Child's Nervous System

, Volume 34, Issue 3, pp 503–510 | Cite as

Does shape affect function? Articulatory skills in babbling of infants with deformational plagiocephaly

  • Christian Linz
  • Tilmann SchweitzerEmail author
  • Lisa C. Brenner
  • Felix Kunz
  • Philipp Meyer-Marcotty
  • Kathleen Wermke
Original Paper



The purpose of this study was to quantitatively analyse pre-speech/early language skills in healthy full-term infants with moderate or severe deformational plagiocephaly (DP) and in infants without any skull asymmetry.


At 6 and 12 months, 51 children with DP (41 moderate, 10 severe cases) were studied, along with 15 infants serving as control. Deformational plagiocephaly (DP) was objectively determined based on cranial vault asymmetry (CVA) using 3D stereophotogrammetry (3dMDhead System® and Analytics 4.0, Cranioform®). Articulatory skills in babbling were assessed using the articulatory skill (ART-index) and mean syllable number (MSN). At 12 months, standardized parental questionnaires were used to evaluate early language outcomes.


Overall, 3546 vocalizations were studied. Statistical tests did not reveal any significant differences of the ART-index between the three groups (ANOVA, F[2,63] = 0.24, p = 0.24). MSN likewise did not differ between the three shape groups (Kruskal-Wallis, p = 0.84). Among the children assigned to the at-risk group for language outcomes at 12 months were seven members of the symmetrical shape group (vs. seven assigned to the normally developing group), nine of the moderate DP group (vs. 27), and one of the severe DP group (vs. six). Fisher’s exact test was used to analyse whether helmet therapy in the moderate DP group affected the results by influencing language outcomes, but did not reveal any significant influence (p = 0.712).


The results of this study do not support arguments suggesting that DP is a cognitive risk condition. The suggestion that a direct neurophysiological relationship exists between a DP condition and a cognitive developmental delay remains controversial.


Pre-speech development Language 3D skull imaging Cranial vault asymmetry 



This research is the first part of ongoing longitudinal studies within the research profile of the Craniofacial Center (CFCW) at the University Clinic Würzburg. We are particularly thankful for the support of the heads of the involved departments: Prof. Dr. A. Stellzig-Eisenhauer (Dept. of Orthodontics), Prof. Dr. Dr. A. Kübler (Dept. of Oral and Maxillofacial Plastic Surgery), Dr. J. Kraus (Dept. of Neurosurgery, Section of Pediatric Neurosurgery), and Prof. Dr. R.-I. Ernestus (Dept. of Neurosurgery). We are also grateful to Dr. Dr. H. Böhm (member of the CFCW) and Sandra Habel for their assistance in the study. We would also like to thank the infants and their parents for voluntarily taking part in this research.

Funding information

This study has been funded by a research grant from the Interdisciplinary Center for Clinical Research (IZKF), University Hospital of Würzburg (F-164).

Compliance with ethical standards

The study was approved by the local research ethics committee (143/09). All the parents gave their informed consent to this longitudinal research and to the publication of the results.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Christian Linz
    • 1
  • Tilmann Schweitzer
    • 2
    Email author
  • Lisa C. Brenner
    • 3
  • Felix Kunz
    • 4
  • Philipp Meyer-Marcotty
    • 4
    • 5
  • Kathleen Wermke
    • 3
  1. 1.Department of Oral and Maxillofacial Plastic SurgeryUniversity Hospital WürzburgWurzburgGermany
  2. 2.Department of Neurosurgery, Section of Pediatric NeurosurgeryUniversity Hospital WürzburgWurzburgGermany
  3. 3.Department of Orthodontics, Center for Prespeech Development & Developmental DisordersUniversity Hospital WürzburgWurzburgGermany
  4. 4.Department of OrthodonticsUniversity Hospital of WürzburgWurzburgGermany
  5. 5.Department of OrthodonticsUniversity Medical CenterGoettingenGermany

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