Treatment of positional plagiocephaly – Helmet or no helmet?

Kluba, Susanne; Kraut, Wiebke; Calgeer, B.; Reinert, Siegmar; Krimmel, Michael

doi:10.1016/j.jcms.2013.09.015

Cited by 58 publications

(43 citation statements)

References 27 publications

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“…Patients presenting with a high severity of deformity as measured by different methods in the literature are more likely to undergo orthotic therapy. 7,19 Our study is consistent with these reports as patients presenting with a large first ODD (OR 1.258, p < 0.001) or high cephalic ratio (OR 1.007, p < 0.001) were more likely to undergo CO therapy.…”

Section: Discussionsupporting

confidence: 90%

“…2,7,13,14,18 Despite support for the use of cranial orthoses, some studies have compared outcomes of customized CO use versus RP and found minimal differences between cohorts treated with these approaches. 3,10,11,19 Conclusions drawn from these studies also commonly determine that financial burden and lack of proven therapeutic benefit dissuade practitioners from recommending orthotic treatment.…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience

Lam

Pan

Strickland

et al. 2017

PED

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OBJECTIVE Following institution of the Back to Sleep Campaign, the incidence of sudden infant death syndrome decreased while the prevalence of positional skull deformation increased dramatically. The management of positional deformity is controversial, and treatment recommendations and outcomes reporting are variable. The authors reviewed their institutional experience (2008–2014) with the treatment of positional plagiocephaly to explore factors associated with measured improvement. METHODS A retrospective chart review was conducted with risk factors and treatment for positional head shape deformity recorded. Univariate and multivariate analyses were used to assess the impact of these variables on the change in measured oblique diagonal difference (ODD) on head shape surface scanning pre- and posttreatment. RESULTS A total of 991 infants aged less than 1 year were evaluated for cranial positional deformity in a dedicated clinical program. The most common deformity was occipital plagiocephaly (69.5%), followed by occipital brachycephaly (18.4%) or a combination of both deformities (12.1%). Recommended treatment included repositioning (RP), physical therapy (PT) if indicated, or orthotic treatment with a customized cranial orthosis (CO) according to an age- and risk factor–dependent algorithm that the authors developed for this clinic. Of the 991 eligible patients, 884 returned for at least 1 follow-up appointment. A total of 552 patients were followed to completion of their treatment and had a full set of records for analysis: these patients had pre- and posttreatment 2D surface scanner evaluations. The average presenting age was 6.2 months (corrected for prematurity for treatment considerations). Of the 991 patients, 543 (54.8%) had RP or PT as first recommended treatment. Of these 543 patients, 137 (25.2%) transitioned to helmet therapy after the condition did not improve over 4–8 weeks. In the remaining cases, RP/PT had already failed before the patients were seen in this program, and the starting treatment recommendation was CO. At the end of treatment, the measured improvements in ODD were 36.7%, 33.5%, and 15.1% for patients receiving CO, RP/PT/CO, and RP/PT, respectively. Univariate analysis showed that sex, race, insurance, diagnosis, sleep position preference, torticollis history, and multiple gestation were not significantly associated with magnitude of ODD change during treatment. On multivariate analysis, corrected age at presentation and type of treatment received were significantly associated with magnitude of ODD change. Orthotic treatment corresponded with the largest ODD change, while the RP/PT group had the least change in ODD. Earlier age at presentation corresponded with larger ODD change. CONCLUSIONS Earlier age at presentation and type of treatment impact the degree of measured deformational head shape correction in positional plagiocephaly. This retrospective study suggests that treatment with a custom CO can result in more improvement in objective measurements of head shape.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience

Lam

Pan

Strickland

et al. 2017

PED

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“…Findings from the current study, as many others in the literature, show greater improvement in head shape with helmet therapy [6,13,25,39,40]. This research compares a large cohort (n = 50 helmeted and n = 50 repositioned) with an average age at follow-up of approximately 4.5 years.…”

Section: Comparison With Other Studiessupporting

confidence: 66%

Long-term outcomes in treatment of deformational plagiocephaly and brachycephaly using helmet therapy and repositioning: a longitudinal cohort study

Naidoo¹,

Skolnick²,

Patel³

et al. 2015

Childs Nerv Syst

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“…There is evidence in persistent cases that helmet orthoses are extremely effective. However, these have an associated cost and may be associated with stigma [11]. …”

Section: Discussionmentioning

confidence: 99%

“…Current treatments for positional plagiocephaly include a ‘wait and see’ approach, parental education regarding head positioning, cranial orthoses, surgery or a combination of these [9–11]. …”

Section: Introductionmentioning

confidence: 99%

Positional plagiocephaly following ventriculoperitoneal shunting in neonates and infancy—how serious is it?

et al. 2016

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PurposeWe test the hypothesis that ventriculoperitoneal (VP) shunt insertion significantly increases contralateral positional plagiocephaly.MethodsWe reviewed 339 children who had a VP shunt inserted at Birmingham Children’s Hospital between 2006 and 2013, noting laterality of shunt insertion and frontal or occipital position. We ascertained the presence of post-operative positional plagiocephaly using the cranial vault asymmetry index. Multinomial logistic regression modelling was used to examine relationships between plagiocephaly, shunt position, gender and age. Adjusted odds and risk ratios for effect of variables on plagiocephaly were calculated.ResultsChildren with occipital VP shunts are at significant risk of developing contralateral positional plagiocephaly, particularly in the first 12 months of life.ConclusionsWe recommend careful follow-up and advice regarding head positioning following surgery. There should be consideration for active monitoring to avoid plagiocephaly, including physiotherapy and health visitor interventions. Endoscopic third ventriculostomy in selected cases or anterior shunt placement could be considered. A larger national study would be of interest to evaluate the extent of an otherwise correctable problem.

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Treatment of positional plagiocephaly – Helmet or no helmet?

Cited by 58 publications

References 27 publications

Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience

Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience

Long-term outcomes in treatment of deformational plagiocephaly and brachycephaly using helmet therapy and repositioning: a longitudinal cohort study

Positional plagiocephaly following ventriculoperitoneal shunting in neonates and infancy—how serious is it?

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