1
|
Kronig SA, Kronig OD, Vrooman HA, Van Adrichem LN. UCSQ Method Applied on 3D Photogrammetry: Non-Invasive Objective Differentiation Between Synostotic and Positional Plagiocephaly. Cleft Palate Craniofac J 2023; 60:1273-1283. [PMID: 35538856 PMCID: PMC10515447 DOI: 10.1177/10556656221100679] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Objective differentiation between unilateral coronal synostosis (UCS) and positional posterior plagiocephaly (PPP) based on 3D photogrammetry according to Utrecht Cranial Shape Quantificator (UCSQ). DESIGN Retrospective study. SETTING Primary craniofacial center. PATIENTS, PARTICIPANTS Thirty-two unoperated patients (17 UCS; 15 PPP) (age < 1 year). INTERVENTIONS Extraction of variables from sinusoid curves derived using UCSQ: asymmetry ratio forehead and occiput peak, ratio of gradient forehead and occiput peak, location forehead and occiput peak. MAIN OUTCOME MEASURE(S) Variables, derived using 3D photogrammetry, were analyzed for differentiation between UCS and PPP. RESULTS Frontal peak was shifted to the right side of the head in left-sided UCS (mean x-value 207 [192-220]), and right-sided PPP (mean x-value 210 [200-216]), and to the left in right-sided UCS (mean x-value 161 [156-166]), and left-sided PPP (mean x-value 150 [144-154]). Occipital peak was significantly shifted to the right side of the head in left-sided PPP (mean x-value 338 [336-340]) and to the left in right-sided PPP (mean x-value 23 [14-32]). Mean x-value of occipital peak was 9 (354-30) in left- and 2 (350-12) in right-sided UCS. Calculated ratio of gradient of the frontal peak is, in combination with the calculated asymmetry ratio of the frontal peak, a distinctive finding. CONCLUSIONS UCSQ objectively captures shape of synostotic and positional plagiocephaly using 3D photogrammetry, we therefore developed a suitable method to objectively differentiate UCS from PPP using radiation-free methods.
Collapse
Affiliation(s)
- Sophia A.J. Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
| | - Otto D.M. Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
| | - Henri A. Vrooman
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Léon N.A. Van Adrichem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
| |
Collapse
|
2
|
Reliability of Using a Smartphone Application to Objectify Skull Deformation. Pediatr Phys Ther 2022; 34:465-470. [PMID: 35876836 DOI: 10.1097/pep.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To establish intrarater and interrater reliability of photographs made in a newly developed smartphone app to determine the severity of infantile skull deformation by taking a cranial photograph of an infant's head. METHODS Using the app, 1 pediatric physical therapist and 2 pediatric physical therapy master students photographed heads of 30 infants aged up to 12 months receiving treatment for asymmetric or delayed motor development. Modified Cranial Vault Asymmetry Index and Cranial Index determined the severity of skull deformation. RESULTS Intrarater reliability was excellent both for mCVAI and CI, with an ICC(3,1) = 0.97, and ICC(3,1) = 0.98, respectively. Interrater reliability with an ICC(2,1) = 0.97 for the mCVAI, and ICC(2,1) = 0.99 for the CI was excellent too. CONCLUSION The reliability of the Skully Care App proved to be excellent when used by pediatric physical therapists.Supplemental Digital Content 1. Video Abstract available at: http://links.lww.com/PPT/A399 .
Collapse
|
3
|
Billi M, Greco A, Colonneli P, Volpi G, Valente D, Galeoto G. The functional manual therapy intervention in infants with non-synostotic plagiocephaly: a pilot study. Minerva Pediatr (Torino) 2022; 74:294-300. [DOI: 10.23736/s2724-5276.17.04838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
4
|
Helmet Therapy for Positional Cranial Deformations; a 5-year follow-up study. J Craniomaxillofac Surg 2022; 50:499-503. [DOI: 10.1016/j.jcms.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 04/22/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
|
5
|
Watt A, Zammit D, Lee J, Gilardino M. Novel Screening and Monitoring Techniques for Deformational Plagiocephaly: A Systematic Review. Pediatrics 2022; 149:184526. [PMID: 35059723 DOI: 10.1542/peds.2021-051736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
This article summarizes the current state of diagnostic modalities for infant craniofacial deformities and highlights capable diagnostic tools available currently to pediatricians.
Collapse
Affiliation(s)
- Ayden Watt
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Dino Zammit
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - James Lee
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Mirko Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
6
|
Consistency of Cranial Shape Measures Obtained From Laser Surface and Computed Tomography Imaging. J Craniofac Surg 2021; 32:2763-2767. [PMID: 34727475 DOI: 10.1097/scs.0000000000007885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Children with cranial shape abnormalities are often subjected to radiation from computed tomography (CT) for evaluation and clinical decision making. The STARscanner Laser Data Acquisition System (Orthomerica, Orlando, FL) may be a noninvasive alternate. The purpose of this study is to determine whether the STARscanner provides valid and accurate cranial measurements compared to CT. DESIGN We performed an institutional review board-approved retrospective review of a prospectively maintained database of patients with metopic suture abnormalities from 2013 to 2016. SETTING Plastic surgery clinic in an institutional tertiary care center. PATIENTS Eight patients were included that presented with metopic suture abnormalities, age less than 1 year, and CT and STARscanner imaging within 30 days of one another. MAIN OUTCOME MEASURES Cranial measurements were collected twice from 3 scan types: STARscanner, CT windowed for soft tissue, and CT windowed for bone. Measurements included: intracranial volume, height, base width, maximum antero-posterior length, maximum medio-lateral width, and oblique diameters. Nested analysis of variance were performed to determine the proportion of error attributable to: between-subject variance, scan type, and rater. RESULTS Measurements from STARscanner and both CT scans windows were highly consistent, with less than 1% of total error attributable to scan type for all measures. CONCLUSIONS Cranial shape measurements obtained from STARscanner images are highly consistent with those obtained from CT scans. The STARscanner has added benefits of speed of acquisition, minimal cost, and lack of radiation.
Collapse
|
7
|
Van Adrichem LNA, Kronig SAJ, Kronig ODM. Validation of Skully Care as a Fast Method for Quantifying Positional Cranial Deformities. Cleft Palate Craniofac J 2021; 59:1107-1113. [PMID: 34559019 PMCID: PMC9411692 DOI: 10.1177/10556656211035022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Craniofacial measuring is valuable for diagnosis and evaluation of growth and treatment of positional skull deformities. Plagiocephalometry (PCM) quantifies skull deformities and is proven to be reliable and valid. However, PCM needs direct skin contact with thermoplastic material, is laborious and time-consuming. Therefore, Skully Care (SC) was developed to measure positional skull deformities with a smartphone application. Design SC is retrospectively compared to PCM. Setting Pediatric physiotherapy centers. Patients Age ≤1 year, analyzed or treated for positional skull deformities. Interventions A total of 60 skull shape analyses were performed. Main Outcome Measures The main outcome measures employed are Pearson correlation coefficient between cranial vault asymmetry index (CVAI; in SC) and oblique diameter difference index (ODDI; in PCM) and between cranial index (CI; in SC) and cranial proportional index (CPI; in PCM). Mann–Whitney U test determined difference of time consumption between PCM and SC. Results High correlation was found between CVAI and ODDI (r = 0.849; P < .01) in positional plagiocephaly and very high correlation between CI and CPI (r = 0.938; P < .01) in positional brachycephaly. SC is significantly faster than PCM (P < .001). Conclusions SC is valid in analyzing positional skull deformities and strongly correlates to PCM, the gold standard in daily physiotherapy practice. The combination of simplicity, validity, speed, and user and child convenience makes SC a promising craniofacial measuring method in daily practice. SC has potential to be the modern successor for analyzing positional skull deformities.
Collapse
Affiliation(s)
- Léon N A Van Adrichem
- Department of Plastic and Reconstructive Surgery and Hand Surgery, 8124University Medical Center Utrecht, the Netherlands
| | - Sophia A J Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, 8124University Medical Center Utrecht, the Netherlands
| | - Otto D M Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, 8124University Medical Center Utrecht, the Netherlands
| |
Collapse
|
8
|
Demographics of Positional Plagiocephaly and Brachycephaly; Risk Factors and Treatment. J Craniofac Surg 2021; 32:2736-2740. [PMID: 34231510 DOI: 10.1097/scs.0000000000007811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In the last 3 decades, the incidence of positional cranial deformations in infants, such as positional plagiocephaly and positional brachycephaly, has increased. The deviating shape often causes parental concern for the later psychosocial wellbeing of the child. Treatment options are nonoperative, varying from positional change to helmet therapy, of which the effect has often been debated. Multiple risk factors have been associated with an increased risk on the development of these deformations. The goal of this study was to assess the impact of known risk factors on the type and severity of resulting positional cranial deformation.Parents were asked to fill out a questionnaire regarding the presence of risk factors, such as gender, age, pregnancy duration, method of delivery and reasons for atypical deliveries, breech position, birth weight, developmental status, positional preference, family history, number of siblings, and torticollis presence. Treatment methods were documented and plagiocephalometry was used to measure the cranial proportions. All children were invited to participate in short-term follow-up. The significance of the risk factors and the effect of different kinds of therapy are discussed. Although no significant correlation was found between severity and risk factors, some risk factors could be correlated with the kind of positional cranial deformation. Of the different therapies, helmet therapy had a significant impact on the reduction of positional plagiocephaly.
Collapse
|
9
|
Pastor-Pons I, Lucha-López MO, Barrau-Lalmolda M, Rodes-Pastor I, Rodríguez-Fernández ÁL, Hidalgo-García C, Tricás-Moreno JM. Interrater and Intrarater Reliability of Cranial Anthropometric Measurements in Infants with Positional Plagiocephaly. CHILDREN-BASEL 2020; 7:children7120306. [PMID: 33348822 PMCID: PMC7766735 DOI: 10.3390/children7120306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: anthropometric measurements with calipers are used to objectify cranial asymmetry in positional plagiocephaly but there is controversy regarding the reliability of different methodologies. Purpose: to analyze the interrater and intrarater reliability of direct anthropometric measurements with caliper on defined craniofacial references in infants with positional plagiocephaly. (2) Methods: 62 subjects (<28 weeks), with a difference of at least 5 mm between cranial diagonal diameters. Maximal cranial circumference, length and width and diagonal cranial diameters were measured. Intrarater (2 measurements) and interrater (2 raters) reliability was analyzed. (3) Results: intra- and interrater reliability of the maximal cranial length and width and right cranial diagonal was excellent: intraclass correlation coefficient (ICC) > 0.9. Intrarater and interrater reliability for the left cranial diagonal was excellent: ICC > 0.9 and difference in agreement in the Bland-Altman plot 0.0 mm, respectively. Intrarater and interrater reliability for the maximal cranial circumference was good: differences in agreement in Bland-Altman plots: intra: −0.03 cm; inter: −0.12 cm. (4) Conclusions: anthropometric measurements in a sample of infants with moderate positional plagiocephaly have shown excellent intra- and interrater reliability for maximal cranial length, maximal cranial width, and right and left cranial diagonals, and good intra- and interrater reliability in maximal cranial circumference measurement.
Collapse
Affiliation(s)
- Iñaki Pastor-Pons
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | - María Orosia Lucha-López
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
- Correspondence: ; Tel.: +34-626-480-131
| | - Marta Barrau-Lalmolda
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | - Iñaki Rodes-Pastor
- Instituto de Terapias Integrativas, 50001 Zaragoza, Spain; (I.P.-P.); (M.B.-L.); (I.R.-P.)
| | | | - César Hidalgo-García
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
| | - Jose Miguel Tricás-Moreno
- Departamento de Fisiatría y Enfermería, Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (C.H.-G.); (J.M.T.-M.)
| |
Collapse
|
10
|
Feijen MMW, van Cruchten C, van der Hulst RRWJ. The Effect of Cranial Shape on Esthetic Self-Worth in Bald Men. J Craniofac Surg 2020; 32:233-237. [PMID: 32833829 DOI: 10.1097/scs.0000000000006916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT During the last 3 decades, the incidence of positional plagiocephaly and brachycephaly has increased. Treatment options are conservative and can include physiotherapy and molding helmet therapy. The decision to start therapy is based on patient history and subjective assessment of cranial shape by the physician and the parents. To determine the impact of these deformations on esthetic self-worth, as well as cranial shape, this study was conducted on a population of adult bald men.Participants were asked to fill in a questionnaire about the amount of comments received on cranial shape, as well as grade their general esthetic and grade craniofacial features using a visual analogue scale. The cranial proportions and symmetry were measured using plagiocephalometry.50 adult bald men were included in this study. The prevalence of nonsynostotic plagiocephaly was 12%; the prevalence of nonsynostotic brachycephaly was 0%. No significant correlation was found between plagiocephaly or brachycephaly, cranial circumference, width or length and amount of comments on cranial shape, cosmetic assessment of appearance or cosmetic assessment of cranial shape. On average, teeth and eyes were given the highest cosmetic value, eyebrows and chin were given the lowest scores.Cranial shape does not have a significant impact on the amount of comments received on cranial shape, nor the cosmetic assessment of either overall appearance or cranial shape in bald men. For bald men, eyes and teeth are more important craniofacial features in cosmetic assessment. There is no clear esthetic need to treat deviating cranial shape with helmet therapy in male patients.
Collapse
|
11
|
Kronig ODM, Kronig SAJ, Vrooman HA, Veenland JF, Jippes M, Boen T, Van Adrichem LNA. Introducing a new method for classifying skull shape abnormalities related to craniosynostosis. Eur J Pediatr 2020; 179:1569-1577. [PMID: 32303825 PMCID: PMC7479008 DOI: 10.1007/s00431-020-03643-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 11/25/2022]
Abstract
We present a novel technique for classification of skull deformities due to most common craniosynostosis. We included 5 children of every group of the common craniosynostoses (scaphocephaly, brachycephaly, trigonocephaly, and right- and left-sided anterior plagiocephaly) and additionally 5 controls. Our outline-based classification method is described, using the software programs OsiriX, MeVisLab, and Matlab. These programs were used to identify chosen landmarks (porion and exocanthion), create a base plane and a plane at 4 cm, segment outlines, and plot resulting graphs. We measured repeatability and reproducibility, and mean curves of groups were analyzed. All raters achieved excellent intraclass correlation scores (0.994-1.000) and interclass correlation scores (0.989-1.000) for identifying the external landmarks. Controls, scaphocephaly, trigonocephaly, and brachycephaly all have the peak of the forehead in the middle of the curve (180°). In contrary, in anterior plagiocephaly, the peak is shifted (to the left of graph in right-sided and vice versa). Additionally, controls, scaphocephaly, and trigonocephaly have a high peak of the forehead; scaphocephaly has the lowest troughs; in brachycephaly, the width/frontal peak ratio has the highest value with a low frontal peak.Conclusion: We introduced a preliminary study showing an objective and reproducible methodology using CT scans for the analysis of craniosynostosis and potential application of our method to 3D photogrammetry. What is Known: • Diagnosis of craniosynostosis is relatively simple; however, classification of craniosynostosis is difficult and current techniques are not widely applicable. What is New: • We introduce a novel technique for classification of skull deformities due to craniosynostosis, an objective and reproducible methodology using CT scans resulting in characteristic curves. The method is applicable to all 3D-surface rendering techniques. • Using external landmarks and curve analysis, specific and characteristic curves for every type of craniosynostosis related to the specific skull deformities are found.
Collapse
Affiliation(s)
- Otto D. M. Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Dutch Craniofacial Centre, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sophia A. J. Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Dutch Craniofacial Centre, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Henri A. Vrooman
- Department of Radiology, Erasmus MC, Rotterdam, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus MC, Rotterdam, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jifke F. Veenland
- Department of Radiology, Erasmus MC, Rotterdam, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus MC, Rotterdam, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Mariëlle Jippes
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Dutch Craniofacial Centre, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Terence Boen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Dutch Craniofacial Centre, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Léon N. A. Van Adrichem
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
12
|
Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther 2018; 30:240-290. [PMID: 30277962 PMCID: PMC8568067 DOI: 10.1097/pep.0000000000000544] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified. PURPOSE This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice. RESULTS/CONCLUSIONS The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.
Collapse
Affiliation(s)
- Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences (Dr Kaplan), Rutgers, The State University of New Jersey, Newark, New Jersey; Orthotics and Prosthetics Department (Dr Coulter), Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry (Dr Sargent), University of Southern California, Los Angeles, California
| | | | | |
Collapse
|
13
|
Nahles S, Klein M, Yacoub A, Neyer J. Evaluation of positional plagiocephaly: Conventional anthropometric measurement versus laser scanning method. J Craniomaxillofac Surg 2018; 46:11-21. [DOI: 10.1016/j.jcms.2017.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/03/2017] [Accepted: 10/06/2017] [Indexed: 11/28/2022] Open
|
14
|
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: 20] [Impact Index Per Article: 2.9] [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
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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
|
17
|
Tang M, Gorbutt KA, Peethambaran A, Yang L, Nelson VS, Chang KWC. High prevalence of cranial asymmetry exists in infants with neonatal brachial plexus palsy. J Pediatr Rehabil Med 2016; 9:271-277. [PMID: 27935564 DOI: 10.3233/prm-160396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study aimed to: 1) evaluate the prevalence of cranial asymmetry (positional plagiocephaly) in infants with neonatal brachial plexus palsy (NBPP); 2) examine the association of patient demographics, arm function, and NBPP-related factors to positional plagiocephaly; and 3) determine percentage of spontaneous recovery from positional plagiocephaly and its association with arm function. METHODS Infants < 1 year of age with NBPP and no previous exposure to plagiocephaly cranial remolding therapy or surgical intervention were recruited for this prospective cross-sectional study. Positional plagiocephaly (diagonal difference) measurements were captured using a fiberglass circumferential mold of the cranium. Included infants were divided into 2 groups: 1) those with positional plagiocephaly at most recent evaluation (plagio group), including infants with resolved positional plagiocephaly (plagio-resolved subgroup); and 2) those who never had positional plagiocephaly (non-plagio group). Standard statistics were applied. RESULTS Eighteen of 28 infants (64%) had positional plagiocephaly. Delivery type might be predictive for plagiocephaly. Infants in the non-plagio group exhibited more active range of motion than infants in the plagio group. All other factors had no significant correlations. CONCLUSIONS A high prevalence of positional plagiocephaly exists among the NBPP population examined. Parents and physicians should encourage infants to use their upper extremities to change position and reduce chance of cranial asymmetry.
Collapse
Affiliation(s)
- Megan Tang
- South Georgia Orthopedic Resources, Hiram, GA, USA
| | | | | | - Lynda Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Virginia S Nelson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
18
|
Craniosynostosis: A multidisciplinary approach based on medical, social and demographic factors in a developing country. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
19
|
|
20
|
|
21
|
Weernink MGM, van Wijk RM, Groothuis-Oudshoorn CGM, Lanting CI, Grant CC, van Vlimmeren LA, Boere-Boonekamp MM. Insufficient vitamin D supplement use during pregnancy and early childhood: a risk factor for positional skull deformation. MATERNAL & CHILD NUTRITION 2016; 12:177-88. [PMID: 25382635 PMCID: PMC6860055 DOI: 10.1111/mcn.12153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vitamin D insufficiency during pregnancy is associated with disturbed skeletal homeostasis during infancy. Our aim was to investigate the influence of adherence to recommendations for vitamin D supplement intake of 10 μg per day (400 IU) during pregnancy (mother) and in the first months of life (child) on the occurrence of positional skull deformation of the child at the age of 2 to 4 months. In an observational case-control study, two hundred seventy-five 2- to 4-month-old cases with positional skull deformation were compared with 548 matched controls. A questionnaire was used to gather information on background characteristics and vitamin D intake (food, time spent outdoors and supplements). In a multiple variable logistic regression analysis, insufficient vitamin D supplement intake of women during the last trimester of pregnancy [adjusted odds ratio (aOR) 1.86, 95% (CI) 1.27-2.70] and of children during early infancy (aOR 7.15, 95% CI 3.77-13.54) were independently associated with an increased risk of skull deformation during infancy. These associations were evident after adjustment for the associations with skull deformation that were present with younger maternal age and lower maternal education, shorter pregnancy duration, assisted vaginal delivery, male gender and milk formula consumption after birth. Our findings suggest that non-adherence to recommendations for vitamin D supplement use by pregnant women and infants are associated with a higher risk of positional skull deformation in infants at 2 to 4 months of age. Our study provides an early infant life example of the importance of adequate vitamin D intake during pregnancy and infancy.
Collapse
Affiliation(s)
- Marieke G M Weernink
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Enschede, The Netherlands
| | - Renske M van Wijk
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Enschede, The Netherlands
| | - Caren I Lanting
- Netherlands Institute for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Leo A van Vlimmeren
- Department of Rehabilitation, Pediatric Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Magda M Boere-Boonekamp
- Department Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Enschede, The Netherlands
| |
Collapse
|
22
|
Abstract
The incidence of positional plagiocephaly and brachycephaly in infants has increased. Treatment options include physiotherapy and helmet therapy.No information exists on the prevalence, cosmetic, and psychological consequences of plagiocephaly and brachycephaly later in life. This study was performed to assess the prevalence and cosmetic relevance of plagiocephaly and brachycephaly, as well as its influence on quality of life in adolescence.The authors performed plagiocephalomety to assess cranial shape and used a questionnaire that included question about educational level, medical history, cosmetic appearance, and cranial shape. To evaluate quality of life, the authors used the KIDSCREEN-27 questionnaire.All data were analyzed using SPSS version 19.0 2010. The authors included 87 adolescents. The prevalence of plagiocephaly, defined as an oblique diameter difference index (ODDI) higher than 106%, was 10.3%; the prevalence of brachycephaly, defined as a cranial proportional index (CPI) higher than 95%, was 0%.There was no significant correlation between the level of the ODDI or CPI and the cosmetic assessment of cranial shape (P = 0.128/0.541). There was no significant correlation with the level of the ODDI (P = 0.428).There was no significant correlation between the level of the ODDI or CPI and the average T-value for quality of life using the KIDSCREEN quality-of-life questionnaire (P = 0.461/0.713). The prevalence of positional deformities in our population of adolescents, born after the "back to sleep" campaign, is low. There was no significant correlation between the presence of a cranial deformity and the cosmetic judgement and quality of life.
Collapse
|
23
|
Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. Eur J Pediatr 2015; 174:1197-208. [PMID: 25823758 DOI: 10.1007/s00431-015-2520-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Deformational plagiocephaly (DP) occurs frequently in otherwise healthy infants. Many infants with DP undergo physiotherapy or helmet therapy, and ample treatment-related research is available. However, the possibility of preventing DP has been left with little attention. We sought to evaluate the effectiveness of intervention in the newborn's environment, positioning, and handling on the prevalence of DP at 3 months and to investigate the causal relationship between DP and cervical imbalance. We carried out a randomized controlled trial, with healthy newborns randomized into two groups at birth. All families received standard positioning instructions to prevent SIDS. Additionally, the intervention group received detailed instructions regarding the infant's environment, positioning, and handling, with the goal of creating a nonrestrictive environment that promotes spontaneous physical movement and symmetrical motor development. Two- and three-dimensional photogrammetry served to assess cranial shape and goniometry to measure cervical motion. At 3 months, the prevalence of DP was lower in the intervention group in both 2D (11 vs 31 %) and 3D analyses (15 vs 33 %), and the asymmetry was milder in the intervention group. Infants with DP at follow-up had also developed more torticollis. CONCLUSION An early educational intervention reduces the prevalence and severity of DP at 3 months. WHAT IS KNOWN •Deformational plagiocephaly, often with associated torticollis, is common in healthy infants. •Parental education is frequently recommended for preventing deformational plagiocephaly, although information regarding the effectiveness of preventive strategies is scarce. WHAT IS NEW •Early parent guidance effectively reduces the prevalence and severity of DP and improves the cervical range of motion at three months. •Educating both parents and professionals about proper infant positioning on a national scale could help minimize public healthcare costs.
Collapse
|
24
|
Baken L, van Gruting IMA, Steegers EAP, van der Spek PJ, Exalto N, Koning AHJ. Design and validation of a 3D virtual reality desktop system for sonographic length and volume measurements in early pregnancy evaluation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:164-170. [PMID: 25041997 DOI: 10.1002/jcu.22207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/28/2014] [Accepted: 06/10/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To design and validate a desktop virtual reality (VR) system, for presentation and assessment of volumetric data, based on commercially off-the-shelf hardware as an alternative to a fully immersive CAVE-like I-Space VR system. METHODS We designed a desktop VR system, using a three-dimensional (3D) monitor and a six degrees-of-freedom tracking system. A personal computer uses the V-Scope (Erasmus MC, Rotterdam, The Netherlands) volume-rendering application, developed for the I-Space, to create a hologram of volumetric data. Inter- and intraobserver reliability for crown-rump length and embryonic volume measurements are investigated using Bland-Altman plots and intraclass correlation coefficients. Time required for the measurements was recorded. RESULTS Comparing the I-Space and the desktop VR system, the mean difference for crown-rump length is -0.34% (limits of agreement -2.58-1.89, ±2.24%) and for embryonic volume -0.92% (limits of agreement -6.97-5.13, ±6.05%). Intra- and interobserver intraclass correlation coefficients of the desktop VR system were all >0.99. Measurement times were longer on the desktop VR system compared with the I-Space, but the differences were not statistically significant. CONCLUSIONS A user-friendly desktop VR system can be put together using commercially off-the-shelf hardware at an acceptable price. This system provides a valid and reliable method for embryonic length and volume measurements and can be used in clinical practice.
Collapse
Affiliation(s)
- Leonie Baken
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Room Na15.23, PO Box 2040, 3000, CA Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
25
|
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.
Collapse
|
26
|
van Wijk RM, van Til JA, Groothuis-Oudshoorn CGM, L'Hoir MP, Boere-Boonekamp MM, IJzerman MJ. Parents' decision for helmet therapy in infants with skull deformation. Childs Nerv Syst 2014; 30:1225-32. [PMID: 24643710 DOI: 10.1007/s00381-014-2399-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/27/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Helmet therapy is regularly prescribed in infants with positional skull deformation. Evidence on the effectiveness is lacking, which complicates decision making. This study aims to assess the relation between parents' decision for treatment of skull deformation in their infant and their level of anxiety, decisional conflict, expectations of treatment effect, perceived severity of deformation and perceived side effects. METHODS Parents of 5-month-old infants with skull deformation were invited to participate in a survey. Data collection included background characteristics, anthropometric assessment, parent-reported outcomes, decision for treatment (helmet therapy or awaiting natural course), decisional conflict scale and questions about perceived (side) effects of helmet therapy. Factors significantly correlated with treatment decision (p < 0.1) were tested in a multiple logistic regression analysis. RESULTS The results of 186 respondents were included in the analysis. Parental satisfaction with their infant's head shape (adjusted odds ratio (aOR) 0.2; 95 % confidence interval (CI) 0.1 to 0.4), expected effect of helmet therapy compared to natural course (aOR 13.4; 95 % CI 5.0 to 36.1) and decision uncertainty (aOR 1.0; 95 % CI 0.9 to 1.0; p = .03) were related to the decision for helmet therapy in infants with skull deformation. CONCLUSION With the outcomes of this study, we can better understand parental decision-making for elective 'normalizing' treatments in children, such as helmet therapy in infants with skull deformation. Health care professionals should address the parents' perception of the severity of skull deformation and their expectations of helmet therapy. Furthermore, they can support parents in decision-making by balancing medical information with parents' expectations, values and beliefs.
Collapse
Affiliation(s)
- Renske M van Wijk
- Department of Health Technology and Services Research, Institute for Innovation and Governance Studies, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands,
| | | | | | | | | | | |
Collapse
|
27
|
Pogliani L, Cerini C, Vivaldo T, Duca P, Zuccotti GV. Deformational plagiocephaly at birth: an observational study on the role of assisted reproductive technologies. J Matern Fetal Neonatal Med 2013; 27:270-4. [PMID: 23773121 DOI: 10.3109/14767058.2013.814629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Following the "back to sleep" recommendations, a striking rise in deformational plagiocephaly (DP) occurred. However, additional maternal, pregnancy and infant conditions may play a role. OBJECTIVES We aimed to evaluate the prevalence of and risk factors for DP at birth. Additionally, given the association between assisted reproductive technologies (ART) use and unfavorable pregnancy events, we explored the association between ART and DP. PATIENTS AND METHODS A total of 413 neonates >33 weeks born at L. Sacco Hospital (Milan, Italy) from May 2011 through to January 2012 were enrolled. Data regarding parental, conceivement, pregnancy and delivery characteristics were recorded. Infants' skull measurements, including the oblique cranial length ratio (OCLR) were taken within 72 h after birth. Plagiocephaly was defined for OCLR > 105.9. RESULTS The prevalence of DP was 20.3%. It was associated with twinning (OR 5.0; 95%CI 2.22-11.1), pregnancy complications (OR 2.86; 95%CI 1.49-5.26), prematurity (OR 2.13; 95%CI 0.98-4.54), ART use (OR 2.00; 95%CI 0.90-4.35) and male gender (OR 1.79; 95%CI 0.94-2.50). Adjusting for multiple pregnancies however, the association between ART and DP disappeared. CONCLUSION Results show that offspring of pregnancies conceived through ART do not have increased risk of DP. However, our numbers are small thus larger studies are needed for definitive conclusions.
Collapse
|
28
|
van Lindert EJ, Siepel FJ, Delye H, Ettema AM, Bergé SJ, Maal TJJ, Borstlap WA. Validation of cephalic index measurements in scaphocephaly. Childs Nerv Syst 2013; 29:1007-14. [PMID: 23468203 DOI: 10.1007/s00381-013-2059-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The cephalic index (CI) of the head can be measured manually using a caliper, the original technique, but it is also possible to determine it using skull X-ray, 2DCT and 3DCT images, 3D photo and with help of plagiocephalometry (PCM). PATIENTS AND METHODS In this study, the manual caliper determination is statistically compared with other measuring methods for scaphocephaly patients (n = 39). RESULTS The CI mean differences for the most representative data are sequentially 3.74, 2.16, 1.09 and 0.97 for the 2DCT, PCM, 3D photo and 3DCT techniques. The CI 2DCT values show a significant difference (p < 0.01) in reference to CI manually, while the other techniques show a p > 0.05. CONCLUSION The conclusions are that significantly different results are achieved when using 2DCT relative to the manual caliper determination. No significant difference is observed between the 3D techniques and the manual method.
Collapse
Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
29
|
van Wijk RM, Boere-Boonekamp MM, Groothuis-Oudshoorn CGM, van Vlimmeren LA, IJzerman MJ. HElmet therapy Assessment in infants with Deformed Skulls (HEADS): protocol for a randomised controlled trial. Trials 2012; 13:108. [PMID: 22776627 PMCID: PMC3475065 DOI: 10.1186/1745-6215-13-108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 06/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In The Netherlands, helmet therapy is a commonly used treatment in infants with skull deformation (deformational plagiocephaly or deformational brachycephaly). However, evidence of the effectiveness of this treatment remains lacking. The HEADS study (HElmet therapy Assessment in Deformed Skulls) aims to determine the effects and costs of helmet therapy compared to no helmet therapy in infants with moderate to severe skull deformation. METHODS/DESIGN Pragmatic randomised controlled trial (RCT) nested in a cohort study. The cohort study included infants with a positional preference and/or skull deformation at two to four months (first assessment). At 5 months of age, all children were assessed again and infants meeting the criteria for helmet therapy were asked to participate in the RCT. Participants were randomly allocated to either helmet therapy or no helmet therapy. Parents of eligible infants that do not agree with enrolment in the RCT were invited to stay enrolled for follow up in a non-randomisedrandomised controlled trial (nRCT); they were then free to make the decision to start helmet therapy or not. Follow-up assessments took place at 8, 12 and 24 months of age. The main outcome will be head shape at 24 months that is measured using plagiocephalometry. Secondary outcomes will be satisfaction of parents and professionals with the appearance of the child, parental concerns about the future, anxiety level and satisfaction with the treatment, motor development and quality of life of the infant. Finally, compliance and costs will also be determined. DISCUSSION HEADS will be the first study presenting data from an RCT on the effectiveness of helmet therapy. Outcomes will be important for affected children and their parents, health care professionals and future treatment policies. Our findings are likely to influence the reimbursement policies of health insurance companies.Besides these health outcomes, we will be able to address several methodological questions, e.g. do participants in an RCT represent the eligible target population and do outcomes of the RCT differ from outcomes found in the nRCT? TRIAL REGISTRATION ISRCTN18473161.
Collapse
Affiliation(s)
- Renske M van Wijk
- Department of Health Technology and Services Research, Institute for Governance Studies, University of Twente, Enschede, The Netherlands.
| | | | | | | | | |
Collapse
|
30
|
Nuysink J, van Haastert IC, Eijsermans MJC, Koopman-Esseboom C, van der Net J, de Vries LS, Helders PJM. Prevalence and predictors of idiopathic asymmetry in infants born preterm. Early Hum Dev 2012; 88:387-92. [PMID: 22051525 DOI: 10.1016/j.earlhumdev.2011.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 07/18/2011] [Accepted: 10/03/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND An idiopathic asymmetry in posture of the head is recognized as a risk factor to develop a deformational plagiocephaly (DP). In our neonatal follow-up clinic, an IA is often observed in infants born preterm at term-equivalent age (TEA). AIMS To explore (1) the prevalence of an idiopathic asymmetry in 192 infants (gestational age ≤32.0 weeks) at TEA and 6 months corrected age (CA), (2) whether demographical, perinatal, and medical factors were predictors of the asymmetry, and (3) differences in motor maturation between infants with and without asymmetry. METHODS In a retrospective study, frequencies of idiopathic asymmetry and DP, putative predictors, and Alberta Infant Motor Scale scores at 6 months CA were abstracted and analyzed with Chi(2), Mann-Whitney, logistic regression and T-test. RESULTS The prevalence rate of a positional preference of the head at TEA was 44.8% (n=86), 10.4% (20/192) had a DP at TEA and 13% (25/192) at 6 months CA. Positional preference, multiple birth and male gender predicted the presence of DP (p<.05, odds ratio 3.0, 3.2, and 3.1 respectively). Gross motor maturity at 6 months CA was less developed in infants with a positional preference at TEA compared to preterm norms (p=0.01). CONCLUSIONS The high prevalence of a positional preference in infants born preterm at term equivalent age requires extra alertness to prevent the development of a deformational plagiocephaly, especially in boys and twins. Although, considering the lower prevalence of plagiocephaly at 6 months CA, therapists should be aware of over treating these infants.
Collapse
Affiliation(s)
- Jacqueline Nuysink
- Child Development and Exercise Center, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
31
|
Öhman A. The inter-rater and intra-rater reliability of a modified “severity scale for assessment of plagiocephaly” among physical therapists. Physiother Theory Pract 2011; 28:402-6. [DOI: 10.3109/09593985.2011.639850] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
32
|
Positional plagiocephaly: what the pediatrician needs to know. A review. Childs Nerv Syst 2011; 27:1867-76. [PMID: 21614494 DOI: 10.1007/s00381-011-1493-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Positional or deformational plagiocephaly is the most common type of cranial asymmetry in infancy and has become more prevalent after the introduction of the "Back to Sleep" campaign in Western countries. However, the supine position cannot be considered as the only etiologic factor and different predisposing variables have been investigated in the last few years. DISCUSSION The pediatrician should correctly diagnose this condition and exclude the possibility of craniosynostosis in any child with plagiocephaly in order to optimize management and reduce potential morbidity associated with different conditions other than positional ones. In addition, the pediatrician needs to be able to educate parents on methods to proactively decrease the likelihood of the development of occipital flattening, initiate appropriate management, and make referrals when necessary.
Collapse
|
33
|
Abstract
The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.
Collapse
|
34
|
Validation of Optical Three-Dimensional Plagiocephalometry by Computed Tomography, Direct Measurement, and Indirect Measurements Using Thermoplastic Bands. J Craniofac Surg 2011; 22:129-34. [PMID: 21187761 DOI: 10.1097/scs.0b013e3181f6f849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
35
|
Hankinson TC, Fontana EJ, Anderson RCE, Feldstein NA. Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes. J Neurosurg Pediatr 2010; 6:193-7. [PMID: 20672943 DOI: 10.3171/2010.5.peds09313] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The traditional reasons for surgical intervention in children with single-suture craniosynostosis (SSC) are cosmetic improvement and the avoidance/treatment of intracranial hypertension, which has been thought to contribute to neurocognitive deficits. Despite considerable work on the topic, the exact prevalence of intracranial hypertension in the population of patients with SSC is unknown, although it appears to be present in only a minority. Additionally, recent neuropsychological and anatomical literature suggests that the subtle neurocognitive deficits identified in children with a history of SSC may not result from external compression. They may instead reflect an underlying developmental condition that includes disordered primary CNS development and early suture fusion. This implies that current surgical techniques are unlikely to prevent neurocognitive deficits in patients with SSC. As such, the most common indication for surgical treatment in SSC is cosmetic, and most patients benefit from considerable subjective cosmetic normalization following surgery. Pediatric craniofacial surgeons have not, however, agreed upon objective means to assess postoperative cranial morphological improvement. We should therefore endeavor to agree upon objective craniometric tools for the assessment of operative outcomes, allowing us to accurately compare the various surgical techniques that are currently available.
Collapse
Affiliation(s)
- Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital of Alabama, University of Alabama, Birmingham, Alabama, USA.
| | | | | | | |
Collapse
|
36
|
BaS analysis: suggesting a new cephalometric model in follow-up of patients with craniostenosis who underwent craniofacial advancement surgery after 1 year from the end of the distraction protocol. J Craniofac Surg 2009; 20:895-8. [PMID: 19381100 DOI: 10.1097/scs.0b013e3181a2ef62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Evaluation of the relapse in patients with craniofacial malformation who underwent craniofacial advancement surgery is very difficult, and data are often unreliable. This is because common skeletal landmarks move from their original position, making standard cephalometries completely useless. To solve this problem, some authors proposed evaluations based on 2- and 3-dimensional computed tomographies, but the biologic risk and the economic outcome do not consent to repeat this kind of examination too often. In this paper, the authors propose a new cephalometric model based on the evaluation of facial skeletal landmarks on the BaS axis. This method, named BaS analysis, might be useful in evaluating improvements of the splanchnocranium in patients who underwent craniofacial advancement.
Collapse
|