1
|
Blanco-Diaz M, Marcos-Alvarez M, Escobio-Prieto I, De la Fuente-Costa M, Perez-Dominguez B, Pinero-Pinto E, Rodriguez-Rodriguez AM. Effectiveness of Conservative Treatments in Positional Plagiocephaly in Infants: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1184. [PMID: 37508680 PMCID: PMC10378416 DOI: 10.3390/children10071184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The objective of this study is to analyze conservative treatments implemented to manage positional plagiocephaly in infants. METHODS This is a systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, performed in the Medline (PubMed), Scopus, Web of Science, and Cochrane databases. Articles were selected according to the eligibility criteria, regarding the effectiveness of conservative treatments in positional plagiocephaly in infants, published in the last 10 years with a score ≥3 in the PEDro Scale. RESULTS A total of 318 articles were identified and 9 of them were finally selected. CONCLUSIONS Physical therapy treatment is considered as the first line of intervention in plagiocephaly with non-synostotic asymmetries and manual therapy is the method that obtains the best results within this intervention. In cases of moderate or severe plagiocephaly, helmet therapy can be an effective second-line intervention; however, the best way to prevent this condition is through counseling of parents or caregivers, and early treatment is essential for optimal therapeutic outcomes. The review was registered in PROSPERO (CDR42022306466).
Collapse
Affiliation(s)
- Maria Blanco-Diaz
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain
- Physical Therapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain
| | - Maria Marcos-Alvarez
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain
| | - Isabel Escobio-Prieto
- Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, University of Seville, 41009 Seville, Spain
- Institute of Biomedicine of Seville (IBIS), 41013 Seville, Spain
| | - Marta De la Fuente-Costa
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain
- Physical Therapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain
| | - Borja Perez-Dominguez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain
| | - Elena Pinero-Pinto
- Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, University of Seville, 41009 Seville, Spain
| | - Alvaro Manuel Rodriguez-Rodriguez
- Physical Therapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain
| |
Collapse
|
2
|
Miyabayashi H, Saito K, Kato R, Noto T, Nagano N, Morioka I. Denominator of Cranial Vault Asymmetry Index: Choosing Between Longer and Shorter Diagonal Lengths. J Craniofac Surg 2023; 34:e369-e372. [PMID: 36922383 PMCID: PMC10205121 DOI: 10.1097/scs.0000000000009263] [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: 10/17/2022] [Accepted: 11/20/2022] [Indexed: 03/17/2023] Open
Abstract
Since it was proposed in this journal in 2001, the cranial vault asymmetry index (CVAI) has been an important parameter for assessing cranial shape. However, different publications currently use different variables in the denominator of the CVAI formula. We thus investigated the use of long and short diagonal lengths as variables in the denominator of the CVAI formula. We searched the databases of PubMed, Google Scholar, and Scopus for articles published between 2016 and 2022 that cited the original work article of CVAI. Articles were included if they were written in English and if the denominator of the CVAI formula was specified. For multiple articles by the same author, only the most recent article was included. In total, 30 articles were included; 10 articles used the longer diagonal length as the denominator and 20 articles used the shorter diagonal length. No uniform trend was observed by a country or journal of publication. Application of the CVAI formula using different denominators yielded interchangeable results, and the resulting values had only negligible differences clinically. However, it would be necessary to create a standard formula for using the CVAI as a parameter for reporting cranial shape assessments consistently.
Collapse
Affiliation(s)
- Hiroshi Miyabayashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
- Department of Pediatrics, Kasukabe Medical Center, Saitama, Japan
| | - Katsuya Saito
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
- Department of Pediatrics, Kasukabe Medical Center, Saitama, Japan
| | - Risa Kato
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
| | - Takanori Noto
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
| |
Collapse
|
3
|
Chow I, Brisbin AK, Anstadt EE, Goldstein JA, Losee JE. Delayed Presentation of Unicoronal Craniosynostosis-Masked by Ipsilateral Posterior Deformational Plagiocephaly. Cleft Palate Craniofac J 2022; 60:768-772. [PMID: 35195470 DOI: 10.1177/10556656221080996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite a greater awareness of the differential diagnosis of head shape abnormalities among pediatricians, the effect of deformational forces on calvarial morphology can complicate the diagnosis of craniosynostosis. In this report, we describe 2 patients diagnosed with unicoronal craniosynostosis (UCS) in a delayed fashion due to the presence of concomitant posterior deformational plagiocephaly (PDP). In both cases, the severity of each patients' PDP obscured changes typically associated with UCS. This unique presentation underscores the importance of having a high index of suspicion for possible premature suture fusion despite the presence of concomitant PDP.
Collapse
Affiliation(s)
- Ian Chow
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alyssa K Brisbin
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erin E Anstadt
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph E Losee
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
4
|
Natural-Course Evaluation of Infants with Positional Severe Plagiocephaly Using a Three-Dimensional Scanner in Japan: Comparison with Those Who Received Cranial Helmet Therapy. J Clin Med 2021; 10:jcm10163531. [PMID: 34441827 PMCID: PMC8396888 DOI: 10.3390/jcm10163531] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to clarify the natural course of positional plagiocephaly using a three-dimensional (3D) scanner and investigate the effectiveness of cranial helmet therapy (CHT). One hundred infants with severe plagiocephaly who visited our institutions between April 2020 and March 2021 were included. Cranial shape was measured using an Artec Eva 3D scanner. A cranial asymmetry (CA) >12 mm was diagnosed as severe plagiocephaly. An infant whose CA subsided to <12 mm was considered to have improved naturally or by CHT. The difference in CA between the second and initial scans was defined as the improvement value (median scan interval was two months). In the natural-course group comprising 56 infants with severe plagiocephaly, 37 (66%) with a median CA of 15.6 mm exhibited no improvement after two months. In the scan age- and evaluation interval-matched case-control study, the CA value in the CHT group improved by three times that in the natural-course group (−4.6 mm [n = 33] vs. −1.55 mm [n = 24], p < 0.001). Severe plagiocephaly did not improve naturally in 66% of the cases. Therefore, CHT should be considered if the CA is >12 mm on the initial evaluation.
Collapse
|
5
|
Cabrera-Martos I, Ortigosa-Gómez SJ, López-López L, Ortiz-Rubio A, Torres-Sánchez I, Granados-Santiago M, Valenza MC. Physical Therapist Interventions for Infants With Nonsynostotic Positional Head Deformities: A Systematic Review. Phys Ther 2021; 101:6206364. [PMID: 33792712 DOI: 10.1093/ptj/pzab106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/08/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study sought to examine the methodological quality and summarize the evidence from clinical trials that examined the effectiveness of physical therapist interventions in the management of nonsynostotic positional head deformities in infants. METHODS The following electronic databases were searched: PubMed/MEDLINE, ScienceDirect, CINAHL, Scopus, PEDro, and Web of Science. Two different authors conducted the searches and completed the data extraction. Randomized and non-randomized clinical trials were included. The risk of bias was assessed using the Downs and Black Scale and the Cochrane Collaboration's tool. RESULTS Six articles were finally included. The main features of interventions included education to parents about positioning, manual therapy, and motor stimulation. The small sample sizes were not adequately powered and methodological quality showed a high risk of bias, mainly from a lack of blinding and limited external validity. CONCLUSION There are indicators that suggest that physical therapist interventions may be useful for infants with nonsynostotic head deformities at improving cranial asymmetries and motor development. However, the validity of such conclusion is limited because most trials included had a high risk of bias. More rigorous research on physical therapy, including randomized controlled trials with larger sample sizes, is required in this area. IMPACT The high prevalence and incidence of nonsynostotic positional head deformities in infants calls for the development of effective interventions. Physical therapists have a promising role in the improvement of cranial asymmetry and motor development. The most reported interventions involved educating parents about positioning and manual therapy. Some studies show that changes obtained after physical therapist intervention were comparable with those obtained after helmet therapy. LAY SUMMARY Early referral to physical therapy may help to prevent or reduce the severity of nonsynostotic positional head deformities. Education about positioning is important to prevent and improve the asymmetry of the baby's head when there is nonsynostotic positional head deformity. Physical therapist interventions can improve motor development in infants with nonsynostotic positional head deformity who have motor delays.
Collapse
Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - María Granados-Santiago
- 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
| |
Collapse
|
6
|
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.
Collapse
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;
| |
Collapse
|
7
|
Deformational plagiocephaly: State of the art and review of the literature. Neurochirurgie 2019; 65:322-329. [PMID: 31562882 DOI: 10.1016/j.neuchi.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023]
|
8
|
Kunz F, Schweitzer T, Große S, Waßmuth N, Stellzig-Eisenhauer A, Böhm H, Meyer-Marcotty P, Linz C. Head orthosis therapy in positional plagiocephaly: longitudinal 3D-investigation of long-term outcomes, compared with untreated infants and with a control group. Eur J Orthod 2019; 41:29-37. [PMID: 29617743 DOI: 10.1093/ejo/cjy012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background As there are very few long-term studies on the effects of head orthosis on deformational plagiocephaly (DP), we investigated the outcomes of patients, including facial symmetry and dental occlusion. Methods Forty-five infants with DP [cranial vault asymmetry index (CVAI) > 3.5 per cent] were divided into two groups: one treated with head orthosis (32 infants) and another without (13 infants). Another group without head asymmetry (CVAI ≤ 3.5 per cent) served as control. Using 3D-stereophotogrammetry, cranial asymmetry was analysed using symmetry-related variables [CVAI, posterior cranial asymmetry index (PCAI), and ear offset]. Data acquisition was performed before (T1) and at the end of treatment (T2), and at the age of 4 years (T3) for the treated group and at T1 and T3 for the remaining groups. Parameters of facial symmetry and dental occlusion were assessed at T3 for infants with DP. Results Symmetry-related variables (∆T1-T3) improved significantly more in the treated than the control group, whereas these parameters did not differ significantly between the untreated and control group. Comparing the treated and untreated groups between T1 and T3, the reduction in the asymmetry at the treated group was significantly higher for the CVAI and PCAI. In follow-up, the untreated group showed higher incidences of facial asymmetries than the treated group. Seventy-five per cent of all lateral crossbites found in patients with DP were contralateral to the posterior flattening. Limitations Due to ethical reasons, the investigation is a non-randomized study. Parameters of facial symmetry were only assed for the treated and untreated groups. Conclusion Head orthosis therapy in patients with DP leads to significantly better long-term outcomes. Facial asymmetries are more frequent in patients with DP who do not receive this treatment.
Collapse
Affiliation(s)
- Felix Kunz
- Department of Orthodontics, University Hospital Würzburg, Germany
| | | | - Stephan Große
- Department of Orthodontics, University Hospital Würzburg, Germany
| | - Nina Waßmuth
- Department of Oral and Maxillofacial Surgery, University Hospital Würzburg, Germany
| | | | - Hartmut Böhm
- Department of Oral and Maxillofacial Surgery, University Hospital Würzburg, Germany
| | | | - Christian Linz
- Department of Orthodontics, University Hospital Göttingen, Germany
| |
Collapse
|
9
|
A Clinical Photographic Method to Evaluate the Need for Helmet Therapy in Deformational Plagiocephaly. J Craniofac Surg 2018; 29:149-152. [PMID: 29194259 DOI: 10.1097/scs.0000000000004192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE With an increase in positional plagiocephaly patients, various therapy methods have been researched and helmet therapy is the most widely used and effective treatment method. To devise a method that would allow medical professionals and patients' parents to more easily identify the shape and outcomes before and after the therapy. METHODS This study included 399 patients who had helmet therapy from November 2014 to February 2016. Patients wore a cast helmet for more than 20 hours per day. A cranial caliper was used to measure their head before they wore the helmet (prehelmet), once a month during outpatient visits, and 6 months after they stopped wearing the helmet (posthelmet). Clinical photographs were taken on a transparent acrylic sheet with a grid of 5-mm intervals to measure cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and symmetry ration (SR). The patients' photographs were then measured twice: first against the background without the grid and then against the background with the grid. RESULTS Average age at prehelmet was 20 weeks while their average therapy period was 12 weeks. Patients' prehelmet CVA was 13.3 mm, and their posthelmet CVA was 3.1 mm. Their prehelmet CVAI was 10.1%, and their posthelmet CVAI was 2.1% (P < 0.001). Their overall prehelmet and posthelmet SRs were 0.820 and 0.969, respectively (P < 0.001). In addition, the measurements based on clinical photographs with and without the grid were compared using Fleiss kappa. The results showed κ = 0.847 and 0.956 when the patient was mild, κ = 0.744 and 0.919 when it was moderate, and κ = 0.767 and 0.924 when it was severe (P < 0.001). In all 3 patients, the consistency was higher with the grid. CONCLUSION Since cast helmet manufacturing for positional plagiocephaly therapy does not require computed tomography scanning, there is no need to administer a sedative, nor does it pose any radiation exposure risk. Since the cast helmet is easier to manufacture and operate and is more cost effective, it could be used to treat more people. In addition, it would be useful for both medical professionals and patients' guardians to use clinical photographs with the acrylic sheet with the grid as a method to analyze shapes and outcomes before and after therapy, along with traditional CVA and CVAI.
Collapse
|
10
|
Linz C, Kunz F, Böhm H, Schweitzer T. Positional Skull Deformities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:535-542. [PMID: 28835328 PMCID: PMC5624275 DOI: 10.3238/arztebl.2017.0535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 12/29/2016] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Especially in the first 6 months of life, skull deformities manifesting as a uni- or bilateral flattening of the occiput often give rise to questions of differential diagnosis and potential treatment. In this review, the authors summarize the current understanding of risk factors for this condition, and the current state of the relevant diagnostic assessment and options for treatment. METHODS The recommendations given in this selective review of the literature are based on current studies and on existing guidelines on the prevention of sudden infant death, the recommendations of the German Society for Pediatric Neurology (Deutsche Gesellschaft für Neuropädiatrie), and the American guidelines on the treatment of positional plagiocephaly in infancy. RESULTS Pre-, peri-, and postnatal risk factors can contribute to the development of positional skull deformities. These deformities can be diagnosed and classified on the basis of their clinical features, supplemented in unclear cases by ultrasonography of the cranial sutures. The putative relationship between positional skull deformities and developmental delay is currently debated. The main preventive and therapeutic measure is parent education to foster correct positioning habits (turning of the infant to the less favored side; prone positioning on occasion when awake) and beneficial stimulation of the infant (to promote lying on the less favored side). If the range of motion of the head is limited, physiotherapy is an effective additional measure. In severe or refractory cases, a skull orthosis (splint) may be useful. CONCLUSION The parents of children with positional skull deformities should be comprehensively informed about the necessary preventive and therapeutic measures. Treatment should be initiated early and provided in graded fashion, according to the degree of severity of the problem. Parental concern about the deformity should not be allowed to lead to a rejection of the reasonable recommendation for a supine sleeping position.
Collapse
Affiliation(s)
- Christian Linz
- University Hospital of Würzburg, Center for Craniofacial Surgery, Department of Oral and Maxillofacial Plastic Surgery
| | - Felix Kunz
- University Hospital of Würzburg, Department of Orthodontics
| | - Hartmut Böhm
- University Hospital of Würzburg, Center for Craniofacial Surgery, Department of Oral and Maxillofacial Plastic Surgery
| | - Tilmann Schweitzer
- University Hospital of Würzburg, Department of Neurosurgery, Section of Pediatric Neurosurgery
| |
Collapse
|
11
|
Zachry AH, Nolan VG, Hand SB, Klemm SA. Infant Positioning, Baby Gear Use, and Cranial Asymmetry. Matern Child Health J 2017; 21:2229-2236. [PMID: 28725930 DOI: 10.1007/s10995-017-2344-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives This study aimed to identify predictors of cranial asymmetry. We hypothesize that among infants diagnosed with cranial asymmetry in the sampled region, there is an association between exposure to more time in baby gear and less awake time in prone and side-lying than in infants who do not present with this condition. Methods The study employed a cross sectional survey of caregivers of typically developing infants and infants diagnosed with cranial asymmetry. Results A mutivariable model reveals that caregivers of children who are diagnosed with cranial asymmetry report their children spending significantly less time in prone play than those children without a diagnosis of cranial asymmetry. Side-lying and time spent in baby gear did not attain statistical significance. Conclusions for Practice Occupational therapists, physical therapists, pediatricians, nurses and other health care professionals must provide parents with early education about the importance of varying positions and prone play in infancy and address fears and concerns that may serve as barriers to providing prone playtime.
Collapse
Affiliation(s)
- Anne H Zachry
- Department of Occupational Therapy, University of Tennessee Health Science Center, 930 Madison Ave, Suite 616, Memphis, TN, 38163, USA.
| | - Vikki G Nolan
- Division of Epidemiology, University of Memphis School of Public Health, Memphis, TN, USA
| | - Sarah B Hand
- Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | |
Collapse
|
12
|
Aarnivala H, Vuollo V, Heikkinen T, Harila V, Holmström L, Pirttiniemi P, Valkama AM. Accuracy of measurements used to quantify cranial asymmetry in deformational plagiocephaly. J Craniomaxillofac Surg 2017; 45:1349-1356. [PMID: 28615136 DOI: 10.1016/j.jcms.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/24/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Various measurements are used to quantify cranial asymmetry in deformational plagiocephaly (DP), but studies validating cut-off values and comparing the accuracy of such measurements are lacking. In this study, we compared the accuracy of four different measurements in classifying children with and without DP diagnosed by visual assessment, and sought to determine their optimal cut-off values. STUDY DESIGN Two experts rated 407 3D craniofacial images of children aged between 3 and 36 months old using the Argenta classification. We then measured the following asymmetry-related variables from the images: Oblique Cranial Length Ratio (OCLR), Diagonal Difference (DD), Posterior Cranial Asymmetry Index (PCAI), and weighted Asymmetry Score (wAS). We created receiver operating characteristic curves to evaluate the accuracy of these variables. RESULTS All variables performed well, but OCLR consistently provided the best discrimination in terms of area under the curve values. Subject's age had no clear effect on the cut-off values for OCLR, PCAI, and wAS; however, the cut-off for DD increased monotonically with age. When subjects with discrepant expert ratings were excluded, the optimal cut-off values for DP (Argenta class ≥ 1) across all age-groups were 104.0% for OCLR (83% sensitivity, 97% specificity), 10.5% for PCAI (90% sensitivity, 90% specificity), and 24.5 for wAS (88% sensitivity, 90% specificity). CONCLUSION We recommend using OCLR as the primary measurement, although PCAI and wAS may also be useful in monitoring cranial asymmetry. The threshold of relative asymmetry required for a deformation to appear clinically significant is not affected by the child's age, and DD has no additional utility in monitoring DP compared to using only OCLR.
Collapse
Affiliation(s)
- Henri Aarnivala
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland; PEDEGO Research Group, University of Oulu, Oulu, Finland.
| | - Ville Vuollo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland; Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Tuomo Heikkinen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Lasse Holmström
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - A Marita Valkama
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland; PEDEGO Research Group, University of Oulu, Oulu, Finland
| |
Collapse
|
13
|
Transferring the Assessment of Cranial Deformities to the Affected. J Craniofac Surg 2017; 28:303-304. [PMID: 28114221 DOI: 10.1097/scs.0000000000003599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
14
|
Aarnivala H, Vuollo V, Harila V, Heikkinen T, Pirttiniemi P, Holmström L, Valkama AM. The course of positional cranial deformation from 3 to 12 months of age and associated risk factors: a follow-up with 3D imaging. Eur J Pediatr 2016; 175:1893-1903. [PMID: 27624627 DOI: 10.1007/s00431-016-2773-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
Deformational plagiocephaly is reported in up to 46.6 % of healthy infants, with the highest point prevalence at around 3 months of age. Few prospective studies on the natural course of skull deformation have been conducted, and we know of no studies using 3D imaging starting from the highest point prevalence period. In this prospective, population-based cohort study, we describe the course of cranial asymmetry and shape in an unselected population using 3D stereophotogrammetry and investigate factors associated with late cranial deformation and failure to recover from previous deformation. We evaluated 99 infants at 3, 6, and 12 months of age. We acquired 3D craniofacial images and performed structured clinical examinations and parental interviews at each visit. Eight outcome variables, representing different aspects of cranial shape, were calculated from a total of 288 3D images. Scores of asymmetry-related variables improved throughout the observation period. However, the rate of correction for cranial asymmetry decreased as the infants grew older, also in relation to the rate of head growth, and a significant amount of asymmetry was still present at 12 months. Positional preference at 3 months predicted an unfavorable course of cranial asymmetry after 3 months, increasing the risk for DP persisting. What is known: • The prevalence of deformational plagiocephaly spontaneously decreases after the first months of life. • Limited neck range of motion and infant positional preference increase the risk of deformational plagiocephaly during the first months of life. What is new: • Positional preference at 3 months predicts an unfavorable spontaneous course of deformation also from three to 12 months of age, presenting a potential target for screening and treatment. • The spontaneous rate of correction for cranial asymmetry decreases after 6 months of age, also in relation to the rate of head growth.
Collapse
Affiliation(s)
- Henri Aarnivala
- Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland. .,Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,PEDEGO Research Group, University of Oulu, Oulu, Finland.
| | - Ville Vuollo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Tuomo Heikkinen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Lasse Holmström
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - A Marita Valkama
- Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland.,PEDEGO Research Group, University of Oulu, Oulu, Finland
| |
Collapse
|
15
|
|
16
|
Öhman A. A Craniometer with a Headband Can Be a Reliable Tool to Measure Plagiocephaly and Brachycephaly in Clinical Practice. Health (London) 2016. [DOI: 10.4236/health.2016.812128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|