Outcome Analysis of Cranial Molding Therapy in Nonsynostotic Plagiocephaly

Abstract

BackgroundIt is known that nonsynostotic plagiocephaly does not spontaneously improve, and the craniofacial deformities that result from it. This study was conducted to analyze the effectiveness of helmet therapy for the nonsynostotic plagiocephaly patient, and to suggest a new treatment strategy based on this analysis.MethodsA total of 108 pediatric patients who had undergone helmet therapy after being diagnosed with nonsynostotic plagiocephaly were included in this study. The patients were classified according to the initiation age of the helmet therapy, severity, and helmet wearing time. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy.ResultsThe discrepancy of CVA and CVAI of all the patients significantly decreased after helmet therapy. According to the initiation time of helmet therapy, the treatment effect was best at 5 months old or less. The helmet wearing time per day was proportional to the treatment effect up to 20 hours. In addition, the rate of the successful treatment (final CVA ≤5 mm) significantly decreased when the initiation age was 9.1 months or older and the treatment period was less than 7.83 months.ConclusionsThis study showed the effectiveness of the helmet therapy for nonsynostotic plagiocephaly patients. Based on analysis of this study, helmet therapy should be started at the age of 9 months or younger for 7.83 months or more, and the helmet wearing time should be more than 20 hours a day.

The Role of Age and Initial Deformation on Final Cranial Asymmetry in Infants with Plagiocephaly Treated with Helmet Therapy

“…Reviewing 159 infants, Graham et al [13] found that patients who started helmet therapy at >8 months of age had larger final TDD with less relative improvement than patients who started helmet therapy at <8 months despite similar initial TDD. In a study consisting of 108 patients, Yoo et al [9] calculated that the rate of successful treatment (TDD ≤ 5 mm) significantly decreased when the age at therapy initiation was >9.1 months. In 116 patients who underwent laser measurement, Thompson et al [14] noted that patients who started therapy at 4-8 months had superior outcomes compared to those who started at <4 or >8 months.…”

Sonographic Analysis of Changes in Skull Shape After Cranial Molding Helmet Therapy in Infants With Deformational Plagiocephaly

“…Therapeutic effects can be accomplished by inducing prominent areas to be retained passively and flattened areas to grow rapidly into the hollow space in the helmet 21 . Infants with deformational plagiocephaly were treated on the basis of a cranial vault asymmetry cutoff value of 10 mm 22 . According to the helmet therapy protocol, caregivers were told to keep the child in the helmet as much as possible, with greater than 23 hours of daily use recommended.…”

“…After the initial helmet fitting, the infants were followed every 2 to 4 weeks to adjust for both head growth and skull shape changes. Helmet therapy was discontinued when cranial vault asymmetry was less than 6 mm, 22 the cranial vault asymmetry index was less than 3.5%, 23 or no further helmet adjustment was possible because of cranial growth.…”

Defining the nature and implications of head turn preference in the preterm infant

“…Prolonged time with the head rotated to one side can impact reflex patterns, muscle tone, and movement for later function. In addition, severe head turn preferences may promote asymmetric movements in early infancy [8,9] and lead to future complications in posture [10–12]. Postural asymmetries, including infantile postural scoliosis, torticollis, and an asymmetrical skull shape including deformational plagiocephaly also result from prolonged head turn preference [13–17].…”