Соматоскопічне обстеження як обов’язкова складова реабілітаційного обстеження дітей з патологією опорно-рухового апарату

Abstract

Стаття присвячена удосконаленню авторського алгоритму соматоскопічного обстеження дітей раннього віку з вродженою м’язовою кривошиєю при різних положеннях тіла, залежно від вікової групи (0–3, 3–6, 6–9, 9–12 місяців), психомоторного розвитку, рефлексів за рахунок врахування супутніх захворювань та патологій опорно-рухового апарату.

Статья посвящена усовершенствованию авторского алгоритма соматоскопического обследования детей раннего возраста с врожденной мышечной кривошеей при различных положениях тела, в зависимости от возрастной группы (0-3, 3-6, 6-9, 9-12 месяцев), психомоторного развития, рефлексов за счет учета сопутствующих заболеваний и патологий опорно-двигательного апарата.

Any deviations from the norms arising in young age will later cause various health disorders. Torticollis is a wide-spread poly-etiological orthopedic pathology which may be diagnosed either after the birth of a child or may be developed later; it may be either a single independent disorder or a symptom of other conditions. Congenital muscular torticollis is a constant wrong head positioning when head is tilted to one side and face being tilted to another side Major symptoms of congenital muscular torticollis of infants are as follows: 1) titling head in one direction (with simultaneous lifting of the shoulder of the same side); 2) tightened sternocleidomastoid muscle (SCM); 3) deeper and asymmetric skin lines on the opposite side of the neck; 4) asymmetry of the face, skull, ear, face muscles atrophy and skull vault asymmetry. Forced head positioning is caused by pathological changes in neck muscles, particularly in SCM muscle and sometimes in other muscles, e.g. trapezius muscle. As for its location, torticollis may appear only on one side, either left or right one, or on both sides of the neck. Pathological process affects the whole body. Not treated/undertreated/not effectively treated torticollis may affect morphological and functional condition of the locomotorium, slow down the development of reflexes and movement skills and cause delays in psychological and physical development. Pathological processes also affect bones, joints, nerves and the whole skeletal and nerve system. The condition may result in “face scoliosis”, deformation of all skull’s and lower jaw’s bones, change of acoustic meatus, restriction of the field of view, high intracranial pressure, cerebral circulation disorder, posture problems, vertebra retardation, scoliosis and growth disorders. Available literature lacks unified recommendations on the diagnostic measures of infants as well as systematized somatoscopy data in accordance with different age groups (0–3, 3–6, 6–9, 9–12 months) and peculiarities of psychological and motor development and reflexes of certain age period. Next, specialists examined the body, determined angular peculiarities of cervical spine movements, checked if the movements were symmetrical and determined functional restrictions. The following methods were used: somatoscopy (original author’s algorithm of somatoscopy), two-sided palpation of SCM muscles. Results of the study: еlaborated mechanism of somatoscopic examination of infants with congenital muscular torticollis helped to determine part of the body which needs rehabilitational measures and evaluate the effectiveness of rehabilitational methods used. Elaborated examination card of infants with congenital muscular torticollis made it possible to obtain objective results of examination depending on certain age groups (0-3, 3-6, 6-9, 9-12 months). During primary morphofunctional status determination, it was found out that children with congenital muscular torticollis also had substantial asymmetries of body parts, muscular tonus disorders, worsening of cervical spine movability, bowing head in the direction of healthy SCM muscle. Besides affected function of SCM muscle which is connected with anatomic or functional disorder causing limited unbending, side bending, cervical spine rotation, turning head to the affected side when lifting and holding head in horizontal position, turning it and maintaining balance.