Research and Literature

Cranial Technologies remains involved in the cutting edge of research for the prevention and treatment of plagiocephaly. Our researchers have been published extensively in peer-review medical journals, and present papers at national and international medical meetings. Cranial Technologies maintains the largest database on deformational plagiocephaly in the world and also funds research studies investigating the cause and prevention of plagiocephaly.

Cranial Technologies initially began conducting research in the mid-1990s in response to the lack of significant research on the topic available at that time. Cranial Technologies’ research efforts increased when the DOC Band became the first cranial orthosis to undergo the FDA approval process. Since there weren’t any other FDA-cleared products on the market at that time, extensive research was needed to prove the necessity, safety and treatment outcomes of the DOC Band®. Many competitive cranial orthotic products on the market today are able to exist thanks to Cranial Technologies’ research efforts.

A recent study looks at the effectiveness of the DOC Band for treatment of moderate and severe brachycephaly; see full article here.

A recent letter published in the AAP News, the official news magazine of the American Academy of Pediatrics, shares feedback on a recent European study. AAP News 2014;35;5

The incidence of positional plagiocephaly: a cohort study.

Pediatrics. 2013 Aug;132(2):298-304. doi: 10.1542/peds.2012-3438. Epub 2013 Jul 8.
Mawji A, Vollman AR, Hatfield J, McNeil DA, Sauve R.

Objective: The objective of this study was to estimate the incidence of positional plagiocephaly in infants 7 to 12 weeks of age who attend the 2-month well-child clinic in Calgary, Alberta, Canada.

Methods: A prospective cohort design was used to recruit 440 healthy full-term infants (born at ≥37 weeks of gestation) who presented at 2-month well-child clinics for public health nursing services (eg, immunization) in the city of Calgary, Alberta. The study was completed in 4 community health centers (CHCs) from July to September 2010. The CHCs were selected based on their location, each CHC representing 1 quadrant of the city. Argenta’s (2004) plagiocephaly assessment tool was used to identify the presence or absence of plagiocephaly.

Results: Of the 440 infants assessed, 205 were observed to have some form of plagiocephaly. The incidence of plagiocephaly in infants at 7 to 12 weeks of age was estimated to be 46.6%. Of all infants with plagiocephaly, 63.2% were affected on the right side and 78.3% had a mild form.

Conclusions: To our knowledge, this is the first population-based study to investigate the incidence of positional plagiocephaly using 4 community-based data collection sites. Future studies are required to corroborate the findings of our study. Research is required to assess the incidence of plagiocephaly using Argenta’s plagiocephaly assessment tool across more CHCs and to assess prevalence at different infant age groups. The utility of using Argenta’s plagiocephaly assessment tool by public health nurses and/or family physicians needs to be established.

Copyright © 2013 American Academy of Pediatrics.

Preclinical pathways to treatment in infants with positional cranial deformity.

Int J Oral Maxillofac Surg. 2014 Oct;43(10):1171-5. doi: 10.1016/j.ijom.2014.05.011. Epub 2014 Jul 15.
Kluba S Lypke J, Kraut W, Krimmel M, Haas-Lude K, Reinert S


Positional plagiocephaly in infants is frequent. As well as positioning, physiotherapy, and osteopathy, helmet therapy is an effective treatment option. The outcome also depends on the timely initiation of treatment. We investigated the preclinical pathways to treatment. Parents of 218 affected children were interviewed. Data were collected regarding detection and the treatments used prior to the first craniofacial consultation at the study clinic in Germany. Descriptive and statistical analyses were performed. For 78.4% of the children, the cranial deformities were first detected at ≤4 months of age. One hundred and twenty-two children received helmet therapy. Parents consulted the pediatrician with a mean latency of 0.4 months; 3.3 months passed until the first craniofacial consultation. Approximately 90% were treated with repositioning and 75.2% received additional physiotherapy or osteopathy prior to presentation. Children treated with physiotherapy/osteopathy presented significantly later (P=0.023). The time-lapse to craniofacial consultation was not significantly different between children with and without later helmet therapy. We identified a relevant delay between the detection of positional cranial deformity and consultation with a craniofacial specialist. For affected children, this may potentially compromise the outcome of helmet therapy. Early referral to a specialist and if necessary the simultaneous application of different treatments should be preferred.

Copyright © 2014 International Association of Oral and Maxillofacial Surgeons.

Treatment of positional plagiocephaly–helmet or no helmet?

J Craniomaxillofac Surg. 2014 Jul;42(5):683-8.

Kluba S, Kraut W, Calgeer B, Reinert S, Krimmel M.,/div>

INTRODUCTION: Positional plagiocephaly has attained widespread attention. There is a lot of data on helmet therapy available, but the natural course of the deformity has not been investigated in depth. The decision for or against helmet therapy can be controversial. This study examined the outcome of both options.
METHODS: 128 infants were enrolled in this prospective, non-randomized, longitudinal study. 62 were treated with and 66 without a helmet. The initial cranial vault asymmetry index (modified CVAI) was determined at 6.3 and 6.2 months of age (SD 1.44/2.14). Follow-up took place at the end of helmet therapy (age: 10.2 months, SD 1.77) or after 1 year (age: 18.5 months, SD 2.28) respectively. The outcome and the correlation of the changes to the initial asymmetry were compared.
RESULTS: All infants showed a significant reduction of their plagiocephaly. Although children with helmet had more severe asymmetry initially, they showed significantly better improvement (68% vs. 31%). Only a weak correlation was found between the initial asymmetry and the amount of improvement in both groups.

CONCLUSION:Despite concerns against helmet therapy (comfort, finances), it should be the treatment of choice for moderate to severe cases. Only mild cases (modified CVAI ≤ 6.5%) can be adequately treated by conservative, i.e. non-helmet, management.Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery.

Helmet treatment of deformational plagiocephaly: the relationship between age at initiation and rate of correction.

Plast Reconstr Surg. 2013 Jan;131(1):55e-61e SeruyaM, OhAK, Taylor JH, Sauerhammer TM, Rogers GF
Department of Plastic and Reconstructive Surgery, Children’s National Medical Center, Washington, DC 20010, USA.
BACKGROUND: The purpose of this study was to evaluate the relationship between age at initiation of helmet therapy for deformational plagiocephaly and the rate of correction.
METHODS: Infants treated for deformational plagiocephaly with a helmet orthosis between 2009 and 2010 were included. Patients were stratified prospectively by the age at which treatment was initiated: group 1, younger than 20 weeks (n = 26); group 2, 20 to 23.9 weeks (n = 59); group 3, 24 to 27.9 weeks (n = 82); group 4, 28 to 31.9 weeks (n = 62); group 5, 32 to 35.9 weeks (n = 45); group 6, 36 to 40 weeks (n = 29), and group 7, older than 40 weeks (n = 43). Pretreatment and posttreatment calvarial asymmetry was measured using direct anthropometry and reported as a transcranial difference.
RESULTS: Three hundred forty-six infants were included; initial transcranial difference was equivalent on all paired-group comparisons. Duration of helmet therapy positively correlated with age at initiation (r = 0.89, p < 0.05). The rate of change in transcranial difference correlated negatively with age at treatment onset (r = -0.88, p < 0.05): group 1, 0.93 mm/week; group 2, 0.64 mm/week; group 3, 0.59 mm/week; group 4, 0.56 mm/week; group 5, 0.41 mm/week; group 6, 0.42 mm/week; and group 7, 0.42 mm/week). At the conclusion of therapy, all groups had improved calvarial symmetry, albeit less completely in groups 6 and 7.

CONCLUSIONS: The correction rate of plagiocephaly with helmet therapy decreases with increasing infant age; after 32 weeks, there is a slow and relatively constant rate of change. Improvement can still be achieved in infants older than 12 months.Copyright © 2013 American Society of Plastic Surgeons.