Physical therapy is effective for deformational plagiocephaly

Background: Many infants with congenital muscular torticollis (CMT) have deformational plagiocephaly (DP), and a small cohort also demonstrate mandibular asymmetry (MA). The aim of this retrospective study was to evaluate mandibular changes in these infants with previous computed tomography (CT) scans who underwent physical therapy (PT) to treat CMT. Methods: A retrospective study included patients presenting to a pediatric plastic surgery clinic from December 2010 to June 2012 with CMT, DP, and MA. A small subset of these patients initially received a 3D CT scan due to concern for craniosynostosis. An even smaller subset of these patients subsequently received a second 3D CT scan to evaluate for late-onset craniosynostosis. Patients were treated with PT for at least 4 months for CMT. Initial CT scans were retrospectively compared to subsequent CT scans to determine ramal height asymmetry changes. Clinical documentation was reviewed for evidence of MA changes, CMT improvement, and duration of PT. Results: Ten patients met inclusion criteria. Ramal height ratio (affected/unaffected) on initial CT was 0.87, which significantly improved on subsequent CT to 0.93 ( P < .05). None of the patients were diagnosed with craniosynostosis on initial CT. One patient was diagnosed with late-onset coronal craniosynostosis on subsequent CT. Conclusions: We identified a small cohort of infants with MA, CMT, and DP. These patients uniformly demonstrated decreased ramal height ipsilateral to the affected sternocleidomastoid muscle. Ramal asymmetry measured by ramal height ratios improved in all infants undergoing PT.

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Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children With Positional Preference

Archives of Pediatrics and Adolescent Medicine ◽

10.1001/archpedi.162.8.712 ◽

2008 ◽

Vol 162 (8) ◽

pp. 712 ◽

Cited By ~ 80

Author(s):

Leo A. van Vlimmeren ◽

Yolanda van der Graaf ◽

Magda M. Boere-Boonekamp ◽

Monique P. L’Hoir ◽

Paul J. M. Helders ◽

...

Keyword(s):

Physical Therapy ◽

Deformational Plagiocephaly ◽

Positional Preference

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Asymmetry in infancy - the effect of pediatric physical therapy on the course of positional preference, deformational plagiocephaly and subsequent developmental delay

http://isrctn.org/> ◽

10.1186/isrctn84132771 ◽

2013 ◽

Author(s):

L.A. van Vlimmeren

Keyword(s):

Physical Therapy ◽

Developmental Delay ◽

Deformational Plagiocephaly ◽

Positional Preference

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Diagnosis and management of deformational plagiocephaly

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.1.peds08330 ◽

2009 ◽

Vol 3 (4) ◽

pp. 284-295 ◽

Cited By ~ 89

Author(s):

Shenandoah Robinson ◽

Mark Proctor

Keyword(s):

Physical Therapy ◽

Parental Education ◽

Well Being ◽

Class Ii ◽

Deformational Plagiocephaly ◽

Subsequent Increase ◽

Diagnosis And Management ◽

Healthy Infants ◽

Objective Evidence ◽

Life Threatening

Object The increase in the prevalence of nonsynostotic occipital deformational plagiocephaly in infants, which resulted from the American Academy of Pediatrics' 1992 recommendation to have healthy infants sleep supine, has been accompanied by significant controversy in diagnosis and management. The controversy was exacerbated by the 1998 FDA classification of cranial orthotic devices as Class II devices requiring premarket notification, and the subsequent increase in treatment-associated costs. Methods Two independent reviews of the literature were conducted to clarify the objective evidence available within the context of pediatric craniofacial knowledge. Results . Although deformational plagiocephaly is not a life-threatening problem, it is a source of disfigurement for children that may be detrimental to their well-being. Current methods for quantifying the degree of disfigurement have limited interrater reliability, and no prospective randomized controlled trials comparing the efficacy of cranial orthoses to repositioning and physical therapy protocols have been published. Despite this lack of Class I evidence, cranial orthoses are routinely and effectively used to treat persistent severe deformational plagiocephaly. The need for the current FDA regulations has not been supported by clinical experience and reported complications. Conclusions This review resulted in the following recommendations: 1) more parental education is needed to minimize the development and progression of deformational plagiocephaly; 2) mild deformity can be treated with repositioning and physical therapy protocols; and 3) severe deformity is likely to be corrected more quickly and effectively with cranial orthosis (when used during the appropriate period of infancy) than with repositioning and physical therapy. The available data do not support the need for FDA classification for cranial orthoses as Class II devices requiring premarket notification. Removal of the regulations, which centralized production of the orthoses to larger companies and markedly increased charges, will probably eliminate much of the controversy and parental anxiety generated by marketing strategies.

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