A question that all of us may have.
What do we tell the family? How can we know if it will take more or less time or sessions?
🧠💪 The new and very recent study published in Pediatric Physical Therapy by Aker and collaborators (Children’s Hospital of Philadelphia) offers interesting answers to this key question for our clinical practice. Based on the analysis of 149 babies treated between 2018 and 2021, the authors looked for which factors predict a longer Length of Care (LOC) in physiotherapy.
What were the main findings?
- The type of torticollis and the deficits in active and passive neck rotation were the factors most closely related to the duration of treatment. Nothing surprising so far.
- Each additional degree of limitation in passive rotation was associated with 1.85 more days of treatment; for active rotation, with almost 1 more day.
- The age at the first evaluation was also relevant: babies assessed at younger ages tended to receive longer treatments, which contradicts previous studies.
That is a surprise. Why could that be?
We all know that the severity is often measured by how late the diagnosis is made.
Could it be that in the younger babies, the therapist couldn’t yet play with them or didn’t have the same means of sensory stimulation available?
The study does not specify what kind of physiotherapy was being carried out, but perhaps with Pediatric Manual Therapy (TMPI approach) the results would have been different.
On the other hand, tummy time or global motor development (AIMS) did not predict the duration of physiotherapy.
💡 Clinical implications
- Carefully assess and document deficits in active and passive rotation — they are strong indicators of how long treatment will take.
- Avoid assuming that an earlier start guarantees a faster discharge; younger infants may need a longer follow-up to balance cervical strength and postural symmetry.
- Do not overvalue “tummy time” as a predictor of progress, even though it remains important for motor stimulation.
- Usa las medidas activas de rotación como parámetro funcional clave, no solo la rotación pasiva: reflejan mejor la calidad del control motor.
- Be cautious when estimating the duration of the intervention: individual variability remains high, and muscle severity (not age) is what most influences progress.
🧩 In summary
“Greater limitation in cervical rotation implies longer treatments, but babies evaluated earlier do not always finish earlier.” — Aker et al., 2025
This study reinforces the importance of a precise assessment of active and passive movement and of avoiding overgeneralizations based on age.
For pediatric physiotherapists, it provides a quantitative foundation to adjust expectations with families and to plan therapeutic workload more effectively.
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