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Patterns of postural asymmetry in infants: a standardized video-based analysis

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Abstract

Cervical rotation deficit (CRD) and trunk convexity (TC) constitute the diagnosis of infantile postural asymmetry (IPA), which is often associated with further asymmetric features. However, very little data on the entire symptom complex are currently available. The aim of this study was to analyse the entire clinical spectrum of IPA based on a standardized video documentation. Forty-five infants (27 male) with an asymmetry score of ≥12 points (scale: 4–24) at a median post-term age of 10 weeks (range: 6–16) were selected from two previously studies using predefined criteria. CRD and TC as reactive movements to an orienting head turn in the prone and supine position were assessed from video recordings by three independent observers. Plagiocephaly, oblique body position and asymmetric foot position were descriptively assessed by consent of the same observers. Hip dysplasia data were derived from sonography charts. The assessment of the reactive movements showed a “scoliosis” pattern in sox infants, a “torticollis” pattern in nine infants, a “mixed prone” pattern in 13 infants and a “mixed” pattern in 26 infants. Side agreement in the prone and supine position of TC and CRD was seen in 27 infants, with a left-sided convexity and left-sided head rotation deficit in two-thirds of the infants. Plagiocephaly was present in 27 infants, oblique body position in 13 infants, hip dysplasia in 4 infants and calcaneus foot in 11 infants. In conclusion, infantile asymmetry pattern analysis showed that morphological and functional anomalies are intricately linked and that infants with only a single apparent sign of asymmetry have actually a much more generalized disturbance.

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Abbreviations

CRD:

Cervical rotation deficit

IPA:

Infantile postural asymmetry

TC:

Trunk convexity

TSC:

Total score difference

References

  1. Argenta LC, Davis LR, Wilson JA, Bell WO (1996) An increase in infant cranial deformity with supine sleeping position. J Craniofacal Surg 7:5–11

    Article  CAS  Google Scholar 

  2. Aufschnaiter D von (1999) Entwicklung und Entwicklungsdiagnostik. In: Hartmannsgruber R, Wenzel D (eds) Physiotherapie Pädiatrie Band 12. Georg Thieme Verlag, Stuttgart, pp 5–25

    Google Scholar 

  3. Behrman RE, Kliegman RM, Jenson HB (2000) Scoliosis, craniosynostosis, torticollis. In: Nelson textbook of pediatrics, 16th edn. W.B. Saunders Co., Philadelphia, pp 1812–1813, pp 2082–2086, pp 2089–2091

  4. Binder H, Eng GD, Gaiser JF, Koch B (1987) Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil 68:222–225

    PubMed  CAS  Google Scholar 

  5. Boere-Boonekamp MM, Linden-Kuiper AT van der (2001) Positional preference: prevalence in infants and follow-up after two years. Pediatrics 107:339–343

    Article  PubMed  CAS  Google Scholar 

  6. Brett EM (1991) Paediatric neurology. 2nd edn. Churchill Livingstone, New York

    Google Scholar 

  7. Brodsky MC, Baker RS, Hamed LM (1996) Torticollis and head nodding. In: Pediatric neurophthalmology. Springer, Berlin Heidelberg New York, pp 351–368

    Google Scholar 

  8. Brunetaeu RJ, Mulliken JB (1992) Frontal plagiocephaly: synostotic, compensational, or deformational. Plast Recontr Surg 89:21–32

    Google Scholar 

  9. Canale ST, Griffin DW, Hubbard CN (1982) Congenital muscular torticollis. A long-term follow-up. J Bone Joint Surg Am 64:810–816

    PubMed  CAS  Google Scholar 

  10. Cheng JC, Au AW (1994) Infantile torticollis: a review of 624 cases. J Pediatr Orthop 14:802–808

    PubMed  CAS  Google Scholar 

  11. Davis BE, Moon RY, Sachs HC, Ottolini MC (1998) Effects of sleep position on infant motor development. Pediatrics 102:1135–1140

    Article  PubMed  CAS  Google Scholar 

  12. Flehmig I (2001) Normale Entwicklung des Säuglings und ihre Abweichungen. Georg Thieme Verlag, Stuttgart

    Google Scholar 

  13. Graf R (1984) Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 102:248–255

    Article  PubMed  CAS  Google Scholar 

  14. Gunturkun O (2003) Adult persistence of head-turning asymmetry. Nature 421:711

    Article  PubMed  CAS  Google Scholar 

  15. Hamanishi C, Tanaka S (1994) Turned head-adducted hip-truncal curvature syndrome. Arch Dis Child 70:515–519

    Article  PubMed  CAS  Google Scholar 

  16. Hunt CE, Puczynski MS (1996) Does supine sleeping cause asymmetric heads? Pediatrics 97:127–129

    Google Scholar 

  17. Kane AA Mitchell LE, Craven KP, Marsh JL (1996) Observations on a recent increase in plagiocephaly without synstosis. Pediatrics 97:877–885

    PubMed  CAS  Google Scholar 

  18. Kapandji IA (1992) Funktionelle Anatomie der Gelenke. Enke, Stutgart

    Google Scholar 

  19. Kattwinkel J, Brooks J, Keenan MJ, Malloy M (1996) American Academy of Pediatrics; positioning and sudden infant death syndrome (SIDS): update. Pediatrics 98:1216–1218

    Google Scholar 

  20. Konishi Y, Mikawa H, Suzuki J (2002) Asymmetrical head-turning of preterm infants: some effects on later postural and functional lateralities. Dev Psychobiol 40:1–13

    Article  Google Scholar 

  21. Lloyds-Roberts GC, Pilcher MF (1965) Structural idiopathic scoliosis in infancy: a study of the natural history of 100 patients. J Bone Joint Surg Am 47-B:520–523

    Google Scholar 

  22. Mau H (1968) Ist die sogenannte Säuglingsskoliose behandlungsbedürftig? Dtsch Med Wochenschr 43:2051–2053

    Article  Google Scholar 

  23. McMaster MJ (1983) Infantile idiopathic scoliosis: can it be prevented? J Bone Joint Surg Am 65-B:612–617

    Google Scholar 

  24. Michel GF, Harkins DA (2001) Postural and lateral asymmetries in the ontogeny of handedness during infancy. Dev Neuropsychol 19:41–51

    Article  Google Scholar 

  25. Niethard FU, Carstens C, Döderlein L, Peschgens T (1997) Kinderorthopädie. Georg Thieme Verlag, Stuttgart

    Google Scholar 

  26. Pang D, Veetai L. (2004) Atlantoaxial rotatory fixation: part 1 – biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery 55:614–626

    Article  PubMed  Google Scholar 

  27. Philippi H, Faldum A, Bergmann H, Jung T, Pabst B, Schleupen A (2004) Idiopathic infantile asymmetry, proposal of a measurement scale. Early Hum Dev 80:79–90

    Article  PubMed  Google Scholar 

  28. Reiss M, Reiss G (1997) Lateral preferences in a German population. Percept Mot Skills 85:569–574

    PubMed  CAS  Google Scholar 

  29. Rosegger H, Steinwendner G (1992) Transverse fetal position syndrome – a combination of congenital skeletal deformities in the newborn infant. Paediatr Paediol 27:125–127

    CAS  Google Scholar 

  30. Skiba M, Diekamp B, Gunturkun O (2002) Embryonic light stimulation induces different asymmetries in visuoperceptual and visuomotor pathways of pigeons. Behav Brain Res 134:149–156

    Article  PubMed  Google Scholar 

  31. St John D, Mulliken JB, Kaban LB, Padwa BL (2002) Antropometric analysis of mandibular asymmetry in infants with deformational posterior plagiocephaly. J Oral Maxillofac Surg 60:873–877

    Article  PubMed  Google Scholar 

  32. Thompson SK (1980) Prognosis in infantile idiopathic scoliosis. J Bone Joint Surg Am 62-B:151–154

    CAS  Google Scholar 

  33. Tunnessen W (1988) Asymmetry. In: Signs and symptoms in pediatrics 2nd edn JB Lippingcott, Philadelphia, pp. 509

    Google Scholar 

  34. Visscher F, Graaf T van der, Spaans M, Lingen RA van, Fetter WPF (1998) Prone position favorable for motor development of infants. Ned Tijdschr Geneeskd 142:2201–2205

    PubMed  CAS  Google Scholar 

  35. Vojta V (2000) Die zerebralen Bewegungstörungen im Säuglingsalter. Hippokrates, Stuttgart

    Google Scholar 

  36. Walsh JJ, Morrissy RT (1998) Torticollis and hip dislocation. J Pediatr Orthop 18:219–221

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Children’s University Hospital, Department of Paediatric Neurology, Im Neuenheimer Feld 150, 69120, Heidelberg, Germany

    Heike Philippi

  2. Institute for Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg-University, Mainz, Germany

    Andreas Faldum

  3. Children’s University Hospital, Johannes Gutenberg-University, Mainz, Germany

    Tatjana Jung, Holger Bergmann, Katharina Bauer, Daniela Gross & Juergen Spranger

Authors
  1. Heike Philippi
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  2. Andreas Faldum
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  3. Tatjana Jung
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  4. Holger Bergmann
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  5. Katharina Bauer
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  6. Daniela Gross
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  7. Juergen Spranger
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Correspondence to Heike Philippi.

Additional information

This study was supported by MAIFOR Fund of the Johannes-Gutenberg University Mainz, Germany

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Philippi, H., Faldum, A., Jung, T. et al. Patterns of postural asymmetry in infants: a standardized video-based analysis. Eur J Pediatr 165, 158–164 (2006). https://doi.org/10.1007/s00431-005-0027-6

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  • DOI: https://doi.org/10.1007/s00431-005-0027-6

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