Efficacy of pediatric integrative manual therapy in positional plagiocephaly: a randomized controlled trial

Abstract

Background Positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. Methods Thirty-four neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (− 10 cm to + 10 cm). Results CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40% compared with 0.34 ± 1.72% in the control group (p = 0.000). CI did not present significant differences between groups. Manual therapy led to a more positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p = 0.004). Conclusion Manual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program. Trial registration Trial registration number: NCT03659032; registration date: September 1, 2018. Retrospectively registered.

Guidance strategies for infantile asymmetry prevention: A Systematic Review

“…This is different from research comparing other interventions to usual care, where other interventions showed greater bene ts 62 , for example, manual therapy and repositioning therapy when compared with usual care 3,39 . These ndings con ict with the conclusions from two recent RCTs 75,76 which reported a signi cant reduction in CVAI and increase in CROM in infants diagnosed with moderate to severe HSA. These were infants who received manual therapy in addition to HCP delivered guidance compared with those who received the HCP guidance alone.…”

Natural-Course Evaluation of Infants with Positional Severe Plagiocephaly Using a Three-Dimensional Scanner in Japan: Comparison with Those Who Received Cranial Helmet Therapy

“…We focused on CA in this study; nevertheless, the severity is defined using CVAI in other previous studies [3,15,19,20] (e.g., mild, 5-6%; moderate, 7-9%; severe, 10-13%; and very severe, >14%) [3,15]. The median CVAI exceeded 10% in both the natural-course and CHT groups in this study 2, indicating a severe plagiocephaly.…”

Consideraciones actuales en el abordaje de la plagiocefalia posicional

“…El tratamiento de la plagiocefalia va dirigido a favorecer el apoyo de la cabeza en el lado no afectado. El manejo a través de posicionamiento cefálico, estimulación del desarrollo motor y kinesiología, tienen una fuerte evidencia 21,[48][49][50][51] . Sólo algunos casos muy seleccionados podrían beneficiarse del uso de casco modelador, como se describirá más adelante.…”

“…Otro método utilizado es la manipulación osteopática que pretende movilizar todas las estructuras comprometidas (ej. fascia y músculos cervicales) con movimientos suaves para restablecer el balance normal del cuerpo 48,50 .…”