title: Effect of rehabilitation on a child with atlantoaxial rotatory fixation.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To discuss a case of atlantoaxial rotatory fixation (AARF) successfully treated with manual therapy.
  
  
  BACKGROUND
  A 9-year-old girl experienced acute torticollis and neck stiffness after a traffic accident. Image studies revealed AARF, a cause of pediatric torticollis. She received closed reduction with the aid of C-arm fluoroscopy under general anesthesia. She was referred to the researchers' rehabilitation clinic because of unsolved torticollis and limited head rotation. At her initial visit, we found that her head tilted to the right and rotated to the left. Tenderness and muscle guarding over the right suboccipital region were also apparent. The first manual therapy significantly improved neck motion after soft tissue release applying to the suboccipital muscle group.
  
  
  METHODS
  We arranged for her to enter a rehabilitation program including (1) soft tissue release technique to the suboccipital muscle group for 10 minutes and (2) muscle energy technique for neck flexion, extension, lateral bending, and rotation for 10 to 15 minutes.
  
  
  RESULTS
  After 3 months' rehabilitation, her symptoms of torticollis, neck pain, and limited range of motion achieved near-total recovery.
  
  
  CONCLUSIONS
  This case report presents the association between suboccipital muscles and AARF, suggesting that the soft tissue release of suboccipital muscle group may facilitate recovery from AARF. More studies are needed to verify the inferences of this case report.
authors: *Department of Physical Medicine & Rehabilitation, Kaohsiung Veterans General Hospital, Taiwan, Republic of China; and †School of Medicine, National Yang-Ming University, Taiwan, Republic of China.
authors: Pei-Te
authors: PT
authors: Hsu
authors: I-Hsiu
authors: IH
authors: Liou
authors: Shu-Fen
authors: SF
authors: Sun
authors: Chiao-Wen
authors: CW
authors: Hwang
authors: Jue-Long
authors: JL
authors: Wang
mesh_terms: D001268:Atlanto-Axial Joint / Q000473:pathology* / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D014103:Torticollis / Q000175:diagnosis* / Q000534:rehabilitation*; D016896:Treatment Outcome