Restoration of Symmetry in Infants with Positional Plagiocephaly: Collaborative Program Combining Helmet Therapy with Physiotherapy

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Authors (including presenting author) :
Chen TMK(1),Au MK(1),Chan VWM(1),Chau RMW (1),Lai HYH(2),CHENG BFC(2),Chung DKW(2),Yip PSC(3),Wong JKF(3)
Affiliation :
(1)Physiotherapy Department, Kowloon Hospital, (2)Prosthetic & Orthotic Department, Kowloon Hospital, (3)Orthopaedic and Traumatology Department, Queen Elizabeth Hospital
Introduction :
Positional plagiocephaly(PP) is a deformation disorder of the skull, resulting in a parallelogram appearance of the head in overhead view. Prevalence reported among infants is 13%-28%. These infants have head positional preference and craniofacial asymmetry may progress over early months when infants lie supine predominately. Besides cosmetic concern, ear and eye misalignment in space resulted in ocular and vestibular impairment. The consequential sensorimotor disturbances lead to persistent functional asymmetry. PP has high comorbidity with congenital muscular torticollis(CMT) and physiotherapy is the first-line treatment. To further enhance treatment outcome for infants with moderate-to-severe PP, a pilot multi-disciplinary program was set up to introduce skull-molding helmet along with current physiotherapy management in July 2018. Helmet therapy aims to provide cushion, preventing excessive pressure on affected parts of the skull and promote bone expanding into the flat areas as infant head grows.
Objectives :
1)To develop a multi-disciplinary program for infants with PP, combining skull-molding helmet with physiotherapy.2)To describe the characteristics of infants with PP and treatment outcomes of the program.
Methodology :
This pilot program was started in Jul 2018. Infants with CMT attending out-patient physiotherapy were assessed by physiotherapist on asymmetry in craniofacial shape, posture, movement and morphologic changes in the sternocleidomastoid muscle. Furthermore, generalized functional asymmetry of the body and limbs in response to visual, auditory, somatosensory stimulations were evaluated. Infants with moderate-to-severe PP were referred to the Paediatric Orthopaedic Clinic for joint multidisciplinary consultation and recruitment. Custom-made skull molding helmet was provided to infant by Prosthetist-Orthotist using CAD/CAM system(Computer-Aided-Design/Computer-Aided-Manufacture).
Result & Outcome :
8 infants were recruited till date. There were 7 males, 1 girl. Side of plagiocephaly was left(4) and right(4). Their diagnosis was torticollis(7) and prematurity(1). The average age at start of physiotherapy and helmet therapy were 3.1 months(0.5-8.7) and 6.0 months(4.6-10.1) respectively. Their average score of ?everity Assessment for Plagiocephaly??was 9.1(7-11/15). All were observed to have head positional preference, ear and eye orbit displacement, asymmetrical mandible, visual focus and hand regard. One unanticipated finding was that all infants have thick upper labrial frenulum and lingual frenulum. The preliminary results of this pilot program showed improving symmetry in above asymmetries listed. This pilot program provides a promising local management approach in restoring cosmetics, averting sensorimotor disturbances and promoting symmetrical functioning of infants with PP.

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