Orthotic (helmet) therapy in the treatment of plagiocephaly

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The goal of this study was to review the current literature on orthotic (helmet) therapy use in the treatment of deformational plagiocephaly.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>PubMed was used to search English articles using the medical subject headings “deformational plagiocephaly” and “orthosis,” and “deformational plagiocephaly” and “helmet.”</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

The effectiveness and safety of conservative interventions for positional plagiocephaly and congenital muscular torticollis: a synthesis of systematic reviews and guidance

“…There were 10 reviews in the final selection for positional plagiocephaly; 2 investigating effectiveness of manual therapy [8,13], 3 for helmet therapy/orthotics [19,21,22], 1 for repositioning advice/therapy [18] and 4 papers which compared helmet therapy with repositioning [7,11,20,23]. All of these reviews conducted a narrative analysis of their results.…”

“…We were able to ascertain that it met at least 16 of the total AGREE II quality appraisal criteria (See Additional file 3). This guideline [27] was based on the systematic reviews by Klimo et al [22], Baird et al [5] and Tamber et al [21], all published in 2016 as part of the taskforce working group. The guideline recommended both physical therapy and repositioning as first line treatment followed by helmet therapy as a second line of treatment for infants with moderate to severe and persisting asymmetry.…”

Positional Skull Deformities

“…This selective literature review provides an overview of the pathogenesis, possible risk factors, symptoms, and diagnosis of positional skull deformities, as well as therapeutic options. We took into account the fact that some existing studies have substantial limitations: small numbers of investigated patients, lacking control groups, and pre-selection in the severity grade under investigation with resultant biases (6). Furthermore, the number of prospective studies is small.…”

“…We are not aware of any studies of possible psychosocial impairments of children owing to a cranial orthosis. The costs for cranial remolding orthosis therapy are about € 2000 (6).…”

“…For this reason, this sensible recommendation should be adhered to (3). Simultaneously, reports of mostly mild skull deformities in children of merely a few weeks in age increased over this period (4)(5)(6), presenting clinically as a unilateral or bilateral flattening of the occiput. Although causality has, strictly speaking, not been proved, an association with the recommendation for putting babies to sleep in the supine position seems plausible.…”