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

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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Response to Pediatric Physical Therapy in Infants With Positional Preference and Skull Deformation

Physical Therapy ◽

10.2522/ptj.20130304 ◽

2014 ◽

Vol 94 (9) ◽

pp. 1262-1271 ◽

Cited By ~ 6

Author(s):

Renske M. van Wijk ◽

Maaike Pelsma ◽

Catharina G.M. Groothuis-Oudshoorn ◽

Maarten J. IJzerman ◽

Leo A. van Vlimmeren ◽

...

Keyword(s):

Logistic Regression ◽

Physical Therapy ◽

Poor Response ◽

Parental Satisfaction ◽

Response To Therapy ◽

Satisfaction Score ◽

Multiple Logistic Regression ◽

Study Objective ◽

Positional Preference ◽

Skull Deformation

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.

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The Otteroo: A Case Series Exploring Its Potential to Support Physical Therapy Intervention in Infants with or at Risk for Developmental Delay

Healthcare ◽

10.3390/healthcare9020109 ◽

2021 ◽

Vol 9 (2) ◽

pp. 109

Author(s):

Isabel Reed ◽

Stacy Menz ◽

Beth A. Smith

Keyword(s):

At Risk ◽

Physical Therapy ◽

Developmental Delay ◽

Case Series ◽

Exercise Program ◽

Home Exercise ◽

Future Research ◽

Survey Responses ◽

Therapy Intervention ◽

Physical Therapy Intervention

The objective of this case series was to examine the potential of the Otteroo as a tool to support physical therapy intervention in infants with or at risk for developmental disability. The Otteroo is a float with potential for use in aquatic therapy sessions or as part of a home exercise program. By tracking the amount of use and caregiver perception of the child’s response, we aimed to generate an understanding of the Otteroo’s potential as a family-based adjunct to physical therapy. Four children at risk of developmental delay participated in this study. The Otteroo was provided for four weeks, with recommendations for use. We used an activity log to track usage and collected survey data of caregiver perception of the child’s response. Activity logs showed that use ranged from 3–7 interactions and a total of 40–99.5 min (x¯ = 54.88, SD = 29.75). The survey responses varied as to whether caregivers perceived their children enjoyed the experience. Future research should focus on finding effective methods of encouraging Otteroo use if efficacy of an intervention is to be tested. This initial work provides a foundation for future efficacy research with the Otteroo in children with or at risk for developmental delay.

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Assessment of Deformational Plagiocephaly Severity and Neonatal Developmental Delay

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000003014 ◽

2016 ◽

Vol 27 (8) ◽

pp. 1934-1936 ◽

Cited By ~ 8

Author(s):

Stefani C. Fontana ◽

Debora Daniels ◽

Thomas Greaves ◽

Niaman Nazir ◽

Jeff Searl ◽

...

Keyword(s):

Developmental Delay ◽

Deformational Plagiocephaly

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Physical therapy is effective for deformational plagiocephaly

The Journal of Pediatrics ◽

10.1016/j.jpeds.2008.10.027 ◽

2009 ◽

Vol 154 (1) ◽

pp. 152-153

Author(s):

Brett Robbins

Keyword(s):

Physical Therapy ◽

Deformational Plagiocephaly

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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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