A new innovative technology that could change the way to treat Positional Plagiocephaly.

By
Beatrice Auffan
June 21, 2019

Plagiocephaly translates to “flat head” syndrome in Greek and is also known as benign positional moulding, positional plagiocephaly, occipital plagiocephaly or plagiocephaly without synostosis. It is a deformation of the skull observed with children at a very young age and is known to be one of the most common cranial deformities in infancy. “Plagiocephaly”, can be used to describe asymmetric head shapes resulting from both synostotic and non-synostotic causes. Synostotic plagiocephaly is a premature fusion of one or both lambdoid sutures whereas non synostotic plagiocephaly is due to a continual influence of external forces on the immature skull.Throughout this article, our purpose is to concentrate on the later diagnostic.

Deformational plagiocephaly usually occurs in the first three months of life, when the skull is most malleable and when an infant spends most of the time lying on his or her back. Even if positional plagiocephaly does not affect the development of the brain, parents can be worried about their child's appearance later in life. In order to prevent this from happening and to raise parent's awareness on the subject many studies have been conducted and a lot of information is released on a daily basis. This deformation can be diagnosed by observing typical features on a child's head such as; unilateral flattening of the occiput, the ipsilateral shift of the ear, the ipsilateral protrusion of the forehead or even facial scoliosis.

In modest or severe cases helmet therapy has more advantages and cures this malformation more efficiently

In order to cure, this malformation two different ways are being confronted today: Conservative Therapy and Helmet Therapy.Inspired by a study aiming to examine the factors associated with adherence to recommended treatment among patients from 2007 to 2014, it was shown that many factors have an influence on how people react to the given treatment [4]. Indeed, people chose either to go with the recommended treatment or not if they had, for example, the right assurance. In addition, the degree of their child’s head deformity and the type of recommended treatment appear to affect rates of adherence to endorsed treatment for positional skull deformation. Henceforth, we will compare the two types of treatment [7].

Conservative therapy is also known as repositioning therapy with or without formal physical therapy.  Repositioning therapy is what we call daily: counter positioning. If the child has a deformity on the left side of his skull, flattened skull, he will then be put on the opposite side resting against a hard surface in order to let his flattened part “regrow” and to contain the deformity. It also can consist inactive and passive range of motion of restricted cervical musculature or even the promotion of a variety of developmental positions for the child to play in. As we shall demonstrate further on, physiotherapy is for mild cases of positional plagiocephaly.

Helmet therapy uses a custom moulded helmet built for every patient according to an initial diagram and following the diagnostic made before. The design and modelof the helmet vary from one case to another according to the morphology and most importantly to the degree of severity, for example in mild plagiocephaly cases the helmet aims to have contact with the whole head surface except the quadrant of reduced volume. The child must be monitored and is obliged to wear the helmet most of the time.

Spentys helmet

 In 1992, the prevalence of deformational plagiocephaly had increased significantly and since then several studies have been conducted by doctors, surgeons and medical personnel. Most of these studies pointed out on the maximum efficacity of orthotic treatment during the window of rapid head growth and its proportional decrease with the increase of cranial rigidity concomitant with age. The pace of re-formation relates to the rate of brain growth, which is much more rapid during the first 6 months than later in infancy.

After demonstrating that cranial moulding helmet therapy was the correct treatment for positional plagiocephaly, talk about a certain “time window” was on the move. In fact, results from an experiment led by Felix Kunz in Germany on 144 subjects, indicated that the degree of asymmetric reduction decreased with increasing age at the start of the treatment [3]. To give an example; for patients with moderate to severe asymmetry with a therapy start at less than 24 weeks, 50% of children acquired a symmetric head shape, but with a therapy start at greater than or equal to 32 weeks, this effect decreased to7%.

This study shows that the age at the start of the treatment and the deformational plagiocephaly severity affect the duration and effectiveness of helmet therapy. The success of the treatment is determined largely by these two factors. Using multiple regression analyses, it is possible to estimate the reduction of a deformational plagiocephaly treated with helmet therapy.

The age at which the treatment starts, and the severity of the case have the most influence on the effectiveness of the treatment

However, the type of helmets used today have many disadvantages. First, economically they represent a large investment for a treatment which first and for most has a cosmetic purpose. Physically, these helmets tend not to go hand in hand with the patient's comfort; it is heavy, causes irritations, redness of skin and it isn't water resistant, etc. Therefore, here at Spentys we want to provide a new and improved solution: a waterproof, air permeable, custom-made, featherweight and financially speaking accessible helmet. However, to obtain such an improvement, a 3D scanning software has been developed by Spentys in order to make this technology attainable to doctors, surgeons and all medical personnel.

Spentys solution

Helmet therapy starts off with a first simple scan of the child's head. By 3D scanning the patient's head you can obtain its perfect dimensions considering all specific morphologies. Spentys offers to scan through a camera attached to an iPad which is light, easy to handle and can be used to scan small as well as large areas. The scan can also be done through the web-platform by a physician. It works for a child's skull but also for all types of prosthesis. Click here to see a video of our production process

Particularly for this technology, the measurement is quite complicated and requires a certain number of steps.

Spentys application

The process is defined by two crucial parts; the first is to measure the scanned head and the next is to analyse the deformation and from there print a custom-made helmet for the patient.

The measurement of the3D scanned head requires a lot of precision even if the software has many automatized steps. This step can be illustrated as a dissection of the skull.Diagonals are traced in order to obtain a clear 3D scan. It proceeds with its examination and uses superposition to clearly recognise the deformities and “flat skull”malformations. With those new average sections, a protective and deformational helmet is 3D designed.

Our purpose it to develop and implement quickly through this high-tech measurement medical device.

Thanks to our algorithms and the implementation of medical expertise, digital modelling can now be done. A 3D model of the tailor-made immobilization device accessible by most of the population exists.

To conclude, conservative and helmet therapy are both effective treatments against positional plagiocephaly, however in modest or severe cases helmet therapy has more advantages and cures this malformation more efficiently. As previously said, the age at which the treatment starts, and the severity of the case have the most influence on the effectiveness of the treatment. Spentys's solution provides the best compromise between the comfort of the physician, of the patient and of the employees.

References

1.    In Kook Cho,MD, Jeung Ryeol Eom, MD, Jeong Woo Lee, MD, PhD, Jung Dug Yang, MD, PhD, Ho YunChung, MD, PhD, Byung Chae Cho, MD, PhD, and Kang Young Choi, MD, PhD.  A Clinical Photographic Method to Evaluatethe Need for Helmet Therapy in Deformational Plagiocephaly.

2.     Yasuo Aihara, Kana Komatsu, Hitoshi Dairoku, OsamiKubo, Tomokatsu Hori, Yoshikazu Okada.

Cranial molding helmet therapy and establishment ofpractical criteria for management in Asian infant positional head deformity.

3.    Felix Kunz,DMD, Tilmann Schweitzer, MD, PhD, Jessica Kunz, DMD, Nina Wabmuth, MSc(Psych.), Angelika Stellzig-Eisenhauer, DMD, PhD, Hartmut Böhm, MD, DMD,Philipp Meyer-Marcotty, DMD,PhD, Christian Linz, MD, DMD, PhD.

Head Orthosis Therapy in Positional Plagiocephaly:Influence of Age and Severity of Asymmetry on Effect and Duration of Therapy.

4.    Sandi Lam,MD, MBA, Thomas G. Luerssen, MD, Caroline Hadley, MD, Bradley Daniels, BS, BenA. Strickland, MD, Jim Brookshier, CPO, LPO and I-Wen Pan, PhD.

The health belief model and factors associated withadherence to treatment recommendations for positional plagiocephaly.  

5.     Christian Freudlsperger, Sahra Steinmacher, DanielSaure, Jens P. Bodem, Reinald Kühle, Jürgen Hoffmann, Michael Engel.

Impact of severity and therapy onset on helmettherapy in positional plagiocephaly.

6.     Jan-Falco Wilbrand, Martina Wilbrand, JoernPomns-Kuehnemann, Joerg-Christoph Blecher, Petros Christophis, Hans-PeterHowaldt and Heidrun Schaaf.

Value and reliability of anthropometricmeasurements of cranial deformity in early childhood.

7.    Jordan P.Steinberg, MD, PhD, Roshni Rawlani, BA, Laura S. Humphries, MD, Vinay Rawlani,MD, Frank A. Vicari, MD.

Effectivenee of Conservative Therapy and HelmetTherapy for Positional Cranial Deformation.

 

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