In a recent article Evidence-based Guidelines for the Management of Infants with Positional Plagiocephaly the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and the American Academy of Pediatrics (AAP) put forth updated guidelines on the diagnosis and treatment of infant positional plagiocehaly. Since publication, the study has been endorsed by the American Academy of Pediatrics. The study evaluated 396 abstracts in several critical areas to determine the role of imaging, physical therapy, helmet therapy and repositioning when making a diagnosis or determining the most important treatment.
The Role of Imaging in Positional Plagiocephaly Diagnostics
One of the first considerations was to evaluate the role imaging should play in the diagnostic process. Some neurosurgeons argue that imaging allows for a proper diagnosis of craniosynostosis, a differential diagnosis for plagiocephaly. By using existing data on the use of three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging the investigators were able to better understand the value (or lack thereof) among these sometimes expensive and invasive tests. What they found was that none of these types of imaging were better at making an appropriate diagnosis than a clinical evaluation by a trained medical professional. By relying on clinical evaluations, many expensive and invasive tests can be eliminated.
The Role of Repositioning in Plagiocephaly Treatment
The second part of the investigation was to investigate the role of repositioning as a first line of defense when treating plagiocephaly. For many doctors, prescribing a several week course of intensive repositioning is the first step in the treatment plan. Researchers used three existing clinical trials to compare a positioning device, parental repositioning and physical therapy. What they found was that the device and organic repositioning were not significantly different in their outcomes, however both were inferior to physical therapy. The finding was that repositioning is effective for almost all levels of plagiocephaly, however the progress is much slower than physical therapy or cranial remolding.
The Role of Physical Therapy in Plagiocephaly Treatment
The next step in this comprehensive study was to examine role of physical therapy in plagiocephaly treatment. When looking into treatment for this diagnosis most parents will find plenty of information on repositioning and cranial remolding. What is often overlooked in the literature is the positive role the physical therapy can play. This study proved that a course of physical therapy was significantly more effective than repositioning in treating plagiocephaly. While it might not be as effective as a helmet treatment, it should be considered as a logical step between repositioning and cranial remolding.
The Role of Helmet Therapy in Plagiocephaly Treatment
The final element included in this study was to evaluate the level of effectiveness in using cranial molding orthosis therapy. By using a number of current studies on helmet therapy, researchers were able to confirm that cranial remolding is highly effective in treating plagiocephaly, especially in more severe cases of the deformity. The findings also reiterate the importance of providing this type of therapy while the infant is still under the age of one.
In this groundbreaking study, thousands of cases of infants diagnosed with plagiocephaly were evaluated to offer the most updated look at the best practices for plagiocephaly diagnosis and treatment. While many findings were confirmed (such as the high level of effectiveness of cranial molding), some interesting new guidelines were introduced (including physical therapy as an option before prescribing cranial remolding). This study is an excellent tool for both medical professionals and parents to better understand the best practices for diagnosing and treating plagiocephaly.