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Pastor I1,2, Lucha O1, Barrau M2, Rodes I2, Rodriguez AL3, Tricas JM1
1Zaragoza University, Unidad de Investigación en Fisioterapia, Zaragoza, Spain, 2Escuela de Terapias Integrativas, Zaragoza, Spain, 3San 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. According to the literature, the association between plagiocephaly and head preferential position with limited active cervical ROM is almost 1:1. The conservative treatment includes educational physiotherapy and orthotic therapy (helmet).
Purpose: The first objective of this study was to observe the cervical ROM in a group of infants with positional plagiocephaly. The second one to study the efficacy of Pediatric Integrative Manual Therapy (PIMT) combined with stimulation and educational physical therapy in active cervical ROM and parent's perception of infants with plagiocephaly compared with a solely stimulation and educational physiotherapy.
Methods: 46 neurologically healthy subjects under 8 months with a diagnosis of plagiocephaly and a difference of more than 5 mm between cranial diameters were randomly divided into 2 groups. 36 infants received 10 sessions of Pediatric Integrative Manual Therapy (PIMT) once a week, apart from advice regarding stimulation and repositioning. The other 10 infants only received advice regarding stimulation and educational physiotherapy. Specialized pediatric physiotherapists trained the parents of the infants.
Active cervical rotation ROM was observed in both groups with photography from a superior view and angular measurement with GeoCebra v. 6. A questionnaire was completed with the medical history of the mother and the child before and after birth. A visual analogue scale (VAS) measured the perception of the parents regarding changes in the head rotation and the global wellbeing of the infant.
Results: 46 subjects were included, (29 males; 17 females). Mean age at initial evaluation, 4,25 months. No significant differences about age in both groups.
The 65,2% had head positional preference to the right, 34,8% to the left. No significant differences about side in both groups.
All the infants showed limited active cervical rotation. The total mean ROM was 122,7º in both groups. No significant differences about ROM in both groups.
After 2,5 months, a significant improvement in cervical ROM was observed (p=0,000) in PIMT group (119,4º to 160,5º), more than 40º of mean improvement. Control group (134,5º to 139,4º).
The VAS showed the parent's perception of head movement changes in the PIMT group in 8,94 (range -10 to +10); 6,55 in control group (p=0,004).
The VAS of parent's perception of change in global wellbeing was 8,43 in the PIMT group and 6,20 in control group (p=0,001).
Conclusion(s): An intervention with PIMT seems to be significant more effective when improving cervical range of motion associated with positional plagiocephaly combined with educational physiotherapy on stimulation and repositioning than a single intervention with stimulation and educational physiotherapy.
Implications: An adapted Manual Therapy in the field of Pediatrics would provide children with musculoskeletal dysfunctions of different etiologies with a very valuable therapeutic tool that has shown evidence in adult patients.
Keywords: Manual therapy, Cervical spine, Positional plagiocephaly
Funding acknowledgements: Instituto de Terapias Integrativas, Zaragoza, Spain.
Purpose: The first objective of this study was to observe the cervical ROM in a group of infants with positional plagiocephaly. The second one to study the efficacy of Pediatric Integrative Manual Therapy (PIMT) combined with stimulation and educational physical therapy in active cervical ROM and parent's perception of infants with plagiocephaly compared with a solely stimulation and educational physiotherapy.
Methods: 46 neurologically healthy subjects under 8 months with a diagnosis of plagiocephaly and a difference of more than 5 mm between cranial diameters were randomly divided into 2 groups. 36 infants received 10 sessions of Pediatric Integrative Manual Therapy (PIMT) once a week, apart from advice regarding stimulation and repositioning. The other 10 infants only received advice regarding stimulation and educational physiotherapy. Specialized pediatric physiotherapists trained the parents of the infants.
Active cervical rotation ROM was observed in both groups with photography from a superior view and angular measurement with GeoCebra v. 6. A questionnaire was completed with the medical history of the mother and the child before and after birth. A visual analogue scale (VAS) measured the perception of the parents regarding changes in the head rotation and the global wellbeing of the infant.
Results: 46 subjects were included, (29 males; 17 females). Mean age at initial evaluation, 4,25 months. No significant differences about age in both groups.
The 65,2% had head positional preference to the right, 34,8% to the left. No significant differences about side in both groups.
All the infants showed limited active cervical rotation. The total mean ROM was 122,7º in both groups. No significant differences about ROM in both groups.
After 2,5 months, a significant improvement in cervical ROM was observed (p=0,000) in PIMT group (119,4º to 160,5º), more than 40º of mean improvement. Control group (134,5º to 139,4º).
The VAS showed the parent's perception of head movement changes in the PIMT group in 8,94 (range -10 to +10); 6,55 in control group (p=0,004).
The VAS of parent's perception of change in global wellbeing was 8,43 in the PIMT group and 6,20 in control group (p=0,001).
Conclusion(s): An intervention with PIMT seems to be significant more effective when improving cervical range of motion associated with positional plagiocephaly combined with educational physiotherapy on stimulation and repositioning than a single intervention with stimulation and educational physiotherapy.
Implications: An adapted Manual Therapy in the field of Pediatrics would provide children with musculoskeletal dysfunctions of different etiologies with a very valuable therapeutic tool that has shown evidence in adult patients.
Keywords: Manual therapy, Cervical spine, Positional plagiocephaly
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.
