Infant Cranial Deformity: Cranial Helmet Therapy or Physiotherapy?

Josefa González-Santos, Jerónimo J González-Bernal, Raquel De-la-Fuente Anuncibay, Raúl Soto-Cámara, Esther Cubo, José M Aguilar-Parra, Rubén Trigueros, Remedios López-Liria, Josefa González-Santos, Jerónimo J González-Bernal, Raquel De-la-Fuente Anuncibay, Raúl Soto-Cámara, Esther Cubo, José M Aguilar-Parra, Rubén Trigueros, Remedios López-Liria

Abstract

Objective: To compare cranial helmet therapy (CHT) and physiotherapy (PT) for the effective treatment of positional plagiocephaly in infants in terms of improving functional recovery. Methods: This was a prospective cohort study involving 48 infants between 5-10 months of age with cranial deformities. The Cranial Vault Asymmetry Index (CVAI) and the Brunet-Lezine scale were calculated at the initiation of the study and after 40 treatment sessions. Results: The infants' first assessment showed a delay in overall development areas with a global developmental quotient (DQ) (posture, coordination, sociability, and language) of 80.15. Although developmental improvements were observed in both groups in the Brunet-Lezine scale after treatment, the MANCOVA test showed no significant differences (F(5) = 0.82, p = 0.506, eta2 = 0.09). The CVAI reduced to 4.07% during the final evaluation in the cranial helmet group and 5.85% in the physiotherapy group without any significant differences between the two therapies (p = 0.70). Conclusions: No statistically significant differences were found between CHT and PT. After treatment, improvements from baseline measurements were observed in each of the readings of cranial deformity.

Keywords: helmet; intervention; physiotherapy; plagiocephaly; treatment.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Martínez-Lage J.F., Arráez Manrique C., Ruiz-Espejo A.M., López-Guerrero A.L., Almagro M.J., Galarza M. Deformaciones craneales posicionales: Estudio clínico-epidemiológico. An. Pediatr. 2012;77:176–183. doi: 10.1016/j.anpedi.2012.02.013.
    1. Di Chiara A., La Rosa E., Ramieri V., Vellone V., Cascone P. Treatment of deformational plagiocephaly with physiotherapy. J. Craniofac. Surg. 2019;30:2008–2013. doi: 10.1097/SCS.0000000000005665.
    1. Feijen M., Franssen B., Vincken N., Van der Hulst R.R. Prevalence and consequences of positional plagiocephaly and brachycephaly. J. Craniofac. Surg. 2015;26:e770–e773. doi: 10.1097/SCS.0000000000002222.
    1. Ballardini E., Sisti M., Basaglia N., Benedetto M., Baldan A., Borgna-Pignatti C., Garani G. Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8–12 weeks of life. Eur. J. Pediatr. 2018;177:1547–1554. doi: 10.1007/s00431-018-3212-0.
    1. Bialocerkowski A.E., Vladusic S.L., Howell S.M. Conservative interventions for positional plagiocephaly: A systematic review. Dev. Med. Child Neurol. 2005;47:563–570. doi: 10.1017/S0012162205001118.
    1. Collett B.R., Wallace E.R., Kartin D., Cunningham M.L., Speltz M.L. Cognitive outcomes and positional plagiocephaly. Pediatrics. 2019;143:e20182373. doi: 10.1542/peds.2018-2373.
    1. Kordestani R.K., Patel S., Bard D.E., Gurwitch R., Panchal J. Neurodevelopmental delays in children with deformational plagiocephaly. Plast. Reconstr. Surg. 2006;117:207–218. doi: 10.1097/01.prs.0000185604.15606.e5.
    1. Collett B.R., Gray K.E., Starr J.R., Heike C.L., Cunningham M.L., Speltz M.L. Development at age 36 months in children with deformational plagiocephaly. Pediatrics. 2013;131:e109–e115. doi: 10.1542/peds.2012-1779.
    1. González-Santos J., González-Bernal J., De-la-Fuente-Anucibay R., Aguilar-Parra J.M., Trigueros R., Soto-Cámara R., López-Liria R. A prospective study of cranial deformity and delayed development in children. Sustainability. 2020;12:1949. doi: 10.3390/su12051949.
    1. Kim D.G., Lee J.S., Lee J.W., Yang J.D., Chung H.Y., Cho B.C., Choi K.Y. The effects of helmet therapy relative to the size of the anterior fontanelle in nonsynostotic plagiocephaly: A retrospective study. J. Clin. Med. 2019;8:e1977. doi: 10.3390/jcm8111977.
    1. Wilbrand J.F., Lautenbacher N., Pons-Kühnemann J., Streckbein P., Kähling C., Reinges M.H., Howaldt H.P., Wilbrand M. Treated versus untreated positional head deformity. J. Craniofac. Surg. 2016;27:13–18. doi: 10.1097/SCS.0000000000002167.
    1. Hutchison B.L., Hutchison L.A., Thompson J.M., Mitchell E.A. Plagiocephaly and brachycephaly in the first two years of life: A prospective cohort study. Pediatrics. 2004;114:970–980. doi: 10.1542/peds.2003-0668-F.
    1. Cummings C. Positional plagiocephaly. Paediatr. Child Health. 2011;16:493–496. doi: 10.1093/pch/16.8.493.
    1. Morrison C.S., Chariker M. Positional plagiocephaly: Pathogenesis, diagnosis, and management. J. Ky. Med. Assoc. 2006;104:136–140.
    1. Laughlin J., Luerssen T.G., Dias M.S. Prevention and management of positional skull deformities in infants. Pediatrics. 2011;128:1236–1241. doi: 10.1542/peds.2011-2220.
    1. Miller R., Clarren S. Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics. 2000;105:26–34. doi: 10.1542/peds.105.2.e26.
    1. Martiniuk A.L., Vujovich-Dunn C., Park M., Yu W., Lucas B.R. Plagiocephaly and developmental delay: A systematic review. J. Dev. Behav. Pediatr. 2017;38:67–78. doi: 10.1097/DBP.0000000000000376.
    1. Murcia Gonzalez M.A. Plagiocefalia posicional: Exploración y tratamiento de fisioterapia. Rev. Fisioter. 2007;6:35–44.
    1. Van Vlimmeren L.A., Engelbert R.H.H., Pelsma M., Groenewoud H.M., Boere-Boonekamp M.M., Der Sanden M.W. The course of skull deformation from birth to 5 years of age: A prospective cohort study. Eur. J. Pediatr. 2017;176:11–21. doi: 10.1007/s00431-016-2800-0.
    1. Cabrera-Martos I., Valenza M.C., Benıtez-Feliponi A., Robles-Vizcaíno C., Ruiz-Extremera A., Valenza-Demet G. Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program. Childs Nerv. Syst. 2013;29:1893–1898. doi: 10.1007/s00381-013-2120-x.
    1. Ho J.P., Mallitt K.A., Jacobson E., Reddy R. Use of external orthotic helmet therapy in positional plagiocephaly. J. Clin. Neurosci. 2016;29:46–51. doi: 10.1016/j.jocn.2015.12.023.
    1. Freudlsperger C., Steinmacher S., Saure D., Bodem J.P., Kühle R., Hoffmann J., Engel M. Impact of severity and therapy onset on helmet therapy in positional plagiocephaly. J. Craniomaxillofac. Surg. 2016;44:110–115. doi: 10.1016/j.jcms.2015.11.016.
    1. Velez-van-Meerbeke A., Castelblanco Coy L. Craneosinostosis y deformidades posicionales del cráneo: Revisión crítica acerca del manejo. Acta Neurol. Colomb. 2018;34:204–214. doi: 10.22379/24224022214.
    1. Clarren S.K. Plagiocephaly and torticollis: Etiology, natural history and helmet treatment. J. Pediatr. 1981;98:92–95. doi: 10.1016/S0022-3476(81)80549-5.
    1. Wen J., Quian J., Zhang L., Ji C., Guo X., Chi X., Tong M. Effect of helmet therapy in the treatment of positional head deformity. J. Paediatr. Salud Infantil. 2019 doi: 10.1111/jpc.14717.
    1. Xia J.J., Kennedy K.A., Teichgraeber J.F., Wu K.Q., Baumgartner J.B., Gateno J. Nonsurgical treatment of deformational plagiocephaly: A systematic review. Arch. Pediatr. Adolesc. Med. 2008;162:719–727. doi: 10.1001/archpedi.162.8.719.
    1. Hinken L., Willenborg H., Dávila L.A., Daentzer D. Outcome analysis of molding helmet therapy using a classification for differentiation between plagiocephaly, brachycephaly and combination of both. J. Craniomaxillofac. Surg. 2019;47:720–725. doi: 10.1016/j.jcms.2019.01.011.
    1. Van Wijk R.M., Van Vlimmeren L.A., Groothuis-Oudshoorn C.G., Van der Ploeg C.P., Ijzerman M.J., Boere-Boonekamp M.M. Helmet therapy in infants with positional skull deformation: Randomised controlled trial. BMJ. 2014;348:g2741. doi: 10.1136/bmj.g2741.
    1. Kluba S., Kraut W., Reinert S., Krimmel M. What is the optimal time to start helmet therapy in positional plagiocephaly? Plast. Reconstr. Surg. 2011;128:492–498. doi: 10.1097/PRS.0b013e31821b62d6.
    1. Çevik S., Işık S., Özkılıç A. The role of age on helmet therapy in deformational plagiocephaly and asymmetric brachycephaly. Childs Nerv. Syst. 2019;35:1–8. doi: 10.1007/s00381-019-04354-2.
    1. Kim H.Y., Chung Y.K., Kim Y.O. Effectiveness of helmet cranial remodeling in older infants with positional plagiocephaly. Arch. Craniofac. Surg. 2014;15:47–52. doi: 10.7181/acfs.2014.15.2.47.
    1. Grigsby K. Cranial remolding helmet treatment of plagiocephaly: Comparison of results and treatment length in younger versus older infant populations. J. Prosthet. Orthot. 2009;21:55–63. doi: 10.1097/JPO.0b013e318195b7cf.
    1. Kim S.Y., Park M.S., Yang J.I., Yim S.Y. Comparison of helmet therapy and counter positioning for deformational plagiocephaly. Ann. Rehabil. Med. 2013;37:785–795. doi: 10.5535/arm.2013.37.6.785.
    1. Kluba S., Kraut W., Calgeer B., Reinert S., Krimmel M. Treatment of positional plagiocephaly–helmet or no helmet? J. Craniomaxillofac. Surg. 2014;42:683–688. doi: 10.1016/j.jcms.2013.09.015.
    1. Tamber M.S., Nikas D., Beier A., Baird L.C., Bauer D.F., Durham S., Klimo P., Jr., Lin A.Y., Mazzola C., McClung-Smith C., et al. Congress of Neurological Surgeons systematic review and evidence-based guideline on the role of cranial molding orthosis (helmet) therapy for patients with positional plagiocephaly. Neurosurgery. 2016;79:e632–e633. doi: 10.1227/NEU.0000000000001430.
    1. Josse D. Brunet-Lézine Révisé: Échelle de Développement Psychomoteur de la Petite Enfance. Établissements d’Applications Psychotechniques; Paris, France: 1997.
    1. O’Broin E.S., Allcutt D., Earley M.J. Posterior plagiocephaly: Proactive conservative management. Br. J. Plast. Surg. 1999;52:18–23. doi: 10.1054/bjps.1997.3007.
    1. Graham T., Adams-Huet B., Gilbert N., Witthoff K., Gregory T., Walsh M. Effects of initial age and severity on cranial remolding orthotic treatment for infants with deformational plagiocephaly. J. Clin. Med. 2019;8:e1097. doi: 10.3390/jcm8081097.
    1. Robinson S., Proctor M. Diagnosis and management of deformational plagiocephaly. J. Neurosurg. Pediatr. 2009;3:284–295. doi: 10.3171/2009.1.PEDS08330.
    1. Lutterodt C.G., Sadri A., Eccles S. Effectiveness of conservative therapy and helmet therapy for positional cranial deformation. Plast. Reconstr. Surg. 2015;136:852e–853e. doi: 10.1097/PRS.0000000000001758.
    1. Steinberg J.P., Rawlani R., Humphries L.S., Rawlani V., Vicari F.A. Effectiveness of conservative therapy and helmet therapy for positional cranial deformation. Plast. Reconstr. Surg. 2015;135:833–842. doi: 10.1097/PRS.0000000000000955.
    1. Steinbock P., Lam D., Singh S., Mortenson P.A., Singhal A. Long-term outcome in infants with positional occipital plagiocephaly. Childs Nerv. Syst. 2007;23:1275–1283. doi: 10.1007/s00381-007-0373-y.
    1. Knight S. Positional plagiocephaly/brachycephaly is associated with later cognitive and academic outcomes. J. Pediatr. 2019;210:239–242. doi: 10.1016/j.jpeds.2019.04.042.

Source: PubMed

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