Treatment of Deformational Plagiocephaly With Physiotherapy

Abstract

Non-synostotic plagiocephaly consists in an asymmetry of the skull due to mechanical forces applied in utero or postnatally: main differential diagnosis is with true synostotic asymmetry, which is caused by the premature closure of a suture. The correction of positional forms is mostly conservative, with 3 main strategies: counterpositioning, physiotherapy and helmet therapy. There is no synthesized evidence on which is the most effective. 1,2 The Authors evaluate the modification of antropometric measurments before and after a pediatric physical therapy program in a sample of patients with non-synostotic skull asymmetry, in order to evaluate the improvements in the skull shape. The hypothesis being tested was that physical therapy alone could improve the antropometric measurments. The authors enrolled in this study 24 patients diagnosed of non-synostotic asymmetry, clinically and with ultrasound, referred to the Maxillo-facial Unit of Policlinico Umberto I, Rome, within 2013 and 2016. A standardized pediatric physical therapy intervention program was designed: it consisted in a combination of excercises and manipulative procedures to reduce positional preference, musculoskeletal disorders and cranial deformity. Infants received 16 sessions of physical therapy, of 40 minutes each, once a week, for four months. 3,4 The Authors evaluate the variation of four anthropometric measurments, performed before and after the physical therapy program: Argenta scale, Oblique Diameter Difference Index (ODDI), Cranial Proportional Index (CPI) or Cephalic Ratio (CR), Cranial Vault Asymmetry Index (CVAI). 5,6 Craniometric evaluations were extrapolated by standardized 2D digital photographs of frontal, sagittal and transverse planes, by the same physician to minimize bias. The management of positional cranial deformities is still controversially discussed and especially the effects of physiotherapy and osteopathy have been only marginally researched. Statistical analysis revealed the effectiveness of the protocol: all anthropometric measurements improved with a high rate, major in youngest children (P < 0.5) and in more severe first presentations (P < 0.05 or P < 0.01). The results suggest manipulative approach may improve the outcome in the long term follow up of cranial asymmetries.

Infant Cranial Deformity: Cranial Helmet Therapy or Physiotherapy?

“…The application of both interventions independently has proven effective in the treatment of plagiocephaly [2,28,34], although the number of studies comparing both techniques is very small [41].…”

“…Non-synostotic plagiocephaly represents an asymmetry of the skull due to mechanical forces applied in the uterus or during the postnatal period [2]. It is accompanied by facial asymmetry and altered ear position.…”

Diagnosis and treatment of positional plagiocephaly

“…Conservative treatments involve a variety of treatments, such as change of positions [7], physiotherapy [30], massage therapy [7], and helmet therapy [30][31][32][33]. Promising outcomes can be achieved from conservative treatments when the treatments are initiated at an early stage of the disease due to the plasticity of the cranium and cranial sutures of the infants [7,[30][31][32][33]. Furthermore, confirmation of other causes of positional plagiocephaly and treatment of possible congenital deformity are required.…”

Delayed Motor Development and Infant Obesity as Risk Factors for Severe Deformational Plagiocephaly: A Matched Case–Control Study

“…Deformational plagiocephaly develops in infants aged 6-8 weeks, whose heads grow rapidly while lying down, and this is analogous to how a pumpkin flattens as it grows on the ground ("Pumpkin Analogy") (1). Later, DP can be improved naturally as infants grow and corrected early by counter-positioning or physiotherapy (8)(9)(10). However, infants with severe deformation aged 4-6 months and those with deformation without improvement after 6 months of age may optionally require cranial remodeling orthotic treatment before 12 months of age, and this treatment is considerably expensive and lengthy and requires continuous care, which can be a burden to parents (11).…”