Effects of Initial Age and Severity on Cranial Remolding Orthotic Treatment for Infants with Deformational Plagiocephaly

Abstract

The aim of this study is to review the effects of an infant's presenting age and severity of deformation on cranial remolding orthotic (CRO) treatment outcomes for patients with deformational plagiocephaly. This study is a retrospective chart review of 499 infants with non-synostotic plagiocephaly who completed CRO treatment. Data collected included age at start of treatment, head shape measurements before and after treatment, total months of CRO treatment, and other factors such as presence/absence of prematurity. The infants were divided into subgroups according to age and severity at initiation of treatment and data for subgroups was analyzed to track the change in head shape over the course of treatment, review overall treatment duration, and discuss the rate of change of cranial deformation. Overall, treatment times tended to statistically increase with increasing initial severity and age. Posttreatment asymmetry measurements statistically trended to greater residual deformation in infants who began treatment in the older or more severe subcategories. This indicates that younger and less severe infants have shorter treatment durations and less residual cranial deformation after CRO treatment. Therefore, clinical consideration may need to be taken to treat infants at younger ages or prior to progression of the cranial deformity.

Keywords: cranial flattening; cranial orthosis; cranial vault asymmetry (CVA); cranial vault asymmetry index (CVAI); deformational plagiocephaly; flat head syndrome; orthotic devices; plagiocephaly; treatment outcomes.

Conflict of interest statement

Tiffany Graham, MSPO, CPO, LPO, FAAOP was a prior employee of Level 4 Prosthetics & Orthotics. She was not employed by Level 4 during the course of this study and Level 4 did not actively participate in this study’s data collection or analysis. Some of the data used included information from patients she treated. All efforts were made to prevent bias of the data. This project was initiated after she had left Level 4 Prosthetics & Orthotics; therefore, none of the data was influenced by this retrospective chart review. Data was collected independently of Level 4 Prosthetics & Orthotics. When working with the data, Tiffany Graham was unaware of the treating practitioner or the patient identity as this information was not recorded by the investigators. The other authors have no conflicts of interest to disclose. The NIH had no role in the design, execution, interpretation, or writing of the study.

Figures

Figure 1

Mean change in CVAI with standard of deviations in CVAI before and after CRO treatment for each subcategory (n = 499). p-values are from Jonckheere–Terpstra test for trend which shows the trend of final CVAI within severity categories as age increases. CVAI: Cranial Vault Asymmetry Index, CRO: Cranial Remolding Orthosis. * indicates significance (p < 0.05).

Figure 2

Study comparison of median monthly asymmetry changes in CVA or CVAI based on infant starting age (Seruya n = 346, Graham n = 498).

Figure 3

Study comparison of mean monthly asymmetry changes based on infant starting age (Kunz n = 144, Graham n = 473).