What is TMR Tots?

What is TMR Tots?

TMR Tots is a modified version of Total Motion Release with a focus on the achievement of functional outcomes.  While the greatest excitement among parents and therapists has been in finding a tearless method to effectively treat children with torticollis, the concept is equally applicable to both children and adults with any mobility issue.

TMR is Total Motion Release for Tots. A modified positional release concept that uses a evaluation and feedback system to assess and treat postural asymmetry in order to achieve objective improvements in functional outcomes. i.e. Issues with alignment limit access to a full palette of muscle function - a child with DS may never get full control of deep back extensors if pulled into flexion from anterior fascial tension which a result of was adaptive shortening from early posture

TMRTots.com. You can see videos etc

Tots was developed initially to treat kids with CP and hypotonia, but has gotten the most attention as a no tears way to treat torticollis and gait asymmetry.


In treating torticollis with TMR, we analyze the patient’s entire body to identify areas of restricted mobility that are connected to the neck tilt and rotation.  There is always a corresponding tilt (often several) that may cause the lower 1/2 of the child's body to also twist and/or side bend. This asymmetry can limit the child's ability to learn to sit up, roll, and crawl with equal use of their legs.  When the child does learn to crawl he may drag one leg, and when he learns to walk he may have one foot may turned out.    He may also have difficulty fully raising one arm to put on a T- shirt.

The standard of care for the treatment of torticollis calls for treatment until the child has symmetrical use of extremities (arms and legs.)  With TMR we treat the whole child and consider the impact of every component of movement as important.  The duration of treatment can vary depending on the number and severity of restrictions and their effect on motor development.

Motor Control

While torticollis has given Tots a lot of attention, the concept has provided ground -breaking results in patients with all types of motor & mobility issues.    Restricted motion from adaptive shortening creates the imbalances, which affect a patient's pelvic posture in the same way regardless of the patients age or diagnosis.  This can impact mobility when dealing with any type of orthopedic & neurological issue.

We have had dramatic improvement with issues including hemiparesis (stroke) cerebral palsy (CP), Spina Bifiida, hypotonia, gait and developmental delays.  A pelvis that is tilted or rotated does not sit squarely on a chair, and creates a chain reaction into the legs and feet.  Ultimately this may lead to the development of orthopedic problems and pain.

(I personally experienced this effect when discovering the connection between low back issues and an unstable strained ankle.   Treatment of my back issue with the exact same methods resolved the chronic ankle pain and helped me recover strength and balance.)

Developmental Delays and Rehabilitation

A patient who is relearning or has not yet learned motor skills may be limited in his ability develop full control when energy is wasted in the struggle to stay upright.  Restrictions causing structural imbalance can place more weight on one buttock in sitting or one foot in standing. Try learning to catch a ball standing one foot!

Prep Work

TMR takes off the “shrink wrap”of tight tissues.  This can jump start progress and make other therapy strategies more effective.   Often children with apparent cognitive limitations have become more responsive to their world when they are no longer wasting energy struggling to sit.  Improved vertical positioning frees up a variety of systems for better potential function to breathe and interact. This has been most dramatic in children teeter tottering in a sacral sit position balanced on the edge of their tailbones with compressed chests.  By using TMR as the prep work for traditional therapy techniques, we have raised the ceiling of our expectations for the patient's achievement of functional independence.

Unitive Concept - Clinical Experience

TMR is a unitive approach based on incorporation of traditional pediatric strategies currently taught in PT and OT programs.  A care plan is developed from clinical observations and includes consideration of the patients unique needs effecting their activities, participation, and body structure and function which focus on the patient or parent's concern.    This is the ICF model embraced by the American Physical Therapy Association (APTA.)   Methods utilized in TMR Tots were developed as a collaborative effort with contributions from dozens of therapists many who have achieved recognition as pediatric certified specialists (PCS). Development of the Tots concept was and continues to be based on their feedback and clinical experience.

5 key features make TMR Tots unique:

1.   Focus

Use of an of the evaluation tool (TMR form) we can develop a more focused plan of care that meets the unique needs of the patient.   Treatment is precise to get to the root problem and quickly fix it.

2.   Build on What They Know.

Motor control skills are developed by identification of the individual's strengths.  Therapeutic play is applicable to children age 0-100, as activities are matched to the unique interests that excite and motivate the patient to move.   Often the patients forget they are doing therapy because they are having fun as they do their therapy while dancing, swimming, and practicing sports skills that were precisely selected to match their motions.   We reinforce the patient's successes with positive motor experiences, which aid in motor recruitment.   Incorporating therapeutic positions into daily routines means repetition of skills at regular intervals though out the entire day.  This approach corresponds with many recent theories in neuroplasticity and motor learning.

3.   Empowerment of Caregiver and Child.

As parents learn therapeutic play skills, they better understand their child's strengths and challenges.   Older children learn to get in touch with their bodies to manage their issues.  Therapeutic activities are incorporated into daily routines at home, school and daycare.   Instead of 1 or 2 hours of therapy a week, treatment becomes 24/7 for even more accelerated results.

4.   No Tears - Parent Satisfaction

The language of TMR is comfort!   It is possible to improve range of motion faster without painful stretching. Given a choice which would you pick for your child?

5.  Results

Consistent clinical experience by therapists reporting positive objective changes documented each session.  Many patients with incomplete correction of torticollis achieved full correction once TMR was used to identify and treat the associated restrictions. Hundreds of testimonials from parents and therapists report less visits were needed to achieve goals.  Often the level of mobility and function surpassed the therapist’s previous experience and expectations raising the ceiling of our expectations on the patient’s potential.


How is this achieved?

The TMR form is a tool to identify the reversible tightness that developed as a result of a period of limited mobility.  Lack of mobility may have been the result of positioning in the womb or NICU, neurological and medical factors causing weakness locking a child into a few dominant postures and movement choices, which were easier to access.

Immobilization causes adaptive shortening which the limits the ability to use muscles, which they may have otherwise learned to control with independent exploration or with therapy when motor issues are a factor.  Imprisoned in this "shrink wrap" the patient cannot access control, which can lock the patient into a few more easily accessed but inefficient patterns.  If this restricted motion is in an asymmetrical posture, their energy can be wasted in an effort to compensate and struggle to hold their head or trunk upright.

When we identify the most restricted motion using a simple testing sequence we are able to quickly determine the area most effective to treat.  The sequence and therapeutic activities are taught to patients and caregivers to check progress and manage the current issue.   These exercises include traditional methods used in physical therapy such as Proprioceptive Neuromuscular Facilitation (PNF) and methods such as Pilates.  Specific exercises are selected using the evaluation form to identify the most effective sequence of application to meet the patient’s needs.

The sequence and therapeutic activities are taught to patients and caregivers to check progress and manage the current issue.   This empowerment process equips them to manage future mobility issues in comfortable activities easily incorporated into their day. Using activities that reinforce success create compliance and a positive therapy experience.