Skip to main content
SpringerLink
Log in

Helmet therapy efficacy and its prediction in Japanese infants with positional plagio- and brachycephaly

  • Research
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

To provide additional information on optimal start times and therapeutic effectiveness based on treatment outcome of Japanese infants with positional plagio- and brachycephaly (PPB) receiving cranial molding helmet therapy (CMHT).

Methods

In this retrospective cohort study, data from a 3D head scanning system was analyzed from 2173 Japanese infants who completed CMHT. Anterior and posterior symmetry ratio (ASR and PSR) and longitudinal to transverse diagonal ratios (LD/TDR) were calculated based on skull shape at helmet design and at completion of therapy. The outcomes were evaluated using the regression analysis and a predictive model using cranial parameters was developed.

Results

The earlier the start of therapy, the greater the therapeutic effect on ASR, PSR, and LD/TDR (ASR, −0.134 percent points (ppt)/day; PSR, −0.086 ppt/day; and LD/TDR, −0.131 ppt/day). In the predictive model, in addition to starting age of the therapy, sex (male), the degree of deformity of the head (DoD) (moderate and severe), quadrant volume, PSR, and head circumference at the start of treatment also had a positive effect on changes in ASR, DoD (moderate and severe), ASR, LD/TDR and transverse diameter for PSR, sex (male), DoD (moderate), quadrant volume, PSR, and head circumference for LD/TDR.

Conclusion

The starting age of therapy had a relatively smaller contribution to outcome effects. Applying the cranial parameter obtained at the start of treatment to the predictive model helps to predict the effect of CMHT and whether PPB can be treated with CMHT in infants of older age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Please contact Yasuo Aihara (yaihara@twmu.ac.jp) to request for the participant-level data of this study.

Abbreviations

ASR:

Anterior symmetry ratio

CMHT:

Cranial molding helmet therapy

DoD:

Degree of deformity of the head

HC:

Head circumference

LD:

Longitudinal diameter

LD/TDR:

Longitudinal to transverse diameter ratio

MSE:

Mean squared error

OSR:

Overall symmetry ratio = (ASR + PSR)/2

PPB:

Positional plagiocephaly and/or brachycephaly

PSR:

Posterior symmetry ratio

TD:

Transverse diameter

References

  1. Panchal J, Amirsheybani H, Gurwitch R, Cook V, Francel P, Neas B, Levine N (2001) Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg 108(6):1492–1500

    Article  CAS  PubMed  Google Scholar 

  2. Martiniuk AL, Vujovich-Dunn C, Park M, Yu W, Lucas BR (2017) Plagiocephaly and developmental delay: a systematic review. J Dev Behav Pediatr 38(1):67–78

    Article  PubMed  Google Scholar 

  3. Kluba S, Kraut W, Reinert S, Krimmel M (2011) What is the optimal time to start helmet therapy in positional plagiocephaly? Plast Reconstr Surg 128(2):492–498

    Article  CAS  PubMed  Google Scholar 

  4. Biggs WS (2003) Diagnosis and management of positional head deformity. Am Fam Physician 67(9):1953–1956

    PubMed  Google Scholar 

  5. Mortenson P, Steinbok P, Smith D (2012) Deformational plagiocephaly and orthotic treatment: indications and limitations. Childs Nerv Syst 28(9):1407–1412

    Article  PubMed  Google Scholar 

  6. Kawaguchi Y, Matsushita A, Kawai T, Furuta S (1980) Handlings of infants with oblique posture. Orthop Traumatol 29(2):197–201

    Article  Google Scholar 

  7. Tamber MS, Nikas D, Beier A et al (2016) Guidelines: congress of neurological surgeons systematic review and evidence–based guideline on the role of cranial molding orthosis (helmet) therapy for patients with positional plagiocephaly. Neurosurg 79(5):E632–E633

    Article  Google Scholar 

  8. Willinger M, Hoffman HJ, Hartford RB (1994) Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda. MD Pediatrics 93(5):814–819

    Article  CAS  PubMed  Google Scholar 

  9. Argenta LC, David LR, Wilson JA, Bell WO (1996) An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 7(1):5–11

    Article  CAS  PubMed  Google Scholar 

  10. Aihara Y, Komatsu K, Dairoku H, Kubo O, Hori T, Okada Y (2014) Cranial molding helmet therapy and establishment of practical criteria for management in Asian infant positional head deformity. Childs Nerv Syst 30(9):1499–1509

    Article  PubMed  Google Scholar 

  11. Lam S, Pan IW, Strickland BA, Hadley C, Daniels B, Brookshier J, Luerssen TG (2017) Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience. J Neurosurg Pediatr 19(3):273–281

    Article  PubMed  Google Scholar 

  12. Kelly KM, Littlefield TR, Pomatto JK, Manwaring KH, Beals SP (1999) Cranial growth unrestricted during treatment of deformational plagiocephaly. Pediatr Neurosurg 30(4):193–199

    Article  CAS  PubMed  Google Scholar 

  13. Çevik S, Işık S, Özkılıç A (2020) The role of age on helmet therapy in deformational plagiocephaly and asymmetric brachycephaly. Childs Nerv Syst 36(4):803–810

    Article  PubMed  Google Scholar 

  14. Kim HY, Chung YK, Kim YO (2014) Effectiveness of helmet cranial remodeling in older infants with positional plagiocephaly. Arch Craniofac Surg 15(2):47–52

    Article  PubMed  PubMed Central  Google Scholar 

  15. Littlefield TR, Pomatto JK, Kelly KM (2000) Dynamic orthotic cranioplasty: treatment of the older infant. Report of four cases Neurosurg Focus 9(3):e5

    CAS  PubMed  Google Scholar 

  16. Kim DG, Lee JS, Lee JW, Yang JD, Chung HY, Cho BC, Choi KY. (2019) The effects of helmet therapy relative to the size of the anterior fontanelle in nonsynostotic plagiocephaly: a retrospective study. J Clin Med 8(11):1977. https://www.mdpi.com/2077-0383/8/11/1977

  17. Wendling-Keim DS, Macé Y, Lochbihler H, Dietz HG, Lehner M (2020) A new parameter for the management of positional plagiocephaly: the size of the anterior fontanelle matters. Childs Nerv Syst 36(2):363–371

    Article  PubMed  Google Scholar 

  18. Kim MJ, Kang MK, Deslivia MF, Kim YO, Choi JW (2020) Applicative factors of helmet molding therapy in late-diagnosed positional plagiocephaly. J Korean Med Sci 35(36):e295

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hauc SC, Long AS, Rivera JC, Ihnat J, Littlefield TR, Shah HP et al (2023) Predictive factors of outcomes in helmet therapy for deformational plagiocephaly and brachycephaly. J Craniofac Surg 34(1):231–234

    Article  PubMed  Google Scholar 

  20. Richards, CJ, Petz AM, Vallery CE, Yosef M, Khalatbari SH, Frank CJ, Richards JA (2023) Success rates of cranial remolding orthosis treatment of plagiocephaly based on initial presentation. J Prosthet Orthot. https://doi.org/10.1097/JPO.0000000000000481. https://journals.lww.com/jpojournal/abstract/9900/success_rates_of_cranial_remolding_orthosis.43.aspx

  21. Graham T, Wang J (2022) Development and validation of a prediction model for the treatment time of deformational head shapes using a cranial remolding orthosis. Children (Basel) 9(3):354

    PubMed  Google Scholar 

  22. Clarren SK, Smith DW, Hanson JW (1979) Helmet treatment for plagiocephaly and congenital muscular torticollis. J Pediatr 94(1):43–46

    Article  CAS  PubMed  Google Scholar 

  23. Leung A, Mandrusiak A, Watter P, Gavranich J, Johnston L (2017) Positional plagiocephaly is associated with sternocleidomastoid muscle activation in healthy term infants. Childs Nerv Syst 33(4):617–624

    Article  PubMed  Google Scholar 

  24. Binder H, Eng GD, Gaiser JF, Koch B (1987) Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil 68(4):222–225

    CAS  PubMed  Google Scholar 

  25. Kluba S, Roßkopf F, Kraut W, Peters JP, Calgeer B, Reinert S, Krimmel M (2016) Malocclusion in the primary dentition in children with and without deformational plagiocephaly. Clin Oral Investig 20(9):2395–2401

    Article  PubMed  Google Scholar 

  26. Moavero R, Papetti L, Bernucci MC, Cenci C, Ferilli MA, Sforza G, Vigevano F, Valeriani M (2019) Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a high risk of developing primary headache: a longitudinal study. Cephalalgia 39(10):1236–1240

    Article  PubMed  Google Scholar 

  27. Cabrera-Martos I, Valenza MC, Valenza-Demet G, Benítez-Feliponi Á, Robles-Vizcaíno C, Ruiz-Extremera Á (2016) Repercussions of plagiocephaly on posture, muscle flexibility and balance in children aged 3–5 years old. J Paediatr Child Health 52(5):541–546

    Article  PubMed  Google Scholar 

  28. Wynne-Davies R (1975) Infantile idiopathic scoliosis. Causative factors, particularly in the first six months of life. J Bone Joint Surg Br 57(2):138–141

    Article  CAS  PubMed  Google Scholar 

  29. Kelly KM, Littlefield TR, Pomatto JK, Ripley CE, Beals SP, Joganic EF (1999) Importance of early recognition and treatment of deformational plagiocephaly with orthotic cranioplasty. Cleft Palate Craniofac J 36(2):127–130

    Article  CAS  PubMed  Google Scholar 

  30. R Core Team (2021) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria

Download references

Acknowledgements

We thank for the radiological technologists, nurses, and staff of Departments of Neurosurgery, Tokyo Women’s Medical University, in preparing this paper.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Yasuo Aihara, Kentaro Chiba & Takakazu Kawamata

Authors
  1. Yasuo Aihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kentaro Chiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takakazu Kawamata
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Aihara wrote the main manuscript text and Dr. Chiba prepared figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to Yasuo Aihara.

Ethics declarations

Ethics approval and consent to participate

This study was conducted after being approved by the Ethics Committee of Tokyo Women’s Medical University (Approval No. 2773). Because this study was conducted with infants, a written consent to participate in this study was obtained from parents or guardians of all of them.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aihara, Y., Chiba, K. & Kawamata, T. Helmet therapy efficacy and its prediction in Japanese infants with positional plagio- and brachycephaly. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06370-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00381-024-06370-3

Keywords

Search

Navigation