymmetry. There are references to the neurophysiological foundations for this proprioceptive musculoskeletal coordination disorder.7, 10, 11 Postural and movement abnormalities of infants with systemic underlying diseases, such as neurologic disorders, genetic anomalies, dysplasias, or metabolic disorders, have to be distinguished from these.
Based on clinical observations, between 8% and 30% of all infants may develop constant postural and movement asymmetries during the first months of life.2, 3 The causes of such early childhood asymmetrical development are the subject of controversial discussion. The terminology and diagnoses are also diverse and are needed for the identical constellation of symptoms for infants without the presence of systemic underlying diseases. They range from “Siebener’s syndrome (syndrome of contractures)”12 to “infantile scoliosis”8 and “cervical diencephalic static syndrome of infants,”13 all the way to “idiopathic infantile asymmetry”14 and finally to “infantile postural asymmetry.”6
Because, from a functional orthopedic viewpoint, segmental disorders in key regions of the locomotor system stand in the forefront as catalysts for constant postural and movement asymmetries, there are various manual medicine and osteopathic concepts for diagnosis and treatment. Current treatment options for infantile postural asymmetry and KISS, respectively, are physiotherapeutic methods and manual medical or osteopathic treatments. There is indeed positive clinical experience of these treatment approaches (latest level of evidence IV for manual medicine)15; however, there are no evidence-based studies on levels I or II. Thus, the scientific evaluation of a manual medical treatment approach is of primary importance.
In a placebo-controlled small study, positive effects of osteopathic treatment of infants, aged between 6 and 12 weeks, were observed.6 Because the score used by Philippi et al6 could not be applied to the target group, the authors developed a sensory-motor symmetry score and tested it for reliability and validity. Therefore, the purpose of this study was to design an objective sensory-motor development score for infants aged 3 to 6 months with infantile postural and movement asymmetry or KISS. This study also assessed if the symmetry score was feasible for investigating manual medical treatment for affected infants in a pilot study.
Section snippets
Methods
The 2 studies to investigate the quality criteria and the pilot study were all approved by the Ethics Committee of the University Hospital of Jena. At the end, 3 different studies were accomplished (Table 1). Respectively, each rater and examining or treating physician is a medical doctor (>15 years) and specialist for manual medicine in pediatrics (>5 years). Only 1 participant, acting as rater in the reliability study, was a medical student in the fifth year of qualification (>1 year of
Results
Testing of the measuring instruments Onde Ruler and MB-Ruler yielded a 100% consistency at a measuring accuracy of the set square of 0.5°. Hence, both software instruments are usable for the symmetry score and this study setting.
Discussion
Several video-based scores14, 22 were conceptualized for usage in routine pediatrics. The present scale serves for reviewing therapeutic results in the treatment of infantile postural and movement asymmetries, or KISS, in the context of clinical studies. The focus is the compilation of objective measurements for infants aged 3 to 6 months. The increasing facilitation of the intentional motor system between the 10th and 14th weeks of life leads physiologically to symmetrization of postural and
Conclusion
The 4-item symmetry score appears to be a valid and reliable tool for the diagnosis and evaluation of infants aged 3 to 6 months who have asymmetries. It is hoped that this will be a useful instrument to measure symmetry changes in pediatric research. Moreover, the combined therapy with single manual medicine and “tummy time” seems to be effective but will need to be explored further with clinical trials.
Acknowledgment
The scientific assistance was carried out by the Department for Research Consulting in Manual Medicine (Forschungsberatungsstelle, Manual Medicine), located at the Institute for Physiotherapy, University Hospital Jena, Germany.
The authors thank Dr. Steffen Derlien, Head of the Work Area of Clinical Rehabilitation Research at the Institute for Physiotherapy at the University Hospital of Jena for Scientific Consultation. The authors thank Dr. Thomas Lehmann, Scientific Associate at the Institute
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): R.S., M.A.
Design (planned the methods to generate the results): D.L.-K.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): R.S., D.L.-K., M.W., U.C.S.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): H.S.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): D.L.-K.
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