EFFICACY OF PEDIATRIC INTEGRATIVE MANUAL THERAPY IN POSITIONAL PLAGIOCEPHALY

I. Pastor-Pons¹, O. Lucha-López¹, I. Rodes-Pastor², M. Barrau-Lalmolda², A.L. Rodríguez-Fernández³, J.M. Tricas-Moreno¹

Background: Head and neck asymmetries are very common in typical healthy newborns. Within these asymmetries, positional plagiocephaly (PP) is a general term describing cranial distortion from pre- or postnatal forces on the infant head. PP features asymmetrical occipital flattening, accompanied by other asymmetries in the head and face. Prevalence data are limited and depend on geographic location. However, the best estimates are that the condition occurs in 20%-30% of infants . Conservative PP treatment usually includes repositioning and physiotherapy.

Purpose: The objective of this study was to analyze how effective, in a group of subjects with PP, pediatric integrative manual therapy (PIMT) combined with educational physiotherapy was in affecting anthropometric features and subjective parental perception of change, compared with  educational physiotherapy solely. This PIMT has been added to educational physiotherapy treatment, which has already established sufficient evidence.​

Methods: 34 neurologically healthy subjects aged less than 6 months old having signs of non-synostosic plagiocephaly were randomly distributed into 2 groups. For 10 weeks, 1 group received Pediatric Integrative Manual Therapy (PIMT) plus educational physiotherapy, while the controls received solely educational physiotherapy. Clinical and demographic data were recorded. The following anthropometric parameters, constituting the dependent study variables, were measured: maximum cranial circumference (MCC)], cranial length, cranial width and diagonal cranial diameter taken from the frontozygomatic suture (fz) to the fellow lambdoid suture (lb). From these data, it was calculated the cranial vault asymmetry (CVA) (the difference between the diagonal diameters), cranial index (CI) and CVA index (CVAI).  Parental perceptions of changes were assessed using a visual analogue scale (-10 cm to +10 cm). Seventeen subjects received 10 sessions of PIMT once a week, plus educational physiotherapy. This PIMT is a conceptual model in pediatric physiotherapy that integrates manual techniques in both soft tissue and bony structures in the infant and child. Following the manual intervention, PIMT effects sensory-motor stimulation with the family’s help to improve the development and functionality. The educational physiotherapy consisted of a series of literature-based recommendations that encompassed repositioning, sensory and motor stimulation of the side opposite the preferential one and prone positions.

Results: The intervention group (PIMT) showed a statistically significant increase in MCC: 2.160 cm against 1.353 cm (p = 0.004). Diameter difference (CVA) dropped from 8.20 to 4 mm in the PIMT group, increasing from 7 to 7.66 mm (p < 0.05) for the controls. CVAI fell from 6.58% to 2.93% in the PIMT group, rising from 5.36% to 6.03% (p < 0.05) in the control group. PIMT significantly increased positive parental perception of skull shape changes (PIMT: 6.65 cm; control: 4.28 cm; p = 0.04).

Conclusion(s): Pediatric Integrative Manual Therapy plus educational physiotherapy improved cranial symmetry and parents’ satisfaction change more effectively than solely educational physiotherapy.

Implications: This is one of the few random controlled studies showing the effectiveness of pediatric manual therapy on cranial asymmetry in positional plagiocephaly. This study offers new options for the treatment in physiotherapy of an alteration that is still too frequent and as an alternative to orthopedic treatment with a helmet.

Funding, acknowledgements: There is no funding source.

Keywords: Positional Plagiocephaly, Deformational Plagiocephaly, Manual Therapy

Topic: Paediatrics

Did this work require ethics approval? Yes

Institution: Aragon Government

Committee: Ethics Committee at the Aragon Health Sciences Institute

Ethics number: No. C.P. - C.I. PI16/0275