Pastor I1, Lucha O1, Rodes I2, Barrau M3, Rodriguez AL4, Tricas JM1
1Zaragoza University, Unidad de Investigación en Fisioterapia, Zaragoza, Spain, 2Escuela de Terapias Integrativas, Zaragoza, Spain, 3Zaragoza University, Zaragoza, Spain, 4San Pablo CEU, Madrid, Spain
Background: After the “Back to sleep” proposal (American Academy of Pediatrics, 1992), the incidence of positional cranial deformities increased significantly. The prevalence reaches 20% of infants in several countries, and it increases in premature babies and multiple births. There is increasing evidence of a correlation between plagiocephaly and future development delays, mandibular asymmetry or visual field defects.
Different correlated factors have been observed, including excessive time in supine position, first child, prematurity or the head preferential position.
Purpose: The objective of this study is to observe the demographic characteristics and the factors related birth, clinical history and care routines in a group of infants with positional plagiocephaly. We also observe the cervical range of motion (ROM) and the degree of correlation between cervical ROM and cranial asymmetry.
Methods: 54 neurologically healthy subjects under 8 months with a diagnosis of plagiocephaly and a difference of more than 5 mm between cranial diameters were observed. These data include a questionnaire about aspects related to the clinical history of the mother, pregnancy, birth, first months in the life of the child, daily time in prone position during the first months, type of transport, etc. Active cervical ROM was measured with a photography and angular measurement with GeoCebra v6. Anthropometric parameters were measured with a caliper. Data analyzed with SPSS v22.
Results: 54 subjects were included, (31 males; 23 females). Mean age at initial evaluation, 4,16 months. The age had light correlation with better asymmetry (p 0,05).
Mean weight at birth was 3256,3 gr.
13 subjects (24,1%) were premature; 41 (75,9%) were not.
35 subjects (65,8%) had flat head on the right side and 19 (35,2%) on the left side.
28 subjects (51,9%) were the first infants; 26 (48,1%) were not.
22 subjects (40,7%) had difficulties in birth; 26 (59,3) had not.
14 subjects (25,9%) had an instrumental birth; 32 (74,1%) had not.
Mean time in prone position during the first month was 3,25 minutes/day. In the second month was 7,27 minutes/day.
54 subjects (96,3%) were transported in stroller, only 2 (3,7%) were transported by backpack.
All infants showed limited cervical ROM. Total mean ROM was 122,47º.
Mean Cranial Index (CI) was 86,21% and Cranial Vault Asymmetry Index (CVAI) was 7,74%. Mean cranial diameters difference (CDD) was 10,54mm.
Significant correlation was found between the CDD and the cervical ROM to the left side in infants with flat head on right side (p=0,05).
Conclusion(s): It can be confirmed the excess time in supine position, the transport system and the limited cervical ROM as important factors in position plagiocephaly. The mean cervical ROM limitation was more than 55º, which is a clear sign of cervical dysfunction. Head asymmetry on one side is correlated with cervical ROM to the other side.
Implications: Identifying and detecting the demographic, physical and behavioral factors of infants with plagiocephaly would lead to a better prevention of this type of pathology. Physiotherapists would play an essential role in the implementation of social programs for prevention. It seems necessary to assess the cervical spine in infants with positional plagiocephaly.
Keywords: Positional plagiocephaly, cervical spine, prone position
Funding acknowledgements: Instituto de Terapias Integrativas, Zaragoza. Spain.
Different correlated factors have been observed, including excessive time in supine position, first child, prematurity or the head preferential position.
Purpose: The objective of this study is to observe the demographic characteristics and the factors related birth, clinical history and care routines in a group of infants with positional plagiocephaly. We also observe the cervical range of motion (ROM) and the degree of correlation between cervical ROM and cranial asymmetry.
Methods: 54 neurologically healthy subjects under 8 months with a diagnosis of plagiocephaly and a difference of more than 5 mm between cranial diameters were observed. These data include a questionnaire about aspects related to the clinical history of the mother, pregnancy, birth, first months in the life of the child, daily time in prone position during the first months, type of transport, etc. Active cervical ROM was measured with a photography and angular measurement with GeoCebra v6. Anthropometric parameters were measured with a caliper. Data analyzed with SPSS v22.
Results: 54 subjects were included, (31 males; 23 females). Mean age at initial evaluation, 4,16 months. The age had light correlation with better asymmetry (p 0,05).
Mean weight at birth was 3256,3 gr.
13 subjects (24,1%) were premature; 41 (75,9%) were not.
35 subjects (65,8%) had flat head on the right side and 19 (35,2%) on the left side.
28 subjects (51,9%) were the first infants; 26 (48,1%) were not.
22 subjects (40,7%) had difficulties in birth; 26 (59,3) had not.
14 subjects (25,9%) had an instrumental birth; 32 (74,1%) had not.
Mean time in prone position during the first month was 3,25 minutes/day. In the second month was 7,27 minutes/day.
54 subjects (96,3%) were transported in stroller, only 2 (3,7%) were transported by backpack.
All infants showed limited cervical ROM. Total mean ROM was 122,47º.
Mean Cranial Index (CI) was 86,21% and Cranial Vault Asymmetry Index (CVAI) was 7,74%. Mean cranial diameters difference (CDD) was 10,54mm.
Significant correlation was found between the CDD and the cervical ROM to the left side in infants with flat head on right side (p=0,05).
Conclusion(s): It can be confirmed the excess time in supine position, the transport system and the limited cervical ROM as important factors in position plagiocephaly. The mean cervical ROM limitation was more than 55º, which is a clear sign of cervical dysfunction. Head asymmetry on one side is correlated with cervical ROM to the other side.
Implications: Identifying and detecting the demographic, physical and behavioral factors of infants with plagiocephaly would lead to a better prevention of this type of pathology. Physiotherapists would play an essential role in the implementation of social programs for prevention. It seems necessary to assess the cervical spine in infants with positional plagiocephaly.
Keywords: Positional plagiocephaly, cervical spine, prone position
Funding acknowledgements: Instituto de Terapias Integrativas, Zaragoza. Spain.
Topic: Paediatrics; Musculoskeletal: spine; Orthopaedics
Ethics approval required: Yes
Institution: Government of Aragón, Spain.
Ethics committee: Ethics Committee for Clinical Research (CEICA)
Ethics number: file no. 18/2017
All authors, affiliations and abstracts have been published as submitted.
