Effectiveness of osteopathic care in the treatment of infant positional posterior plagiocephaly

Introduction. Posterior Positional plagiocephaly (PPP) is a cranial deformation seen in infants. The case number increased since 1992, following the supine sleeping advice. Most of the time several factors are combining together, leading to a multi-level lack of mobility of the infant, thus leading to the cranial deformation. Studies show this deformation to be linked with perturbations in various fields.Objective. This study aims to assess the efficacy of osteopathic care on the severity of the PPP.Materials and methods. 100 infants were recruited in an osteopathic practice in Lyon (France). All the infants followed the same study protocol; however, the treatment was individualized. Three consultations occurred with a 15 days′ interval over 30 days′ period. Craniometric measurements were realized with Mimos® craniometer on each consultation.Results. The mean severity of the PPP was 10,1 mm at Day 0. At day 30, this average was down to 6 mm. It is a significant (p<0,001) clinical and statistical decrease. Out of the 100 infants, 98 had a decreased deformation while two stagnated.Conclusions. As every infant is unique, every plagiocephaly is different, thus the treatment was not standardised. This study suggest some effectiveness for osteopathic care in the cranial asymmetry of infants with PPP. Other studies should be done, some with a control group, in order to compare our results with spontaneous evolution of plagiocaphaly.

Variation in cranial asymmetry among the Delphinoidea

The remarkable directional cranial asymmetry of odontocete skulls has been proposed to be related to sound production. We investigated the variation in quality and quantity of cranial asymmetry in the superfamily Delphinoidea using geometric morphometrics and then investigated the relationship between asymmetry and aspects of sound production. In the average asymmetric shape, the dorsal aspect of the skull outline and interparietal suture crest were displaced to the right, while the nasal septum, nasal bones and right premaxilla were displaced to the left. The nasal bone, premaxilla and maxilla were all larger on the right side. Three delphinoid families presented similar expressions of asymmetry; however, the magnitude of the asymmetry varied. The Monodontidae showed the greatest magnitude of asymmetry, whereas the Phocoenidae were much less asymmetric. The most speciose family, the Delphinidae, presented a wide spectrum of asymmetry, with globicephalines and lissodelphinines among the most and least asymmetric species, respectively. Generalized linear models explaining the magnitude of asymmetry with characteristics of echolocation clicks, habitat use and size revealed associations with source level, dive depth and centroid size. This supports a relationship between asymmetry and sound production, with more asymmetric species emitting louder sounds. For example, louder clicks would be beneficial for prey detection at longer ranges in deeper waters.

Interrater and Intrarater Reliability of Cranial Anthropometric Measurements in Infants with Positional Plagiocephaly

(1) Background: anthropometric measurements with calipers are used to objectify cranial asymmetry in positional plagiocephaly but there is controversy regarding the reliability of different methodologies. Purpose: to analyze the interrater and intrarater reliability of direct anthropometric measurements with caliper on defined craniofacial references in infants with positional plagiocephaly. (2) Methods: 62 subjects (<28 weeks), with a difference of at least 5 mm between cranial diagonal diameters. Maximal cranial circumference, length and width and diagonal cranial diameters were measured. Intrarater (2 measurements) and interrater (2 raters) reliability was analyzed. (3) Results: intra- and interrater reliability of the maximal cranial length and width and right cranial diagonal was excellent: intraclass correlation coefficient (ICC) > 0.9. Intrarater and interrater reliability for the left cranial diagonal was excellent: ICC > 0.9 and difference in agreement in the Bland-Altman plot 0.0 mm, respectively. Intrarater and interrater reliability for the maximal cranial circumference was good: differences in agreement in Bland-Altman plots: intra: −0.03 cm; inter: −0.12 cm. (4) Conclusions: anthropometric measurements in a sample of infants with moderate positional plagiocephaly have shown excellent intra- and interrater reliability for maximal cranial length, maximal cranial width, and right and left cranial diagonals, and good intra- and interrater reliability in maximal cranial circumference measurement.

Nonsynostotic Plagiocephaly: Prevention Strategies in Child Health Care

The dissertation, comprising a clinical intervention and three supporting studies, aimed to assess if it is possible to prevent nonsynostotic plagiocephaly while promoting safe infant sleeping practices. Five individuals were trained to assess cranial asymmetry and then reliability-tested; the interpreted results indicate substantial strength of rater-agreement. Intervention participants were allocated to group. Only intervention group nurses participated in the continuing education on plagiocephaly developed for nurses. A survey compared information intervention and control group parents received from nurses; intervention group parents were significantly more aware of recommendations than the controls. Nurse education was evaluated by asking intervention and control group nurses and parents two open-ended questions; the intervention group reported new re-positioning strategies. The effect of the intervention on cranial shape was evaluated by assessing asymmetry at 2, 4, and 12 months (176 intervention group; 92 controls). It was nine times more common that cranial asymmetry at two months reversed by four months when parents were aware of written recommendations from their nurse (OR = 9.09 [0.02; 0.48], p = 0.004) when adjusted for group. An infant’s risk of asymmetry persisting until 12 months was significantly reduced in the intervention group (RR = 0.35 [0.13; 0.94], p = 0.03). Preventing brachycephaly was difficult. Conclusions: the assessors were considered reliable; educating nurses promoted the integration of new recommendations in practice; the intervention was associated with early reversal of nonsynostotic plagiocephaly.

Functional skull asymmetries in Carollia perspicillata (Phyllostomidae Gray, 1825: Carollinae)

Analysing asymmetry in wild or domestic species enables the evaluation of the morphological responses to functional requirements and/or stress. This report is a study of the cranial asymmetry of Seba's short-tailed bat Carollia perspicillata by means of geometric morphometric techniques. We studied three types of bilateral asymmetries -fluctuating asymmetry, directional asymmetry and antisymmetry- using 15 skull landmarks on dorsal aspect of 45 skulls of Carollia perspicillata (21 males and 24 females) from different localities in Colombia. Directional asymmetry appeared to be significant and clearly higher than fluctuating asymmetry, with the braincase presenting the larger variance. There were no differences between sexes. Echolocation has a great anatomical effect on the bat cranium, and this would explain detected asymmetry.