Original Research
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M.Y.K. Department of Physical Medicine and
Rehabilitation, CHA University College of Medi-
cine, Bundang CHA Hospital, Kyonggi-do, Korea
Disclosure: nothing to disclose
D.R.K. Department of Physical Medicine and
Rehabilitation, CHA University College of Medi-
cine, Bundang CHA Hospital, 351 Yatap-dong,
Bundang-gu, Sungnam-si, Kyonggi-do, 463-
712, Korea. Address correspondence to D.R.K.;
e-mail: coolkwon@cha.ac.kr
Disclosure: nothing to disclose
H.I.L. Department of Physical Medicine and
Rehabilitation, CHA University College of Medi-
Kyonggi-do, Korea
ose
d on the Table of
urnal.org
nuary 20, 2009;
ehabilitation
739, August 2009
j.pmrj.2009.06.008
73niofacial asymmetry that appears to result from restricted growth on the affected side.
The initial therapy for the patient with CMT should consist of physiotherapy with passive
d active exercises and massage. If contraction of the SCM muscle persists beyond 1 year
age or craniofacial anomaly develops, surgical treatment is indicated [7]. In the authors’
erience, an aggressive stretching program can become challenging because of the extent
cine, Bundang CHA Hospital,
Disclosure: nothing to discl
Disclosure Key can be foun
Contents and at www.pmrjo
Submitted for publication Ja
accepted June 11.
PM&R ? 2009 by the American Academy of Physical Medicine and R
1934-1482/09/$36.00 Vol. 1, 736-
Printed in U.S.A. DOI: 10.1016/
6erapeutic Effect of Microcurrent Therapy in
ith Congenital Muscular Torticollis
in Young Kim, MD, PhD, Dong Rak Kwon, MD, PhD, Hak Il Lee, MD
jective: The aim of this study was to determine whether microcurrent therapy is
rapeutically effective in infants with torticollis.
sign: Prospective, unblinded, controlled trial.
tting: Bundang CHA Hospital.
bjects: Fifteen infants were included in this study who received torticollis treatment
m April to July 2008. The control group (CG) included 8 infants (3 male, 5 female) with
ean age of 7.1 months. The experimental group (EG) included 7 infants (6 male, one
ale) with a mean age of 10 months.
thods: The CG underwent stretching exercises for 30 minutes after ultrasound ther-
y and the EG underwent stretching exercises for 2 minutes after microcurrent therapy for
minutes. Each group received 3 treatments per week for 2 consecutive weeks.
in Outcome Measures: Measurements included head tilting angle at supine (TA)
d neck rotation range of motion to the affected side (RR) at the first day and the 14th day
treatment. The incidence of crying during therapy also was recorded. The results were
essed by Mann-Whitney U and the Fisher exact tests.
sults: In the CG, 4 infants showed TA improvement, one infant showed RR improve-
nt, and 8 infants cried during therapy. In the EG, 6 infants showed TA improvement, 5
ants showed RR improvement, and 3 infants cried during therapy. In the CG, mean TA
s 16.3
9.2° at the first day and 13.9
8.2° at the 14th day of treatment. In the EG,
an TA was 15.7
8.2° at the first day and 6.7
4.3° at the 14th day of treatment. TA
provement was greater in the EG (P .01) as compared with the CG. In the CG, mean RR
s 65.0
24.6° at the first day and 66.3
25.7° at the 14th day of treatment. In the EG,
an RR was 70.0
11.5° at the first day and 80.7
6.7° at the 14th day of treatment. RR
wed greater improvement in the EG (P  .05). The incidence of crying during therapy
s significantly lower in the EG (P  .05).
nclusion: Microcurrent therapy in infants with torticollis appears more effective in
proving TA and RR and shows better therapeutic compliance than traditional therapy.
TRODUCTION
ngenital muscular torticollis (CMT) is a neck deformity that involves shortening of the
rnocleidomastoid (SCM) muscle [1,2]. The main clinical features of torticollis include a
aracteristic head tilt, limited neck rotation, and/or a palpable mass [3]. The prevalence of
T varies from 0.3% to 2.0% [4]. Many theories have been proposed, but the true cause
CMT remains unknown. Coventry and Harris [5] reported that 80% of torticollis cases
olved spontaneously without treatment. Canale et al [6] found that if CMT persisted
yond the age of l year, it did not resolve spontaneously. If torticollis persists, craniofacial
formities or plagiocephaly can occur. Therefore, earlier aggressive treatment improves notfants

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737PM&R Vol. 1, Iss. 8, 2009the tightness of the child’s affected SCM and because of the
ild’s resistance to therapy with increasing age.
Recently, the evidence supporting electrical stimulation as
eatment modality for wound healing and soft tissue injury
s been evaluated [8]. The principle of electrical stimulation
analgesia, and tissue and wound healing has been adapted
o therapies such as electroacupuncture, transcutaneous
ctrical nerve stimulation therapy and, more recently, mi-
current therapy [9].
Microcurrent therapy is low intensity alternative current
0200 microamperes). The patient feels no sensation
ring treatment. The therapeutic mechanism of action is not
own but may be related to a reduction in the disturbance of
intracellular Ca
2
homeostasis. The latter has been pro-
sed to be the mechanism for taut band formation [10].
cordingly, the aim of this study was to measure the effec-
eness of treatment for CMT with microcurrent therapy as
asured by reduction in head tilt, improvement in neck
ation, and infant tolerance of treatment during therapy.
ATERIAL AND METHODS
teen infants who received torticollis treatment were re-
ited at Bundang CHA Hospital from April to July 2008.
ey did not have developmental dysplastic hips, cervical
ne disorder, or neurologic disease. Clinical features, espe-
lly facial asymmetry and passive range of motion (ROM) of
ck rotation, were evaluated and recorded. Manual stretch-
and microcurrent therapy were performed by a physio-
rapist specifically trained in neuromuscular disorders in
diatric patients with a standardized program session 3
es per week for 2 weeks.
The control group consisted of 8 infants (3 male, 5 female)
th a mean age of 7.1
4.9 months. The treatment session
sisted of regular physiotherapy for 30 minutes, including
M exercises, postural training, and gentle stretching. The
erimental group comprised 7 infants (6 male, one female)
th a mean age of 10
14.3 months. Each treatment session
sisted of 30 minutes of microcurrent therapy (EMI, Cos-
c Co, Seoul, Korea) followed by stretching for 2 minutes.
Measures included head tilting angle at supine (TA) and
ck rotation ROM to the affected side (RR) at the first day
d the 14th day. Neck ROM was measured by one physia-
t and physical therapist. The physiatrist and pediatric
ysiotherapist who were experienced in evaluating infants
th CMT using these methods were responsible for per-
ming all the measurements. Neck rotation was measured
th an arthrodial protractor. The infant was lying supine on
examination table with the shoulders stabilized. The
miner supported the head and neck in the neutral posi-
n, over the edge of the examination table. In this position
neck could be rotated and moved freely in all directions.
cording to Cheng et al [11], there is an interexaminer
iability correlation coefficient of 0.71 for neck ROM inants.
The TA was measured with the infant lying in supine on a
ge protractor with the shoulders stabilized This method
cry
SP
ans found to have a high intrarater reliability with the inter-
ss correlation coefficient reported as 0.94-0.98. The max-
al values for passive ROM in rotation and tilting angle of
cervical spine were recorded; both left and right sides
re measured. The infant’s mood and willingness to coop-
te indicated when to stop. If any infant was tense and
cooperative, the measurements were discontinued.
Muscle function of the lateral flexor muscles of the neck
s estimated in the same sample of infants by use of the
scle Function Scale, a 5-degree scale with scores from 0 to
By holding the infant horizontally around the trunk with-
t support for the head, the therapist could estimate the
eral head righting reaction [12]. The same physician and
ysiatrist performed each individual subject’s pre- and
st-therapy measurements. In determining quantitative im-
vement, changes in rotation and tilt were recorded.
After both groups fell asleep with the aid of their mothers,
etching and microcurrent therapy commenced. The num-
r of patients who cried during therapy was measured to
termine patient tolerance for treatment. Microcurrent ther-
ies were performed by the same physiatrist or physical
rapist. The microcurrent generators were programmed to
vide an alternating current. The current intensity was 100
, and current frequency was 8 Hz. The current level was
nificantly below the threshold of sensation of the patient.
e muscles selected for treatment were based on the clinical
gment of the muscles’ contraction. Electrical probes were
ached over each muscle. One assistant was needed to
ure the child in a supine or side-lying position. The SCM
scle was isolated by turning the child’s head toward the
tralateral side, thus allowing the muscle to be easily
lpated during the attachment of an electrical probe
gure 1).
Mann-Whitney U tests were used to compare the im-
vement of TA and RR in both groups. Fisher exact tests
re used in both groups for comparison of the incidence of
ure 1. Microcurrent therapy for treatment of torticollis elec-
de placement on the affected SCM muscle.ing during therapy. SPSS for Windows (Release 12.0,
SS Inc, Chicago, IL) statistical software was used in the
alyses.