“Molding Helmet Therapy for severe Deformational Brachycephaly: Position of Eurion and Therapeutic Effect”

Abstract

Background: Molding helmet therapy is used routinely for moderate to severe deformational plagiocephaly. However, there have been few reports of its use for deformational brachycephaly (DB). The incidence and severity of DB are high in the Asian population, including Japanese people, but there are no reports of treatment for severe cases. The current study showed significant improvement even in severe DB with various deformities. The difference in improvement according to the morphologic classification was investigated. Methods: The study included 47 patients treated with helmet therapy for DB with a cephalic index of greater than 100%. Three-dimensional head scans were used for classification and measurement. DB was classified into four types according to the position of the eurion and the presence of deformational plagiocephaly. The therapeutic effect was determined by changes in cephalic index and cranial asymmetry. Results: Patients exhibited a mean change of 8.0% in cephalic index and 6.4 mm in cranial asymmetry. An older age at initiation was associated with less change in both cephalic index and cranial asymmetry. A significant difference in the amount of cephalic index change was observed depending on the position of the eurion when the starting age was 6 months or older (P < 0.05). Conclusions: Molding helmet therapy for severe DB results in significant morphological improvement. However, depending on the position of the eurion, the effect of treatment may be decreased if it is started too late. It is necessary to understand the difference in improvement depending on the morphology and to ensure early intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Prevalence and Severity of Positional Posterior Plagiocephaly and Positional Posterior Brachycephaly in Children and Adolescents in Japan

“…Several studies have reported the mean CI in Japan. 6 - 8 ) Koizumi et al reported a mean CI of 86.5 in children 0-3 years old. 7 ) Tomita et al reported a mean CI of 87.3 in 0-6 years old Japanese children without cranial abnormality.…”

“… 4 ) Okamoto et al reported that the incidence and severity of PPB were higher in Japan than in the United States and European countries. 8 ) They reported that a normal CI was 72%-81% in children in the United States and European countries, whereas the CI of Asian children, including Japanese children, ranges from 80% to 93%. The present study also demonstrated similar results, with an overall mean CI of 85.2.…”

“…There are several reports on the efficacy of helmet therapy in treating PPP and PPB in Japanese infants. 5 , 8 , 9 ) Evidence-based guidelines to treat infants with positional plagiocephaly were published in 2016 by the Congress of Neurological Surgeons. 10 ) According to their guidelines, helmet therapy is recommended for infants with persistent moderate to severe plagiocephaly after a course of conservative treatment (repositioning and/or physical therapy).…”

“…Based on Japanese standards, mild brachycephaly was defined as a CI of 94 or above, and severe brachycephaly was defined as a CI of 101 or above. 4 - 8 ) The protocol for this study was approved by the Ethics Committee of Hyogo Prefectural Kobe Children's Hospital (No. R5-80) and conducted following the principles outlined in the Declaration of Helsinki and its revisions.…”