It is rewarding helping Mom’s and their babies with PT!

Here is what a Mom recently posted about us on Yelp:

“The highly noted Dr Graham (out of Cedar Sinai) recommended PTSolutions when he examined my son at 2 months and found a moderate-severe Torticollis. I called PTSolutions that very day and they got me in immediately. Dr. Flores recommended a twice weekly program plus exercises at home. She worked with my son regularly over the next several months and his Torticollis went away. He still had to wear the helmut but when I went back to Dr. Graham he was exceptionally impressed with the work Dr. Flores had accomplished and that the Torticollis was gone! My son LOVES Dr. Flores. He was always happy to be at PTS and always comfortable with the very helpful staff!

BTW – I liked how much Dr. Flores was invested in helping my son that I asked her to look at me and my neck/shoulder issues. She set up a program for me and has dramatically helped me improve my strength and ability to lift my son. A miracle after all the other failed physically therapy places I’d been.

This is a highly professional facility that is INVESTED in YOUR recovery! My highest recommendations and a heartfelt thank you to this great place!” Alex. S. West Hollywood, CA

We strive for moments like this, impacting the lives of families on a daily basis. What a joy!

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December 5, 2012. Tags: , , , , , , , , . Testimonials. Leave a comment.

Plagiocephaly: Early Intervention prevents, PT corrects the cause, Helmet improves shape

It is recommended to start physical therapy intervention as as soon as a parent or pediatrician detects a developing flat spot (plagiocephaly, brachycephaly).  It is equally important for pediatricians and OBGYN doctors to educate new moms that may have a newborn that is at risk for positional plagiocephaly.  Usually, pediatricians and OBGYN doctors refer these moms to a pediatric specialist for a consultation.

What are the risk factors?  Intra-uterine constraint (first pregnancy, multiple birth, breeched/ transverse positioning, intra-uterine fibroids, larger than average infant head or body size, > 40 weeks delivery) and traumatic birth history (infant head in birth canal for long period of time, use of vacuum/clamp, emergency c-section or premature delivery).

 “It is completely possible to identify newborns who are at risk for positional plagiocephaly and help the families of these newborns at risk,  prevent the flattening from ever happening. ”  Dr Yvette Flores

We recommend a physical therapy evaluation within the first two months of life.  Physical therapy intervention could be as short as 2 visits: the first visit is to evaluate and educate the parents on what to do, the second visit is to follow up after a month or so to make sure the parents are doing a great job and the child’s head is looking good.

Physical therapy intervention has a high success rate at improving and restoring head shape symmetry when initiated between birth to 3 months of age.  In severe cases, however, helmet therapy is recommended.

Helmet therapy is most effective when done between 5 months to 8 months of age, in conjunction with physical therapy.  Helmet therapy eliminates the challenge parents have of sleeping their child ‘off’ the flat spot by offering an environment where nothing touches the flat spot 23 hours a day.  Depending on the severity of the flat spot and the child’s age, the helmet is used for 2 to 5 months.

We typically don’t recommend helmet therapy earlier than 5 months because:

1) Physical therapy alone usually can guide the families to normal restored head shape

2) Initiating helmet therapy too early can result in the need for another helmet shortly after the child grows out of the first.

3) Helmets are costly with no guarantee that health insurance will cover it.  On average, they are about $4000 depending on which center you go to.  If we can help families save four thousand dollars with just physical therapy alone, we are all for it.

4)  If the underlying ‘root cause’ of the plagiocephaly isn’t corrected by the time the helmet therapy is done, there is a chance of re-flattening. Here is an analogy: take a piece of play doh, putty or soft clay.  Make a round ball out of it and place it on a flat surface such as a table.  After a few minutes, you will see that the round ball begins to flatten where it is in contact with the table.  The same thing occurs with infant heads which is impressionable from birth to 12 months: repetitive pressure on the same spot can cause re-flattening.  If the child still has signs of positional ‘favoring’ (prefers sleeping with head turned or tilted to the left), it is likely that the original spot that was rounded out with the helmet can get dented in again over time.

Bottom line:  Positional plagiocephaly can be PREVENTED by :

1) Simply educating new parents on preventative techniques: if your pediatrician or OBGYN doctor does not refer new parents for a physical therapy early intervention session, parents can take the initiative to schedule this session directly with a pediatric physical therapist that specializes in head and neck challenges.  We recommend doing this within the first 2 months of life.

2) As a new parent, find out if your newborn is at risk by looking at the risk factors listed above and seeing how many (if any) pertain to your pregnancy and birth history.  If you identify with even 2 items on the list, it is imperative that you learn preventative techniques to start applying right away.  Schedule a session with a skilled pediatric therapist to learn what you can do that is safe and effective.

If your child has an obvious developing flat spot in the back of his/her head….

*Tell your baby’s pediatrician that you would like to schedule a consultation with a pediatric physical therapist.  It is a smart idea to get the opinion of a physical therapist who specializes in head & neck challenges on your baby’s developing flat spot, to learn techniques you can start doing right away to prevent it from getting flatter, and to determine if you child is a candidate for a physical therapy (and helmet therapy) program.

A referral or prescription for a physical therapy evaluation is not required in the state of California (and possibly other states). Should your child benefit from a course of physical therapy, the therapist can then get the prescription from your pediatrician.

January 15, 2012. Tags: , , , , , , , , , , . Early Head Start, FYI's for New Parents. Leave a comment.

I am #9418 who signed the Positional Plagiocephaly Petition

Ever since the Back to Sleep Campaign and the recent fear-induced note from the FDA about sleep positioners, specialists such as myself have been concerned about our efforts to provide needed education and awareness to new parents. I came across a fabulous effort on behalf of the moderators of the yahoo group: Positional Plagocephaly. They are having parents sign a petition to create much needed awareness by the American Academy and American Board of Pediatrics. I agree with this petition and have signed it myself!

I have posted the petition below for your review as well as the link, should you decide to add your voice to this cause.

Sincerely,
Dr. Yvette Flores, PT, DPT
—————————————————

To: American Academy of Pediatrics Task Force on Infant Positioning and SIDS, and The American Board of Pediatrics

John Kattwinkel, MD, Chairperson
John G. Brooks, MD
Maurice E. Keenan, MD
Michael Malloy, MD

And

To: The American Board of Pediatrics,

Prior to the 1992 Implementation of the Back to Sleep Campaign, it was estimated that 1 in 300 babies had varying degrees of cranial asymmetry {abnormal head shape}. As of today, it is estimated that 1 in 60 babies have a cephalic disorder, known as Positional Plagiocephaly. The numbers are increasing in epidemic proportions globally. We respect the American Academy of Pediatrics commitment towards the quality of health for our children. However, we as parents feel the Task Force on Infant Positioning and SIDS has not fulfilled its duties with educating the public or the medical establishment on the complexities of this campaign.

The American Academy of Pediatrics’ stand has been a supine sleeping position to reduce the risk of Sudden Infant Death Syndrome. The AAP has only recently released a statement of the importance of “tummy time.” The recommendations in this statement do not indicate an effective course of treatment – or serve as standard medical care – for Deformational or Positional Plagiocephaly.

Deformational and Positional Plagiocephaly is characterized as follows:

PLAGIOCEPHALY- significant flattening of the right or left skull, typically accompanied by ear misalignment and facial asymmetry

SCAPHOCEPHALY – Long and narrow head shape

BRACHYCEPHALY – shortening of the head due to flatness,increased head height, often accompanied by an under bite.

Suggested Manifestations of Cranial Asymmetry are as follows:

torticollis- Face turns to the right or left with a head tilt
Misaligned ears,
Nose pushed to one side,
Unilateral cheek prominence,
Bossing of the forehead,
One eye appearing larger than the other.

Head shape abnormalities are believed to cause:

Migraines,
Temporomandibular Joint {TMJ} Syndrome,
Eyesight problems, and
Severe Psychological Consequences

We as parents will continue to place our children in a supine sleeping position. We are asking the American Academy of Pediatrics to implement a policy requiring our children’s doctors to carefully evaluate every child at birth for cranial abnormalities, and follow up at every well-baby checkup thereafter. We are asking the American Board of Pediatrics to offer various options for treatment when these abnormalities are present.

The phrase, “It will round out,” is simply not true in most cases. Aggressive repositioning is not always successful. We as parents would like to be given a referral to an educated specialist, in a timely manner. The ideal timeframe for maximum correction is between 3 and 6 months. We as parents do not want babies with perfectly round heads. What we expect is recognition and response to the rise of documented disorders related to the “Back to Sleep” campaign.

Sincerely,

——————————————————

To sign the petition yourself, go to: http://www.petitiononline.com/0799/petition.html

November 24, 2010. Tags: , , , , , , . Early Head Start, FYI's for New Parents. Leave a comment.

Early Head Start

 Early Head Start: A Preventative & Corrective Program for Infants & Toddlers with Congenital Head & Neck Challenges By Dr. Yvette Flores, PT, DPT 

Congenital head & neck challenges can be detected by a PT specialist as early as the first day of life. However, infants with a head & neck challenge typically don’t show obvious signs until 3 months of age. Such signs are a positional favoring such as turning or tilting the head one way more than the other way. The most obvious sign frequently seen at 3 months of age is a developing flat spot in the back of the head. If left un-treated, this flat spot can worsen pretty rapidly to the point of requiring use of a pricey, corrective helmet to improve the head shape. More and more pediatric specialists are now recommending the Early Head Start program to identify infants at risk, prevent or correct head deformation, and correct the root cause of the neck challenge within the first 6 months of life.There are several markers that place a newborn at risk. Knowing these signs allow Pediatricians and new parents to screen for risk and follow the Early Head Start 3-step program, if warranted. Such signs are: a clear favoring turning his/her head one way, tilting his/her head to one side, or a developing “flat spot” in the back of the head. These signs are most obvious when the infant is asleep in a car seat/ stroller, or when the infant is tired or not feeling well. Sometimes, parents notice these signs before the physician does, and when brought up with the physician, are instructed to alternate head position during back sleeping. Traditionally, parents are also given a handout on a couple of neck stretches to do at home. If parents are not successful with their attempts to follow the handout, they are then referred to a physical therapist for proper instruction. Today, parents are referred directly to a PT specialist for successful early intervention, thereby minimizing head deformation, need for a costly helmet, need for extensive physical therapy and/or need for invasive measures such as surgical release of the tight muscles.

The Early Head Start program is designed to detect newborns & infants at risk, identify the cervical muscles involved, and initiate the steps to full correction and recovery. Step #1: Early identification allows for early intervention. Step #2: Early intervention prevents head deformation, tighter neck muscles, and habitual favoring. Step #3: A course of physical therapy will help to ensure complete resolution within the narrow window of time available for full correction, should an infant already exhibit head & neck challenges.

The bottom line: The Early Head Start program saves families hundreds if not thousands of dollars in medical expenses, ensures healthy head and neck development, full range of motion, strength, normal symmetry, and promotes age-appropriate gross motor skills.

The Early Head Start 3-Step Program

Step #1: Identify markers for risk (birth to 12 weeks old)

Unusual positioning in utero or lack of adequate space in utero, especially during the last trimester, is a common marker for risk. The most popular examples include: breeched positioning, diagonal positioning with head down under pelvis, multiple births, first time Mom (possible small uterus), and baby has a larger than average head size. Another common marker is a traumatic birth. Popular examples include emergency C-section, cord wrapped around neck, vaginal delivery with a very long labor, baby getting stuck in vaginal canal, use of a vacuum or other aggressive means to remove baby. A premature birth followed by a stay in the NICU, can also be an identifying marker for a congenital head & neck challenge. Lastly, if your baby appears to have a strong dislike toward tummy time, especially after the age of 3 months, there is a chance that he or she has a congenital head & neck challenge.

Step #2: Early Intervention (birth to 12 weeks old)

Receive instruction and tips on (1) how to alternate head position during naps and sleep time to prevent flattening of the back of the head, (2) how to introduce and build up daily tummy time for symmetrical neck and back strengthening, (3) how to maintain a symmetrical head position, especially when in a carrier such as the car seat or stroller, and (4) recommended tools such as car seat head positioners and sleep positioners, to make your efforts easier.

Step #3: Physical Therapy Program (initiate between birth to 5 months for optimal results)

A course of physical therapy (PT) is the best conservative approach toward full correction. The ideal age range to start PT, which yields the best prognosis for full correction of a head and neck challenge, is between 8 weeks to 16 weeks old. If a baby has unaddressed head & neck challenges greater than 32 weeks, the window for full correction is significantly narrowed and the likelihood of a longer PT program and need for helmet therapy is higher. On average, full correction of the underlying cause can be achieved within 4 to 12 sessions. More may be needed, depending on the severity of your baby’s condition and the success of the instructed home program. A PT program entails neck stretches for tight muscles, strengthening exercises targeting weak neck muscles & back and core muscles, manual therapy of soft tissue and joint mobilization, and age-appropriate gross motor activities to maintain and improve upon symmetrical body balance and strength. A tailored home program will also be given on the first visit and modified as your baby progresses through his or her PT program.

*For more information, please visit our website: www.BabyTherapySolutions.com. If your baby has not been screened for a potential head & neck challenge and you would like our professional opinion, please contact us regarding our 15 minute complimentary screen. If you have been told by a physician or other infant healthcare provider that your baby has a positional favoring or developing flat spot, we recommend a PT initial evaluation as soon as possible. Please call to discuss details of this evaluation and schedule an appointment. Your pediatrician will get our report of findings and the next step, if any is required, will be determined. Physical Therapy Solutions is located at 2634 Wilshire Blvd, Santa Monica CA 90403. (O) 800-507-2634, (F) 310-774-3652.

Copyright © 2010. Physical Therapy Solutions. All Rights Reserved. Any duplication of this material without written permission is prohibited.

 

 

 

April 9, 2010. Tags: , , , , , , , , , , . Early Head Start. 3 comments.

Testimonial 1: 6 mo old graduates from PT after 4 visits!

We received a referral this past September from a local Pediatrician in Santa Monica.  A 4 month old baby girl was showing signs of left head flattening and Mom wanted to know if she will need a helmet or not.  Our evaluation revealed a left tilt favoring between 0 degrees (normal) to 5 degrees.  Little Maggie* also did not demonstrate an ability to actively tilt her head to the right past midline.  Her head flattening was moderate and to the left back side.  The muscles on the left side of her neck were alot tighter than the right.  All of this evidence pointed to what her Pediatrician concurred to be a diagnosis of moderate left plagiocephaly with left tilt favoring. 

Maggie was seen for physical therapy every two weeks for the next 3 visits and then again after a month for her 4th and final visit.  Maggie did get the helmet a week after her evaluation, which Mom states was the best decision she and Dad could have made for her.  At her second PT visit, Maggie was already demonstrating signs of improvement: she kept her head midline (no tilt favoring noted) and she could actively tilt to the opposite side.  Her primary limitations at this point were: still limited right cervical rotation and limited age-appropriate  prone motor skills.  During the third visit, Maggie’s head shape was improving, she continued to keep her head midline, she finally had full normal cervical rotation both ways, and she demonstrated imiproved prone motor skills.  In addition, she was learning to sit up independently and mom was thrilled.  During her 4th and last visit, Mom reported that she only had a couple more weeks in the helmet before her head shape was normal.  Mom was happy to share she no longer saw any differences or favoring.  Maggie was sitting up by herself now, and her prone motor skills were right on track!  At that point, we all agreed that Mom and Dad were able to continue with a home maintenance program and that Maggie no longer needed physical therapy.

Here is what Maggie’s Mom wrote about us:

“Our daughter was diagnosed with an asymmetric flat head at her 4 month appointment and recommended to wear a helmet.  We were fortunate to be referred to Dr. Flores’ office for physical therapy.  Our daughter ended up getting both the helmet and physical therapy, and at 6 months, her head looks great!  We are very happy with the result.  The helmet was never a problem for our daughter, but we feel that physical therapy helped with fixing the underlying problem.  It also empowered us as parents to contribute to our daughter’s improvement.  I would definitely recommend Dr. Flores, who is obviously very experienced both in treating and relating to babies.”

Although it is not common to see infants with complete resolution of head & neck asymmetries after just 4 physical therapy visits, it’s always a blessing to experience and be a part of.  My professional opinion of Maggie’s cause for her head flattening is a mild case of one sided neck muscle tightness, which is formally described as congenital muscular torticollis. 

Three things worked in Maggies favor and explains why she improved so quickly with a short amount of physical therapy treatments:

1.  Maggie initiated PT within the first quarter of life (at 4 months old vs. 8 months).  There is a strong correlation between early intervention with head & neck challenges and minimal therapy time.  The sooner any favoring is detected and addressed, the sooner the resolution.  

2.  Maggie’s parents were extremely consistent and successful with her daily home program of stretches, positioning and strengthening exercises.  

3.  Maggie’s condition of neck muscle tightening was mild, and although her head flatness was  moderate, she was still young enough to have more time for correction.

For more information on these conditions and treatments, visit our website at: www.torticollistherapy.com

(*To protect the identity of our patient, the name Maggie was used instead)

December 10, 2009. Tags: , , , , . Testimonials. 2 comments.