An Interdisciplinary Approach to Improve Head Tilt in Pediatric Torticollis Patients with the Use of Prism Glasses

Background: Infants with head tilts are most often diagnosed with torticollis and are referred to a pediatric physical therapist for evaluation and treatment. Determining if the head position is muscular or non-muscular when assessing these infants is key in making the appropriate referrals to other specialists and determining the best treatment approach. Most pediatric physical therapists treat patients with head tilts with manual therapy (i.e. massage, myofascial release, and passive/active range of motion). Many physical therapists only consider a visual etiology as a possibility after other treatment options have been exhausted and the head tilt persists. Although the incidence of torticollis has increased, based on the author’s experience, the number of cases of non-muscular etiology has also increased. There is a lack of current research on the use of prism glasses for treating head tilts in young children and infants carrying a diagnosis of torticollis, especially those presenting without any active/passive motion limitations. Traditionally, these patients undergo years of treatment without resolution of the head tilt. Case Report: A two-year-old patient initially presented with a diagnosis of torticollis with an intermittent and alternating head tilt for physical therapy. After several months of manual therapy, with little improvement in her head posture, the patient’s physical therapist referred her to a behavioral optometrist for a comprehensive vision examination and to pursue alternative treatment options. The optometric evaluation revealed ocular misalignment causing poor depth perception skills and prism glasses were prescribed full-time with the recommendation of continuing physical therapy for gross motor development. Conclusion: Prism glasses are an appropriate treatment consideration for some pediatric patients with persistent head tilts because they can provide immediate improvement in head position and depth perception. It is important to include optometrists in the multi-disciplinary team when working with patients with head tilts. Pediatric physical therapists would benefit from training on how to properly screen visual skills when evaluating children with head tilts. With such training, an appropriate optometric referral could be initiated early on in treatment.