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Significant Factors in Cranial Remolding Orthotic Treatment of Asymmetrical Brachycephaly
Tiffany Graham1, Kelly Millay1, Jijia Wang2
1Health Care Sciences, Prosthetics-Orthotics Program, University of Texas Southwestern Medical Center,6011 Harry Hines Blvd, Dallas, TX 75390-9091, USA.
Insights
Early cranial remolding orthosis (CRO) treatment is most effective for infants with asymmetrical brachycephaly. Younger infants and those with less severe cranial index (CI) values achieve better head shape correction.
Area of Science:
- Pediatric orthopedics
- Craniofacial abnormalities
- Infant development
Background:
- Asymmetrical brachycephaly is a common condition in infants.
- Cranial remolding orthosis (CRO) is a treatment option for positional plagiocephaly.
- Determining optimal timing for CRO intervention is crucial for successful outcomes.
Purpose of the Study:
- To identify the most effective age for initiating cranial remolding orthosis (CRO) treatment in infants diagnosed with asymmetrical brachycephaly.
- To evaluate the influence of initial cranial measurements and patient factors on treatment success.
Main Methods:
- Retrospective chart review of infants with asymmetrical brachycephaly treated with CRO.
- Inclusion criteria: age 3-18 months, cranial vault asymmetry index (CVAI) ≥ 3.5, cranial index (CI) ≥ 90.
- Exclusion criteria: comorbidities, treatment dropout, loss to follow-up, noncompliance.
Main Results:
- Younger treatment initiation age, lower initial CVAI, and lower initial CI were statistically significant predictors of successful head shape correction.
- Initial CI was a stronger predictor of correction than initial CVAI.
- Prematurity and torticollis did not significantly affect treatment outcomes.
Conclusions:
- Infants with asymmetrical brachycephaly should commence CRO treatment as early as possible for optimal correction.
- Less severe initial cranial index (CI) values correlate with a higher likelihood of achieving full correction.
- Early intervention maximizes the potential for successful treatment of this condition.
Abstract:
This retrospective chart review focuses on determining the most effective time to begin cranial remolding orthosis (CRO) treatment for infants with asymmetrical brachycephaly. Subjects with asymmetrical brachycephaly started CRO treatment between 3 and 18 months of age. These infants had a cranial vault asymmetry index (CVAI) ≥ 3.5 and a cranial index (CI) ≥ 90. Subjects were excluded if they had any comorbidities affecting growth, dropped out of treatment, were lost to follow-up, or were noncompliant. Factors which were found to statistically influence treatment outcomes were subject initial age, initial CVAI, and initial CI. Overall, younger subjects were more likely to achieve a corrected head shape. The presence of prematurity or torticollis had statistically nonsignificant effects on the success of treatment. Initial CI was found to be a stronger predictor than initial CVAI as to which subjects achieved correction. The less severe the starting CI, the more likely the subject was to achieve full correction. The clinical understanding is that it requires more cranial growth to "round out" a full posterior skull flattening than an asymmetry. Based on the study results, infants with asymmetrical brachycephaly should be treated as early as possible to increase chances of achieving full correction of the deformity.
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