Active counterpositioning or orthotic device to treat positional plagiocephaly?
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Published on: February 5, 2019
1School of Medicine, University of Auckland, New Zealand. silas@xtra.co.nz
Insights
Active counterpositioning and orthotic helmets effectively treat positional plagiocephaly. Orthotic helmets offer comparable outcomes to active counterpositioning but in a significantly shorter treatment duration.
Area of Science:
- Pediatrics
- Orthopedics
- Neurosurgery
Background:
- Positional plagiocephaly is a common condition in infants.
- Nonsurgical management options include active counterpositioning and orthotic helmets.
Purpose of the Study:
- To compare the efficacy and duration of active counterpositioning versus orthotic helmet treatment for positional plagiocephaly.
Main Methods:
- A randomized sample of infants with positional plagiocephaly was assessed.
- Two-dimensional head tracings were used to calculate Cranial Index and Cranial Vault Asymmetry Index.
- Infants were managed with either active counterpositioning or orthotic helmets.
Main Results:
- 74 infants were included in the study.
- Active counterpositioning management averaged 63.7 weeks, while orthotic helmet treatment averaged 21.9 weeks.
- Both methods showed comparable improvements in Cranial Vault Asymmetry Index (1.9% vs. 1.8%).
Conclusions:
- Orthotic helmets provide comparable outcomes to active counterpositioning for positional plagiocephaly.
- Orthotic helmet treatment is approximately three times shorter than active counterpositioning.
- Active counterpositioning may yield slightly better long-term outcomes.
Abstract:
Active counterpositioning and orthotic helmets are the two main nonsurgical management options for positional plagiocephaly. The purpose of this study was to compare these two management regimens. We included a random sample of infants referred between January 1, 1998 and October 31, 1999 to Middlemore Hospital and Auckland Surgical Center, for management of positional plagiocephaly. Two-dimensional head tracings were taken for each infant, every 3 to 12 months. From these tracings, we obtained Cranial Index and Cranial Vault Asymmetry Index. Seventy-nine infants were assessed during an average of 48.2 weeks. Five infants had normal head tracings, and were therefore excluded from the study. Of the 74 infants included in this study, 45 were managed with active counterpositioning, and 29 with orthotic helmets. Average management time for active counterpositioning was 63.7 weeks, and 21.9 weeks for orthotic helmet treatment. For infants managed with active counterpositioning, the average change in Cranial Vault Asymmetry Index was 1.9%. In the orthotic group, average change in Cranial Vault Asymmetry Index was 1.8%. Orthotic helmets have an outcome comparable to that of active counterpositioning, although the management period is approximately three times shorter. Active counterpositioning generally had a slightly better outcome than orthotic management after the management period.