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King HH, Mai J, Morelli Haskell MA, Wolf K, Sweeney M. Effects of osteopathic manipulative treatment on children with plagiocephaly in the context of current pediatric practice: a retrospective chart review study. J Osteopath Med 2024; 124:171-177. [PMID: 37999741 DOI: 10.1515/jom-2023-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
CONTEXT Deformational plagiocephaly (DP) is on the rise in pediatric patients. The current standard of care recommended for management is repositioning with possible addition of cranial orthoses. However, strong data are lacking to support these recommendations. Osteopathic manipulative treatment (OMT) is another treatment option for DP that is also lacking evidential support. OBJECTIVES This retrospective chart review study investigated the effects of OMT at restoring a more symmetrical cranial bone configuration in children with DP. METHODS A retrospective chart review was performed on medical records of patients with a diagnosis of DP from three private practices over a 4-year period from September 2017 to December 2021. Inclusion criteria were diagnoses of DP by a referring physician and aged 10 months or less at the time of initial evaluation and treatment. Patients were excluded if they had confounding diagnoses such as genetic syndromes or severe torticollis. A total of 26 patients met these criteria, and their records were reviewed. The main outcome reviewed was anthropometric assessment of the cranium, mainly the cranial vault asymmetry index (CVAI). RESULTS Participants demonstrated a mean CVAI - a measure that determines the severity of DP - of 6.809 (±3.335) (Grade 3 severity) at baseline, in contrast to 3.834 (±2.842) (Grade 2 severity) after a series of OMT treatments. CVAI assessment after OMT reveals statistically significant (p≤0.001) decreases in measurements of skull asymmetry and occipital flattening. No adverse events were reported throughout the study period. CONCLUSIONS The application of OMT has shown potential benefit for reducing cranial deformity in patients with DP.
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Affiliation(s)
- Hollis H King
- University of California San Diego School of Medicine, Center for Integrative Medicine, San Diego, CA, USA
| | - Julie Mai
- Osteopathy's Promise to Children, San Diego, CA, USA
| | | | - Kimberly Wolf
- Osteopathic Manipulative Medicine Department, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Megan Sweeney
- Osteopathy's Promise to Children, San Diego, CA, USA
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Filisetti M, Cattarelli D, Bonomi S. Positional plagiocephaly from structure to function: Clinical experience of the service of pediatric osteopathy in Italy. Early Hum Dev 2020; 146:105028. [PMID: 32450443 DOI: 10.1016/j.earlhumdev.2020.105028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Aim of the study is to evaluate disorders related to positional plagiocephaly and introduce a new model of early intervention based on the osteopathic integrated approach. METHODS We review clinical experience of the "Program for Neurodevelopmental Follow-up and Pediatric Osteopathy", a service dedicated to newborns at risk for developmental disorders. RESULTS We present clinical data of 310 newborns followed during first years of life. Data analysis examines perinatal history, general features and disorders that could be related to plagiocephaly. CONCLUSIONS The experience confirms that plagiocephaly is not only a problem regarding the shape of the head, it involves the functions. In our Service most babies (81%) with positional plagiocephaly showed isolated or associated disorders that had an impact on growth, behavior and development. The early intervention based on the osteopathic integrated approach is addressed not only to the cranial shape but consider the baby as a whole, and the environment where he lives.
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Affiliation(s)
| | | | - Stefano Bonomi
- Desenzano del Garda Hospital (ASST del Garda, Bs), Italy; Osteopathic Center for Children Italy (Lonato del Garda, Bs), Italy
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González-Santos J, González-Bernal JJ, De-la-Fuente Anuncibay R, Soto-Cámara R, Cubo E, Aguilar-Parra JM, Trigueros R, López-Liria R. Infant Cranial Deformity: Cranial Helmet Therapy or Physiotherapy? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072612. [PMID: 32290217 PMCID: PMC7177616 DOI: 10.3390/ijerph17072612] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Josefa González-Santos
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - Jerónimo J. González-Bernal
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - Raquel De-la-Fuente Anuncibay
- Department of Educational Sciences, Discondu Research Team, Educational Research Centre, University of Burgos, 09001 Burgos, Spain;
| | - Raúl Soto-Cámara
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - Esther Cubo
- Department of Health Sciences, Cavidito Research Team, Health Research Centre, University of Burgos, 09001 Burgos, Spain; (J.G.-S.); (J.J.G.-B.); (R.S.-C.); (E.C.)
| | - José M. Aguilar-Parra
- Department of Psychology, Hum 878 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain
- Correspondence: (J.M.A.-P.); (R.T.)
| | - Rubén Trigueros
- Department of Language and Education, University of Antonio de Nebrija, 28015 Madrid, Spain
- Correspondence: (J.M.A.-P.); (R.T.)
| | - Remedios López-Liria
- Department of Nursing Science, Physiotherapy and Medicine, Hum 498 Research Team, Health Research Centre, University of Almería, 04120 Almería, Spain;
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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. 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. 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). 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.
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van Vlimmeren LA, Engelbert RHH, Pelsma M, Groenewoud HMM, Boere-Boonekamp MM, der Sanden MWGNV. The course of skull deformation from birth to 5 years of age: a prospective cohort study. Eur J Pediatr 2017; 176:11-21. [PMID: 27815732 PMCID: PMC5219011 DOI: 10.1007/s00431-016-2800-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/17/2016] [Accepted: 10/18/2016] [Indexed: 12/04/2022]
Abstract
In a continuation of a prospective longitudinal cohort study in a healthy population on the course of skull shape from birth to 24 months, at 5 years of age, 248 children participated in a follow-up assessment using plagiocephalometry (ODDI-oblique diameter difference index, CPI-cranio proportional index). Data from the original study sampled at birth, 7 weeks, 6, 12, and 24 months were used in two linear mixed models. MAIN FINDINGS (1) if deformational plagiocephaly (ODDI <104%) and/or positional preference at 7 weeks of age are absent, normal skull shape can be predicted at 5 years of age; (2) if positional preference occurs, ODDI is the highest at 7 weeks and decreases to a stable lowest value at 2 and 5 years of age; and (3) regarding brachycephaly, all children showed the highest CPI at 6 months of age with a gradual decrease over time. CONCLUSION The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, brachycephaly is within the normal range for all children, whereas the severity of plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate/severe range in 1%. Medical consumption may be reduced by providing early tailored counselling. What is Known: • Skull deformation prevalence increased after recommendations against Sudden Infant Death Syndrome, little is known about the longitudinal course. • Paediatric physical therapy intervention between 2 and 6 months of age reduces deformational plagiocephaly at 6 and 12 months of age. What is New: • The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, deformational brachycephaly is within the normal range for all children, whereas the severity of deformational plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate to severe range in only 1%. • Paediatric physical therapy intervention does not influence the long-term outcome; it only influences the earlier decrease of the severity of deformational plagiocephaly.
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Affiliation(s)
- Leo A van Vlimmeren
- Department of Rehabilitation, Paediatric Physical Therapy, Radboud university medical center, P.O. 9101, 6500 HB Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, P.O. 9101, 6500 HB Nijmegen, The Netherlands
| | - Raoul HH Engelbert
- ACHIEVE, Center of Applied Research, Faculty of Health, University of Applied Sciences, Tafelbergweg 51, 1000 CN Amsterdam, The Netherlands
- Academic Medical Center, Department of Rehabilitation, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maaike Pelsma
- Department of Rehabilitation, Paediatric Physical Therapy, Radboud university medical center, P.O. 9101, 6500 HB Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, P.O. 9101, 6500 HB Nijmegen, The Netherlands
| | - Hans MM Groenewoud
- Department for Health Evidence, Radboud university medical center, P.O. 9101, 6500 HB Nijmegen, The Netherlands
| | - Magda M Boere-Boonekamp
- Department Health Technology and Services Research, Institute for Governance Studies, University of Twente, P.O. 217, 7500 AE Enschede, The Netherlands
| | - Maria WG Nijhuis-van der Sanden
- Department of Rehabilitation, Paediatric Physical Therapy, Radboud university medical center, P.O. 9101, 6500 HB Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, P.O. 9101, 6500 HB Nijmegen, The Netherlands
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Park JY, Kim HJ, Lee S, Jung SG. Aesthetic Correction of Severe Facial Asymmetry in a Deformational Plagiocephaly Patient: A Case Report and Literature Review. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2017. [DOI: 10.14730/aaps.2017.23.3.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jae Yeon Park
- Department of Plastic and Reconstructive Surgery, National Medical Center, Seoul, Korea
| | - Hyo Joong Kim
- Department of Plastic and Reconstructive Surgery, National Medical Center, Seoul, Korea
| | - Seil Lee
- Department of Plastic and Reconstructive Surgery, National Medical Center, Seoul, Korea
| | - Sung Gyun Jung
- Department of Plastic and Reconstructive Surgery, National Medical Center, Seoul, Korea
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Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study. Childs Nerv Syst 2016; 32:2211-2217. [PMID: 27465676 DOI: 10.1007/s00381-016-3200-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. METHODS This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4-5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge. RESULTS Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment. CONCLUSIONS Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.
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Cabrera-Martos I, Valenza MC, Valenza-Demet G, Benítez-Feliponi Á, Robles-Vizcaíno C, Ruiz-Extremera Á. Repercussions of plagiocephaly on posture, muscle flexibility and balance in children aged 3-5 years old. J Paediatr Child Health 2016; 52:541-6. [PMID: 27329908 DOI: 10.1111/jpc.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/04/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022]
Abstract
AIM The objective of the study was to assess posture, muscle flexibility and balance in children aged 3-5 years old with a history of nonsynostotic plagiocephaly. METHODS Fifty-two children with previous history of plagiocephaly were evaluated, along with 52 control subjects matched for age, sex, height, weight and physical activity. The outcome measures included static posture, assessed through the measurement of angles and distances between anatomical landmarks; muscle flexibility, evaluated with the Stibor, Shober and finger-to-floor distance tests and balance, assessed by the Pediatric Balance Scale. RESULTS One-way analysis of variance afforded statistically significant differences (P < 0.05) in head position, muscle flexibility (thoracic mobility and trunk and lower limbs muscle shortening) and balance. CONCLUSION Children with previous history of non-synostotic plagiocephaly present changes in head position, muscle shortening and a poor balance when compared to control children at 3-5 years old.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Gerald Valenza-Demet
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | | | - Ángeles Ruiz-Extremera
- Early Care and Monitoring Unit, Pediatrics Service, San Cecilio University Hospital, Granada, Spain, Granada, Spain
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Abstract
BACKGROUND Pediatric physical therapy seems to reduce skull deformation in infants with positional preference. However, not all infants show improvement. OBJECTIVE The study objective was to determine which infant and parent characteristics were related to responses to pediatric physical therapy in infants who were 2 to 4 months old and had positional preference, skull deformation, or both. DESIGN This was a prospective cohort study. METHODS Infants who were 2 to 4 months old and had positional preference, skull deformation, or both were recruited by pediatric physical therapists at the start of pediatric physical therapy. The primary outcome was a good response or a poor response (moderate or severe skull deformation) at 4.5 to 6.5 months of age. Potential predictors for responses to pediatric physical therapy were assessed at baseline with questionnaires, plagiocephalometry, and the Alberta Infant Motor Scale. Univariate and multiple logistic regression analyses with a stepwise backward elimination method were performed. RESULTS A total of 657 infants participated in the study. At follow-up, 364 infants (55.4%) showed a good response to therapy, and 293 infants (44.6%) showed a poor response. Multiple logistic regression analysis resulted in the identification of several significant predictors for a poor response to pediatric physical therapy at baseline: starting therapy after 3 months of age (adjusted odds ratio [aOR]=1.50, 95% confidence interval [95% CI]=1.04-2.17), skull deformation (plagiocephaly [aOR=2.64, 95% CI=1.67-4.17] or brachycephaly [aOR=3.07, 95% CI=2.09-4.52]), and a low parental satisfaction score (aOR=2.64, 95% CI=1.67-4.17). A low parental satisfaction score indicates low parental satisfaction with the infant's head shape. LIMITATIONS Information about pediatric physical therapy was collected retrospectively and included general therapy characteristics. Because data were collected retrospectively, no adjustment in therapy for individual participants could be made. CONCLUSIONS Several predictors for responses to pediatric physical therapy in infants who were 2 to 4 months old and had positional preference, skull deformation, or both were identified. Health care professionals can use these predictors in daily practice to provide infants with more individualized therapy, resulting in a better chance for a good outcome.
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Affiliation(s)
- Kyu-Jin Chung
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Yong-Ha Kim
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea
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