Estudio retrospectivo. Influencia de la Terapia Kinesiológica Temprana en el uso de Casco Modelador Craneal / Retrospective study. Influence of early physical therapy on the need to wear a skull molding helmet

Introducción. La plagiocefalia no sinostósica es una condición de salud caracterizada por una asimetría de cráneo que tiene diversas consecuencias en el desarrollo. Los principales tratamientos son la kinesioterapia y el casco de moldeado craneal (CMC). Objetivo. Evidenciar la influencia de la kinesioterapia temprana en la necesidad de usar casco modelador craneal. Métodos. Se realizó un estudio cuantitativo, descriptivo y retrospectivo en lactantes mayores de tres meses ingresados al Centro de Rehabilitación Integral de Carabineros (CRICAR) con diagnóstico confirmado de plagiocefalia mediante la técnica de craneometría. Se recopilaron datos de 39 pacientes diagnosticados con plagiocefalia, evaluados y tratados entre 2017 y 2019. Se dividieron en dos grupos, ingreso temprano (bajo los 5,5 meses de edad cronológica) e ingreso tardío (sobre los 5,5 meses de edad cronológica). Resultados. Al realizar un análisis bivariado, se obtuvo que 9 de 20 pacientes tuvieron que usar CMC en el grupo de ingreso tardío, y solo 4 de 19 pacientes en el grupo de ingreso temprano. Al contrastar la razón de riesgo de usar CMC en el grupo expuesto versus el grupo no expuesto se obtiene que es 3 veces mayor, sin embargo, esta diferencia no es estadísticamente significativa (OR=3.06, IC95% 0.6-16.8) Conclusiones. El principal resultado de este estudio es la disminución en la diferencia de diagonales evaluadas con craneometría. Además, se ha observado que en nuestra muestra el uso de CMC es tres veces mayor cuando el ingreso a terapia kinesiológica es tardío.

Introduction. Non-synostotic plagiocephaly is health condition characterized by a skull asymmetry that has various developmental consequences. The main treatments are kinesiotherapy and cranial molding helmet (CMH). The purpose of this study is to evidence the influence of early kinesiotherapy on the need to use CMH. Methods. A quantitative, descriptive and retrospective study of infants older than three months, admitted to the Carabineros Comprehensive Rehabilitation Center (CRICAR) since January 2017 with a confirmed diagnosis of plagiocephaly by craniometry technique was performed. Data were collected from 39 patients diagnosed with plagiocephaly, evaluated and treated between 2017 and 2019. They were divided into two groups, early admission (under 5.5 months of chronological age) and late admission (over 5.5 months of chronological age). Results. When performing a bivariate analysis, we obtained that 9 out of 20 patients had to use CMC in the late admission group, and only 4 out of 19 patients had to use it in the opposite group. When contrasting the oods ratio of using CMC in the exposed group versus the non-exposed group we obtain that it is 3 times higher, however, this difference is not statistically significant (OR=3.06, IC95% 0.6-16.8). Conclusions. The main result of this study is the decrease in the difference in diagonals assessed with craniometry. In addition, it has been observed that in our sample the use of CMC is three times higher when admission to physical therapy is late.

Effect of Sleeping Positions Guidance on Deformational Plagiocephaly and/or Brachycephaly in Prematures / 中国康复理论与实践

Objective To investigate the effect of sleep position guidance on deformational plagiocephaly and/or brachycephaly (DPB) in the prematures. Methods 321 preterm infants in neonatal intensive care unit from October, 2012 to September, 2015 were divided into sleep positions guidance group (n=159) and control group (n=162). The sleep positions guidance group accepted sleeping positions guidance when they were in neonatal intensive care unit and followed up in child care clinic, and the control group accepted routine treatment and nursing. The incidences of DPB were compared. Results The incidences of mild (χ2=6.591, P=0.010), moderate (χ2=4.862, P=0.027) and se-vere (χ2=11.261, P=0.001) DPB were less in the sleep positions guidance group than in the control group. Conclusion Sleeping positions guidance may reduce the incidence of DPB in prematures.

Analysis of Facial Asymmetry in Deformational Plagiocephaly Using Three-Dimensional Computed Tomographic Review

BACKGROUND: Infants with deformational plagiocephaly (DP) usually present with cranial vault deformities as well as facial asymmetry. The purpose of this study was to use three-dimensional anthropometric data to evaluate the influence of cranial deformities on facial asymmetry. METHODS: We analyzed three-dimensional computed tomography data for infants with DP (n=48) and without DP (n=30, control). Using 16 landmarks and 3 reference planes, 22 distance parameters and 2 angular parameters were compared. This cephalometric assessment focused on asymmetry of the orbits, nose, ears, maxilla, and mandible. We then assessed the correlation between 23 of the measurements and cranial vault asymmetry (CVA) for statistical significance using relative differences and correlation analysis. RESULTS: With the exception of few orbital asymmetry variables, most measurements indicated that the facial asymmetry was greater in infants with DP. Mandibular and nasal asymmetry was correlated highly with severity of CVA. Shortening of the ipsilateral mandibular body was particularly significant. There was no significant deformity in the maxilla or ear. CONCLUSION: This study demonstrated that the cranial vault deformity in DP is associated with facial asymmetry. Compared with the control group, the infants with DP were found to have prominent asymmetry of the nose and mandible.

Comparison of Helmet Therapy and Counter Positioning for Deformational Plagiocephaly

OBJECTIVE: To compare effectiveness on correcting cranial and ear asymmetry between helmet therapy and counter positioning for deformational plagiocephaly (DP). METHODS: Retrospective data of children diagnosed with DP who visited our clinic from November 2010 to October 2012 were reviewed. Subjects or =10 mm of diagonal difference were included for analysis. For DP treatment, information on both helmet therapy and counter positioning was given and either of the two was chosen by each family. Head circumference, cranial asymmetry measurements including diagonal difference, cranial vault asymmetry index, radial symmetry index, and ear shift were obtained by 3-dimensional head-surface laser scan at the time of initiation and termination of therapy. RESULTS: Twenty-seven subjects were included: 21 had helmet therapy and 6 underwent counter positioning. There was no significant difference of baseline characteristics, head circumferences and cranial asymmetry measurements at the initiation of therapy. The mean duration of therapy was 4.30+/-1.27 months in the helmet therapy group and 4.08+/-0.95 months in the counter positioning group (p=0.770). While cranial asymmetry measurements improved in both groups, significantly more improvement was observed with helmet therapy. There was no significant difference of the head circumference growth between the two groups at the end of therapy. CONCLUSION: Helmet therapy resulted in more favorable outcomes in correcting cranial and ear asymmetry than counter positioning on moderate to severe DP without compromising head growth.

A Simple Evaluation Method Using a "Sun-Wukong's Headband" Wire for Positional Plagiocephaly Correction after Cranial Remodeling Helmet Therapy

PURPOSE: A cranioremodeling helmet for correcting plagiocephaly was recently developed. However, no discrete objective methods to evaluate how the deformity is being corrected have been developed. We have established an easy and cost-effective method that can be used not only to show the correction process, but can also be used by physicians to assess the degree of plagiocephaly two-dimensionally. METHODS: For two-dimensional evaluation, a length of malleable memory wire (2 mm in diameter) resembling "Sun-Wukong's headband" was placed on the patient's head. The wire around the patient's head was positioned on a plane including points 1 cm above the eyebrow and 1 cm above the auricle. The wire was placed on a sheet of paper and the outline was marked using pens of various colors during each visit. The degree of plagiocephaly correction could then be shown to the patient's parents at every consultation. RESULTS: The method established by the present study easily shows the horizontal cross-section transformation of the head, illustrates plagiocephaly correction by the helmet, and shows the degree of correction in a two-dimensional manner. CONCLUSION: A soft-shell helmet is widely used for correcting plagiocephaly. However, evaluating the effectiveness of the helmet has been determined in a subjective manner, and a more objective method is now in demanded. Our study found that a "Sun-Wukong's headband" wire can accurately measure two-dimensional changes. Future studies will be required to identify landmarks needed for assessing plagiocephaly correction.