Positional plagiocephaly is associated with sternocleidomastoid muscle activation in healthy term infants.

PURPOSE: To explore the relationship between sternocleidomastoid activation and positional plagiocephaly in healthy full term infants. METHODS: Participants were 82 infants from a regionally based-longitudinal study of infant development. Sternocleidomastoid (SCM) activation was assessed using active head-righting responses of body-on-head with and against gravity and head-on-body against gravity at 3, 6 and 9 weeks. Plagiocephaly was assessed using the Modified Cranial Vault Asymmetry Index (mCVAI) at 9 weeks. RESULTS: More severe plagiocephaly was associated with more severe asymmetry in active head-righting responses at all ages (p < 0.001). Greater right-sided occipital flatness was related to stronger contralateral/left SCM activation at 3 and at 9 weeks (p = 0.008). Greater left-sided occipital flatness was related to stronger contralateral/right SCM activation at 3 weeks (p = 0.004). In infants with any right-sided occipital flatness, the mCVAI was greater in infants with asymmetrical gravity assisted body-on-head responses at 3 weeks (mCVAI = 4.31 (2.01)%, 95% CI 2.87-5.75) compared to those with symmetrical responses (mCVAI = 2.64 (1.66)%, 95% CI 2.06-3.22) (p = 0.011). CONCLUSIONS: Sternocleidomastoid activation asymmetry is a significant contributor to plagiocephaly development by 9 weeks of age due to stronger contralateral SCM activation. Active head-righting responses are appropriate to assess sternocleidomastoid activation in infants under 2 months of age.

Adapting to higher demands: using innovative methods to treat infants presenting with torticollis and plagiocephaly.

PURPOSE: Referrals for torticollis/plagiocephaly have increased dramatically because of "Back to Sleep" campaigns and front-line staff becoming more proficient at recognition and referral to physiotherapy. These infants generally respond well to early intervention so longer waitlists raise concern about clinical outcomes due to delay. METHODS: Therapists developed a group-based, team service delivery model based on best practices in individual treatment programs. The program was implemented and evaluated for assessment and treatment of infants presenting with these conditions, including caregiver satisfaction. RESULTS: Compared with individual treatment, the group format enabled therapists to increase capacity to serve this population by 70%, with equivalent quality and achievement of discharge criteria, as well as a modest service cost saving per child. Caregiver questionnaires indicate satisfaction with the service. CONCLUSIONS: Group service delivery is a cost-effective and efficient way to manage increased referrals for torticollis/plagiocephaly while maintaining comparable treatment outcomes. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A64.

[Correction of pronounced plagiocephaly with orthosis : results of a prospective follow-up control]. / Korrektur der ausgeprägten Plagiozephalie mittels Orthese : Ergebnisse einer prospektiven Verlaufskontrolle.

For the treatment of pronounced deformational plagiocephaly in infants different therapeutic options are under discussion in the literature. This article presents a prospective observational study of 45 infants enrolled with distinct plagiocephaly and treated with a custom-made helmet orthosis. Treatment with the helmet orthosis was indicated by a difference in the skull diagonals of more than 0.5 cm or a cranial vault asymmetry (CVA) index > 3.5. The follow-up results were controlled with the help of a mobile spatial laser scanner and the CVA index and the skull deformity were measured. The average duration of treatment was 131 days. The CVA index improved from 9.95 to a normal value of 3.35 (median) and the skull deformity improved from 1.3 cm to 0.5 cm (median). The only side effects observed were easily treatable pressure marks. The results of this study reveal that pronounced deformational plagiocephaly can be successfully treated with a custom-made helmet orthosis and closely controlled monitoring.