Predictive Factors of Outcomes in Helmet Therapy for Deformational Plagiocephaly and Brachycephaly

Abstract

Deformational plagiocephaly and brachycephaly, or abnormal flattening of the infant skull due to external forces, are often managed with orthotic helmet therapy. Although helmet therapy is widely used, the factors that predict poor outcomes are not well characterized. In this study of over 140,000 patients who received helmet therapy, older age and greater severity at presentation, and noncompliance with treatment were each independently associated with worse craniometric and provider-reported outcomes. Each additional point of cranial vault asymmetry index or cephalic index at a presentation is associated with an increased likelihood of residual brachycephaly at completion [odds ratio (OR): 1.067; 95% Cl: 1.058–1.075; P<0.0001 and OR: 2.043; 95% CI: 2.021–2.065; P <0.0001, respectively], whereas each additional point of cranial vault asymmetry index at a presentation associated with increased likelihood of residual asymmetry at completion (OR: 2.148; 95% Cl: 2.118–2.179; P<0.0001). Patients were more likely to have residual brachycephaly or asymmetry with increasing age at treatment initiation (OR: 1.562; 95% CI: 1.524–1.600; P<0.0001 and OR: 1.673; 95% Cl: 1.634–1.713; P <0.0001, respectively, for each additional month of age at initiation). These results highlight a need for prompt referral for helmeting, especially in cases with severe features or when patients present late to care. Potentially modifiable factors are age at helmeting and compliance with treatment protocols, and consideration of these factors may be important for achieving success in some cases.

A Study on the Effectiveness of Helmet Therapy for Cranial Deformations According to Cranial Shape

“…Several studies have reported that helmet therapy is effective in preventing the progression of plagiocephaly 25 . However, as reported by Hauc et al 25 in 2022, the effectiveness of helmet therapy decreases with increasing severity of deformity 26 . As children’s skull shapes vary, it is difficult to predict the effectiveness of helmet therapy accurately 27 .…”

“…Surgical treatment is prioritized in plagiocephaly associated with craniosynostosis; however, postoperative helmet therapy can help prevent the progression of plagiocephaly and reduce skull shape changes and relapse 24 . Several studies have reported that helmet therapy is effective in preventing the progression of plagiocephaly 25 . However, as reported by Hauc et al 25 in 2022, the effectiveness of helmet therapy decreases with increasing severity of deformity 26 .…”