Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial

Abstract

Background Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. Methods Thirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen’s d. Results All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study. Conclusion The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program. The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032. Registration date: September 1, 2018.

Active Cervical Range of Motion in Babies with Positional Plagiocephaly: Analytical Cross-Sectional Study

“…The photographic image was analyzed with the program GeoCebra v.6 in order to measure active cervical rotation ROM in degrees (°). This measurement has shown a good reliability [ 33 ]. Clinical and demographic data and the anthropometric and active cervical rotation (ROM) measurements were registered in the same evaluation session.…”

Efficacy of pediatric integrative manual therapy in positional plagiocephaly: a randomized controlled trial

“…This PIMT protocol was applied by several pediatric physical therapists with specialized training and 4 years of experience. The effects of this PIMT treatment in the cervical spine mobility are described in another manuscript previously published [ 53 ].…”

The Alberta Infant Motor Scale: A tool for the assessment of motor aspects of neurodevelopment in infancy and early childhood

“…The AIMS has also been used in populations with less severe developmental conditions commonly seen by pediatricians or pediatric physiotherapists such as positional plagiocephaly. Two RCT studies investigated the effectiveness of manual therapy in the management of nonsynostotic (positional) plagiocephaly ( 42 , 43 ). Cabrera-Martos et al analyzed the efficacy of manual therapy in infants with severe (type 4 or 5 on the Argenta scale) plagiocephaly on the reduction of head asymmetry, duration of treatment, and motor development ( 42 ).…”

“…Despite both control and treatment arms having normal motor performance upon study discharge, the experimental group received a significantly shorter treatment duration (mean of 109.84 days relative to 148.65 days in controls) ( 42 ). The subsequent research by Pastor-Pons et al investigated the efficacy of pediatric integrative manual therapy in 34 infants with positional plagiocephaly (with a minimal difference of 5 mm between cranial diagonal diameters) younger than 28 weeks of age ( 43 ). The control group received an evidence-based educational program including exercises to limit positional preference and advising parents on positioning, baby management, and care to stimulate ( 43 ).…”

“…The subsequent research by Pastor-Pons et al investigated the efficacy of pediatric integrative manual therapy in 34 infants with positional plagiocephaly (with a minimal difference of 5 mm between cranial diagonal diameters) younger than 28 weeks of age ( 43 ). The control group received an evidence-based educational program including exercises to limit positional preference and advising parents on positioning, baby management, and care to stimulate ( 43 ). In addition to the standard treatment the control arm received, the experimental arm received additional manual therapy centered on mobilization techniques of the occiput, atlas, and axis (ten 20-min sessions once a week) based on the pediatric integrative manual therapy (PIMT) ( 43 ).…”