What Is the Optimal Time to Start Helmet Therapy in Positional Plagiocephaly?

Kluba, Susanne; Kraut, Wiebke; Reinert, Siegmar; Krimmel, Michael

doi:10.1097/prs.0b013e31821b62d6

Cited by 94 publications

(55 citation statements)

References 28 publications

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“…Of the remaining 36 papers, 21 were primary research literature articles, 5,6,[9][10][11][12][13][14][15][16][17]20,25,26,31,33,[35][36][37]39,41 12 were reviews, 7,8,[22][23][24]29,30,32,34,38,40,42 2 were letters, 3,18 and 1 described the methodology of an ongoing randomized controlled trial. 43 Of the 21 primary research articles, there were 7 Class II studies, 10,11,13,17,25,31,36 1 Class III study, 33 and 13 Class IV studies. 5,6,9,12,[14][15][16]20,26,…”

Section: Resultsmentioning

confidence: 99%

“…Kluba et al in 2011 showed that patients who began helmet therapy prior to 6 months of age showed better relative and absolute reduction in head asymmetry when compared with patients who started after 6 months. 13 They found that patients older than 6 months on average continued to have an abnormal cranial vault index at 4.5% at last follow-up. This suggests that a later starting age for helmet therapy may result in incomplete resolution of the asymmetry compared with beginning helmet therapy earlier.…”

Section: Are Cranial Orthoses Suitable For Children Older Than 1 Yearmentioning

confidence: 98%

“…They are usually custom fit and molded to allow for growth in certain regions of the cranium and concomitant growth restriction in others. Most helmets apply passive restriction rather than active compression forces, 5,9,12,13 encouraging the infant's malleable and rapidly expanding skull to grow into a desired configuration. There are helmets that reportedly apply active molding forces to aid in the corrections, such as the Dynamic Orthotic Cranioplasty Band (Cranial Technologics, Inc.) and the pneumatic orthotic helmet described by Lee et al 16 Some researchers argue that there is no true distinction between passive and active devices because the application of constant active pressure would easily exceed the ischemic tolerance of the overlying skin and lead to pressure ulceration.…”

Section: Brief History Of Orthotic Therapymentioning

confidence: 99%

“…27 Moss prescribed only neck-stretching exercises, positioning changes, and parental training to 66 infants with deformational plagiocephaly of mild to moderate severity, and found that the outcomes were comparable to infants who were treated by headbands in a previous study. 27 However, because the rate of correction is faster if infants start using the helmets earlier, 13,36 parents and providers alike may feel the pressure to begin infants with mild to moderate cases of deformational plagiocephaly on helmet therapy to prevent long-term cosmetic issues.…”

Section: Helmet Therapy In Comparison With Conservative Treatmentsmentioning

confidence: 99%

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Orthotic (helmet) therapy in the treatment of plagiocephaly

Goh

Bauer²,

Durham³

et al. 2013

FOC

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Object The goal of this study was to review the current literature on orthotic (helmet) therapy use in the treatment of deformational plagiocephaly. Methods PubMed was used to search English articles using the medical subject headings “deformational plagiocephaly” and “orthosis,” and “deformational plagiocephaly” and “helmet.” Results Forty-two articles were found. There were no Class I studies, 7 Class II studies, 1 Class III study, and 13 Class IV studies. Cranial orthoses have been shown to be effective in treating deformational plagiocephaly. It continues to be debated as to whether the statistical significance of treatment with cranial orthoses compared with conservative therapies is clinically significant. Children older than 12 months of age with deformational plagiocephaly may still benefit from orthotic therapy. The long-term effects of orthotic therapy are controversial. Conclusions There is a lack of Class I literature evidence supporting the use of helmet therapy in deformational plagiocephaly. There are controversies surrounding the use of orthotic therapy such as appropriate use, cost, use in older children, and long-term outcomes. Clinical indications for orthotic therapy need to be better defined with further research studies.

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Section: Resultsmentioning

confidence: 99%

Section: Are Cranial Orthoses Suitable For Children Older Than 1 Yearmentioning

confidence: 98%

Section: Brief History Of Orthotic Therapymentioning

confidence: 99%

Section: Helmet Therapy In Comparison With Conservative Treatmentsmentioning

confidence: 99%

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Orthotic (helmet) therapy in the treatment of plagiocephaly

Goh

Bauer²,

Durham³

et al. 2013

FOC

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“…Active re-positioning during sleep and play, physiotherapy to address torticollis and stretch otherwise tight musculature, and orthotic molding helmets can improve the cosmetic outcome, with surgery almost never required. In more severe cases, orthotic molding can provide for more complete and rapid resolution of PP than with repositioning alone, with more favorable cosmetic outcomes observed when such treatment is applied earlier in the disease course between 6 and 12 months [4]. Mulliken and coworkers [5] describe the natural history of plagiocephaly without intervention to yield residual deformity among 45% of patients at 24 months of age.…”

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confidence: 99%

Cosmetic and Cognitive Outcomes of Positional Plagiocephaly Treatment

Shamji¹,

Fric-Shamji²,

Merchant³

et al. 2012

CIM

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Purpose: Positional plagiocephaly is an acquired deformation of an intrinsically normal infant skull by sustained or excessive extrinsic forces. Non-surgical techniques include counter-positioning, supervised prone time and orthotic molding for more refractory cases. Long-term e ects of positional plagiocephaly on development remain unde ned, and this study evaluated cosmetic and cognitive outcomes of plagiocephaly management.Method: Surveys were administered to parents of patients treated for positional plagiocephaly through the Children's Hospital of Eastern Ontario. Categorical responses interrogated cosmetic outcome, school performance, language skills, cognitive development and societal function. Pearson coe cient analysis tested outcomes dependency on gender, age, and plagiocephaly side at the 0.05 level of signi cance.Results: Eighty respondents (51 male, 29 female) were divided as 58 right-and 22 lesided pathology. Positional therapy was uniformly applied, and a helmet orthosis was utilized in 36% of cases. Median follow-up age was nine years with normal head appearance in 75% of cases. Only 4% of parents and 9% of patients observed signi cant residual asymmetry. ese results did not vary by gender, age or deformity side. Le -sided disease predicted poorer language development and academic performance. Expressive speech abnormality occurred in twice as many patients with le -sided disease (36% versus 16%, p=0.04) along with three-fold greater special education requirements (27% versus 10%, p=0.04).Conclusions: Non-surgical plagiocephaly management achieved good cosmetic outcome among patients in this study. Children with le -sided disease frequently encountered diculties with cognitive and scholastic endeavors, although the roles of the underlying disease and the treatment measures in this delay cannot be di erentiated.

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