Comparison of Helmet Therapy and Counter Positioning for Deformational Plagiocephaly

Abstract

ObjectiveTo compare effectiveness on correcting cranial and ear asymmetry between helmet therapy and counter positioning for deformational plagiocephaly (DP).MethodsRetrospective data of children diagnosed with DP who visited our clinic from November 2010 to October 2012 were reviewed. Subjects ≤10 months of age who showed ≥10 mm of diagonal difference were included for analysis. For DP treatment, information on both helmet therapy and counter positioning was given and either of the two was chosen by each family. Head circumference, cranial asymmetry measurements including diagonal difference, cranial vault asymmetry index, radial symmetry index, and ear shift were obtained by 3-dimensional head-surface laser scan at the time of initiation and termination of therapy.ResultsTwenty-seven subjects were included: 21 had helmet therapy and 6 underwent counter positioning. There was no significant difference of baseline characteristics, head circumferences and cranial asymmetry measurements at the initiation of therapy. The mean duration of therapy was 4.30±1.27 months in the helmet therapy group and 4.08±0.95 months in the counter positioning group (p=0.770). While cranial asymmetry measurements improved in both groups, significantly more improvement was observed with helmet therapy. There was no significant difference of the head circumference growth between the two groups at the end of therapy.ConclusionHelmet therapy resulted in more favorable outcomes in correcting cranial and ear asymmetry than counter positioning on moderate to severe DP without compromising head growth.

Aesthetic Correction of Severe Facial Asymmetry in a Deformational Plagiocephaly Patient: A Case Report and Literature Review

“…In a study in 2012, the prevalence was estimated to be between 12% and 22% [3]. Because of similar facial features (a parallelogram-shaped skull, flattening of the affected occiput, ipsilateral frontal bossing, contralateral occiput bulging, and anterior shifting of the ipsilateral ear [4,5]), it was once often misdiagnosed as other congenital malformations, such as hemifacial microsomia, unilateral coronal craniosynostosis, or unilateral lambdoidal synostosis (ULS). The incidence skyrocketed in the United States after 1992 [6].…”

“…Several methods for diagnosing DP and classifying its severity have been proposed, including the Hutchinson severity scale using the diagonal difference (DD) (mild, 3 mm < DD < 10 mm; moderate, 10 mm < DD < 12 mm; and severe, DD > 12 mm) [5], anthropometric caliper measurements (by Willbrand et al 2012), the cra- nial vault asymmetry index, plagiocephalometry using a flexicurve ruler, and radiographic imaging such as CT scans [9]. Although there is currently no established way to quantify the severity of DP accurately, some attempts have been made to categorize its severity [7].…”

“…A considerable amount of the literature presents helmet therapy as the most effective treatment modality when early intervention is implemented [5]. Helmet therapy corrects cranial asymmetry and ear position, while counterpositioning therapy corrects only ear shifting [5].…”

“…A considerable amount of the literature presents helmet therapy as the most effective treatment modality when early intervention is implemented [5]. Helmet therapy corrects cranial asymmetry and ear position, while counterpositioning therapy corrects only ear shifting [5]. The rationale behind early therapy is that it harnesses the plasticity of the skull and it can be initiated as early as 4 to 6 months postnatally [13].…”

Adherence to a treatment of cranial deformities with a sensorised brace device

“…It is used to recover the head symmetry and, as a consequence, avoid the problems described before. To obtain favourable results, with the minimum time, it is necessary to wear the orthopaedic helmet 20 hours per day during 6 months in average, and, for this reason, it is important to have available an adherence control system, which informs us with the maximum reliability and minimum hassle for the baby when using the helmet [3].…”