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, Departamento de Fisioterapia, 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. The conservative treatment includes educational physiotherapy and orthotic therapy (helmet). Educational physiotherapy showed efficacy in prevention, but not in the treatment of cranial deformity.
Purpose: The objective of this study is to observe the efficacy of Pediatric Integrative Manual Therapy (PIMT) combined with educational physiotherapy in the treatment of positional plagiocephaly compared with a treatment based solely on educational physiotherapy, regarding the cranial shape and parent's perception of change.
Methods: 46 neurologically healthy subjects under 8 months with diagnosis of plagiocephaly (more than 5 mm between cranial diameters) were randomly divided into 2 groups. 36 infants received 10 sessions of PIMT once a week, apart from advice regarding stimulation and repositioning. The other 10 infants only received advice regarding stimulation and educational physiotherapy.
Cranial Index (CI), Cranial Vault Asymmetry Index (CVAI) and difference between the diagonal diameters were obtained in both groups with caliper. A questionnaire was completed with the medical history of the mother and the child. A visual analogical scale (VAS) measured perception of the parents regarding changes in the shape of the child's head and in global wellbeing.
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% of the sample had flat head on right side, while the 34,8% had flat head on left side. No significant differences about side in both groups.
After 2,5 months, a significant improvement was observed in CVAI in the PIMT group (7,45% to 3,60%). Less improvement was observed in control group (8,42% to 6,50%) (p=0,008). The mean cranial diameters difference showed a improvement in PIMT group in 50% (10,26 mm to 5,12mm); less significant in control group (11,30mm to 8,80mm).
The CI didn't show a significant difference.
The VAS showed the parent's perception of cranial shape changes in the PIMT group in 7,76 (range -10 to +10); 5,49 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 combined with educational physical therapy on stimulation and repositioning seems to be more effective with regard to changes in Cranial Vault Asymmetry Index and diameters difference in cases of positional plagiocephaly than the educational physical therapy. Even the parent's perception of changes in head shape and wellbeing were better in the PIMT group.
Implications: An adapted Manual Therapy in the field of Pediatrics would give children with musculoskeletal dysfunctions of different etiologies a very valuable therapeutic tool that has shown evidence in adult patients. It could be a cheaper treatment than helmet in positional plagiocephaly and more interested in motor development.
Keywords: Positional Plagiocephaly, Manual Therapy, cranial asymmetries
Funding acknowledgements: Instituto de Terapias Integrativas. Zaragoza. Spain
Purpose: The objective of this study is to observe the efficacy of Pediatric Integrative Manual Therapy (PIMT) combined with educational physiotherapy in the treatment of positional plagiocephaly compared with a treatment based solely on educational physiotherapy, regarding the cranial shape and parent's perception of change.
Methods: 46 neurologically healthy subjects under 8 months with diagnosis of plagiocephaly (more than 5 mm between cranial diameters) were randomly divided into 2 groups. 36 infants received 10 sessions of PIMT once a week, apart from advice regarding stimulation and repositioning. The other 10 infants only received advice regarding stimulation and educational physiotherapy.
Cranial Index (CI), Cranial Vault Asymmetry Index (CVAI) and difference between the diagonal diameters were obtained in both groups with caliper. A questionnaire was completed with the medical history of the mother and the child. A visual analogical scale (VAS) measured perception of the parents regarding changes in the shape of the child's head and in global wellbeing.
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% of the sample had flat head on right side, while the 34,8% had flat head on left side. No significant differences about side in both groups.
After 2,5 months, a significant improvement was observed in CVAI in the PIMT group (7,45% to 3,60%). Less improvement was observed in control group (8,42% to 6,50%) (p=0,008). The mean cranial diameters difference showed a improvement in PIMT group in 50% (10,26 mm to 5,12mm); less significant in control group (11,30mm to 8,80mm).
The CI didn't show a significant difference.
The VAS showed the parent's perception of cranial shape changes in the PIMT group in 7,76 (range -10 to +10); 5,49 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 combined with educational physical therapy on stimulation and repositioning seems to be more effective with regard to changes in Cranial Vault Asymmetry Index and diameters difference in cases of positional plagiocephaly than the educational physical therapy. Even the parent's perception of changes in head shape and wellbeing were better in the PIMT group.
Implications: An adapted Manual Therapy in the field of Pediatrics would give children with musculoskeletal dysfunctions of different etiologies a very valuable therapeutic tool that has shown evidence in adult patients. It could be a cheaper treatment than helmet in positional plagiocephaly and more interested in motor development.
Keywords: Positional Plagiocephaly, Manual Therapy, cranial asymmetries
Funding acknowledgements: Instituto de Terapias Integrativas. Zaragoza. Spain
Topic: Paediatrics; Musculoskeletal; 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.
