Helmet Use and Treating Plagiocephaly: Another Perspective

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By Frank Vicari, MD

The publication of research led by Renske M. van Wijk, PhD, regarding helmet versus non-helmet therapy for treatment of plagiocephaly in the Netherlands sparked controversy in 2014 and led to a lively discussion at the American Academy of Orthotists and Prosthetists' Annual Meeting & Symposium in February. The O&P EDGE invited one of the speakers from that session to share his research group's findings on the subject.

The incidence of babies developing flat heads, or "flat head syndrome," has reached epidemic proportions. The Back to Sleep campaign contributed to this increase, as have devices that encourage prolonged supine positioning during both sleep and waking hours. My research team and I have learned that this is a complicated and multifactorial condition that requires a multidisciplinary approach. However, our recently published research indicates that it can be corrected more than 90 percent of the time. The approach that has proven effective in a series of about 4,400 patients involves a coordinated program of tummy time, physical therapy, and, when necessary, fitting the patient with a cranial helmet.

I have treated thousands of infants at the multispecialty Head Shape Evaluation Clinic, Park Ridge, Illinois. Patients are evaluated by a team of experts and accurate skull measurements are obtained with the use of an Orthomerica STARscanner™. An individualized treatment plan is then developed to maximize the opportunity for successful correction of the condition.

Sleep preferences, turn preferences, and muscle imbalances are common findings in these children, making physical and occupational therapy integral to their evaluation and treatment. While a home program and therapy was demonstrated to correct the head shape irregularity in a majority of the cases, when the severity is too great or the progress is considered insufficient, helmet therapy is initiated. Helmets were used in 33 percent of the patients in our study. Our general preference is to use a customized foam and plastic helmet, which provides some flexibility for the orthotist in maintaining fit in the growing cranial vault.

In contradistinction to the 2014 Netherlands study, we found that helmets are very effective in correcting head shape issues-approximately 95 percent of the time in our study. I would point out two material aspects that factor into success for the patients we treat: We have the ability to accurately predict the shape of the child's cranial vault with laser-guided digital imaging, and we have superb quality control when manufacturing the cranial orthosis. Additionally, we work with experienced orthotists to ensure that the helmet continues to fit properly throughout the treatment course, which is critical to favorable results.

Treatment failure was also predictable in our study. Referring specifically to the infants who required helmet therapy, there were essentially two predictors of failure: severity and age at the time of treatment initiation, and patient compliance. To insure the optimum result, it is critical that all involved caregivers be organized into an integrated team that includes the appropriate surgical specialties, nursing support, physical therapy, and orthotics.

Frank Vicari, MD, has been a pediatric plastic surgeon/craniofacial surgeon in the Chicago area for more than 25 years. His latest study, "Effectiveness of Conservative Therapy and Helmet Therapy for Positional Cranial Deformation," was published in the March issue of Plastic and Reconstructive Surgery.