Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children With Positional Preference

Vlimmeren, Leo A. van; Graaf, Yolanda van der; Boere-Boonekamp, Magdalena M.; L’Hoir, M.P.; Helders, Paul J. M.; Engelbert, Raoul

doi:10.1001/archpedi.162.8.712

Cited by 134 publications

(108 citation statements)

References 62 publications

(118 reference statements)

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“…5,20,28,39,54,67,70 For nonsynostotic plagiocephaly, treatment options include alternate head positioning, physical therapy (PT), and helmet therapy. 15 A recent RCT determined that adding PT is superior to parental counseling on head positioning alone.…”

Section: Current Treatment Optionsmentioning

confidence: 99%

“…15 A recent RCT determined that adding PT is superior to parental counseling on head positioning alone. 15,67 Therapy with a molding helmet has also shown a significant improvement in skull shape, with 1 study indicating relative improvement in skull shape in comparison with repositioning therapy. 15,22 Generally, mild disfigurement should be managed with repositioning techniques and PT, whereas helmet orthosis is reserved for more serious defects, especially lasting past the age of 6 months.…”

Section: Current Treatment Optionsmentioning

confidence: 99%

“…28 No difference was found in outcomes after 12 months of followup, with 80% of infants displaying "good" improvement. In another RCT assessing the utility of PT, van Vlimmeren et al 67 assigned 33 patients to PT and 32 to usual care. The PT group was determined to have a lower risk of PP at both 6 and 12 months (46% and 57%, respectively).…”

Section: Current Treatment Optionsmentioning

confidence: 99%

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Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Shweikeh

Nuño

Danielpour

et al. 2013

FOC

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Object Positional plagiocephaly (PP) has been on the rise in recent years. In this review, the authors' aim was to assess the effectiveness of current recommendations to parents on this exceedingly common problem through a comprehensive literature search. Additionally, the current treatment options and the most recent studies on PP are reviewed. Methods A search of the existing literature was conducted to obtain all relevant studies on guidelines, recommendations, parental and clinician practices, and epidemiological aspects. Results Although the incidence and risk factors for PP have been well delineated, there continues to be debates on its management and association with developmental delays. Current guidelines and recommendations on prevention set by the American Association of Pediatrics may not be easily followed by both parents and clinicians. There is also evidence that certain populations, including those with lower education, socioeconomic status, and in particular geographic regions may be more affected by the condition. Additionally, the marketing and financial aspects of PP treatments exist and should be addressed. Conclusions Better awareness and education are necessary to inform the population as a whole, although certain populations should be given special attention. Additionally, current guidelines and recommendations can be modified to foster a better grasp of the condition by both parents and clinicians. Adjusting current recommendations, introducing initiatives, and offering elaborate educational campaigns would help deliver these aims. Educating parents on PP as early as possible through clearer guidelines and close monitoring is central to preventing and managing this common condition.

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Section: Current Treatment Optionsmentioning

confidence: 99%

Section: Current Treatment Optionsmentioning

confidence: 99%

Section: Current Treatment Optionsmentioning

confidence: 99%

See 1 more Smart Citation

Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Shweikeh

Nuño

Danielpour

et al. 2013

FOC

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“…program over parental counseling without physiotherapy support. 30 As noted previously, no prospective randomized trials have compared the use of cranial orthoses to active repositioning therapy. 3 There is widespread consensus in the literature that complications associated with helmet therapy are low or negligible.…”

Section: Resultsmentioning

confidence: 98%

Complications associated with molding helmet therapy for positional plagiocephaly: a review

Gump

Mutchnick²,

Moriarty³

2013

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Molding helmet therapy is a widely accepted treatment for positional plagiocephaly that is generally considered to be low risk. Multiple large outcome studies have shown good results, but adverse events are rarely reported. The literature on helmet therapy was reviewed to clarify the clinical experience with associated complications. Although significant complications were extremely rare, there was a large degree of variability in detection of lesser problems such as minor skin irritation. Patients with a primarily brachycephalic morphology may be at higher risk for poorly fitting orthoses. Most reported complications are minor and self-limited. Maintenance of good helmet hygiene appears to be the most effective strategy for reducing or eliminating complications.

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“…2 Therapeutic options include observation, active counterpositioning, external orthotics, and surgery. 4,5,8,15,18,22 Most craniofacial surgeons today agree that deformational plagiocephaly does not warrant surgical intervention. 5,15 Varying the infant's positioning is the key to avoiding positional cranial deformation.…”

mentioning

confidence: 99%

Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

Couture¹,

Crantford

Somasundaram³

et al. 2013

FOC

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Object There has been a tremendous increase in the incidence of deformational plagiocephaly in children throughout the world. Therapeutic options include observation, active counterpositioning, external orthotics, and surgery. The current treatment in the US is highly debated, but it typically includes external orthotic helmets in patients with moderate to severe plagiocephaly presenting between 4 and 10 months of age or in children with significant comorbidities limiting passive (no-pressure) therapy. The present study was designed to evaluate 3 key issues: 1) the accuracy of the Argenta classification in defining a progressive degree of severity, 2) identification of an upper age limit when treatment is no longer effective, and 3) the effectiveness of an off-the-shelf prefabricated helmet in correcting deformational plagiocephaly. Methods An institutional review board–approved retrospective study was conducted of all patients at the authors' clinic in whom deformational plagiocephaly was assessed using the Argenta classification system over a 6-year period; the patients underwent helmet therapy, and a minimum of 3 clinic visits were recorded. Inclusion criteria consisted of an Argenta Type II–V plagiocephalic deformity. Patients' conditions were categorized both by severity of the deformity and by patients' age at presentation. Statistical analysis was conducted using survival analysis. Results There were 1050 patients included in the study. Patients with Type III, IV, and V plagiocephaly required progressively longer for deformity correction to be achieved than patients with Type II plagiocephaly (53%, 75%, and 81% longer, respectively [p < 0.0001]). This finding verified that the Argenta stratification indicated a progressive severity of deformity. No statistically significant difference in the time to correction was noted among the different age categories, which suggests that the previously held upper time limit for correction may be inaccurate. An overall correction rate to Type I plagiocephaly of 81.6% was achieved irrespective of severity and degree of the original deformity. This suggests that an inexpensive off-the-shelf molding helmet is highly effective and that expensive custom-fitted orthoses may not be necessary. The patients in the older age group (> 12 months) did not have a statistically significant longer interval to correction than the patients in the youngest age group (< 3 months). The mean length of follow-up was 6.3 months. Conclusions Patients treated with passive helmet therapy in the older age group (> 12 months) had an improvement in skull shape within the same treatment interval as the patients in the younger age group (< 3 months). This study supports the use of passive helmet therapy for improvement in deformational plagiocephaly in infants from birth to 18 months of age and verifies the stratification of degree of deformity used in the Argenta classification system.

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Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children With Positional Preference

Abstract: isrctn.org Identifier: ISRCTN84132771.

Cited by 134 publications

References 62 publications

Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Complications associated with molding helmet therapy for positional plagiocephaly: a review

Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

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