Children with myelodysplasia frequently have abnormal hand function. Etiologies include brainstem and cervical cord compression due to the Chiari II malformation, syringomyelia, hydrocephalus, and cerebral dysmorphism. Determination of potentially correctable causes of hand dysfunction may be difficult. We describe the use of the Jaymar dynamometer for assessing grip strength as a means of detecting early changes in hand function.

Shortening of the sternocleidomastoid muscle causes the neck to laterally flex and the chin to rotate toward the opposite side. The etiology of "wry neck," or torticollis, is unknown but the immediate cause of deformity is fibrosis within the sternocleidomastoid muscle. When surgery for congenital muscular torticollis is the course of correction, it is necessary to immobilize the head and neck for a period of 2 to 3 days after surgery. Because infants and young children cannot be counted on to cooperate with postsurgery instructions, the torticollis head and neck immobilizer is recommended. The Department of Occupational Therapy at the Children's Hospital of Alabama in Birmingham receives a request for immobitization while the child is still in surgery. The splint cart and materials are taken into the recovery room where the apparatus is cut, formed, and fitted before the child is taken to his or her hospital room. Perforated Polyform l is used because it has been found to be the easiest low-temperature thermoplastic material to form. It requires the least amount of heating and cools fastest to secure the mold. Perforation also allows the material to breathe by proViding ventilation around the head and neck.

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