Use of orthotic helmets in children with positional plagiocephaly and brachycephaly: a systematic review
Amauri Dalla Corte1, Marcelo Anchieta Rohde2
1School of Medicine, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo (RS), Brazil.
Insights
Helmet therapy (cranial orthotics) is safe and effective for moderate to severe positional plagiocephaly and brachycephaly in infants when initiated early. Individualized treatment decisions are crucial, considering deformity severity and patient age.
Area of Science:
- Pediatric neurosurgery
- Developmental pediatrics
- Orthotics and prosthetics
Background:
- Positional plagiocephaly (PP) and brachycephaly are common cranial deformities in infants.
- Early intervention is key for effective treatment of these conditions.
Purpose of the Study:
- To systematically review the evidence on the efficacy and safety of cranial orthotic therapy (helmet therapy) for infants with moderate to severe positional plagiocephaly and brachycephaly.
Main Methods:
- A systematic review of PubMed, EMBASE, and Cochrane databases was conducted.
- Searches included regulatory agency repositories for relevant notifications.
Main Results:
- Repositioning therapy is effective for mild to moderate cases.
- Physical therapy, especially manual therapy with caregiver counseling, shows superior outcomes for non-synostotic asymmetry.
- Helmet therapy is recommended for moderate to severe deformities, with better outcomes when initiated in early infancy.
Conclusions:
- Helmet therapy is safe and effective for moderate to severe positional plagiocephaly/brachycephaly, particularly when started early.
- Methodological limitations exist in current studies.
- Treatment decisions should be individualized based on deformity severity, age, and response to other therapies.
Purpose:
This review aims to evaluate the scientific evidence on the efficacy and safety of cranial orthotic therapy (helmet therapy) in children under 12 months with moderate to severe posicional plagiocephaly and brachycephaly.
Methods:
A systematic review was performed in PubMed, EMBASE, and Cochrane databases. Additional searches were conducted in regulatory agency repositories for relevant notifications.
Results:
A total of 19 studies were included in the review, assessing various treatment modalities for PP. Repositioning therapy demonstrated effectiveness in reducing cranial asymmetry for mild to moderate cases, but several studies (class I and II evidence) indicated that it was less effective than both physical therapy and helmet use. Physical therapy, particularly manual therapy combined with caregiver counseling, showed superior outcomes for non-synostotic cranial asymmetry. Helmet therapy was consistently recommended for infants with moderate to severe deformities, with better outcomes when initiated during early infancy.
Conclusion:
Helmet therapy is safe and effective for specific cases, especially moderate to severe PP or brachycephaly, with improved results when started early. However, available studies have methodological limitations, and the decision to use helmet therapy should be individualized, considering the severity of the deformity, patient age, and response to other treatments.
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