VALIDATION OF THE SKULLY CARE APPLICATION AS A QUICK AND CHILD FRIENDLY METHOD FOR MEASURING POSITIONAL CRANIAL DEFORMITIES

L.N. van Adrichem¹, E.J. van der Grift², O.D. Kronig¹, S.A. Kronig¹

Background: Positional skull deformations in newborns and very young children is a common problem in daily practice (1). Craniofacial measuring is essential for diagnosis and evaluation of growth and therapies (2). Traditional anthropometry does not sufficiently analyze craniofacial shape (2). Plagiocephalometry with a thermoplastic strip was introduced in 2005 (1). Following a reliability study (1) and a validation study (2) plagiocephalometry (PCM) proved to be a reliable and valid method in research (3,4) and treatment of positional skull deformations. The method needs however direct contact with the newborn and young child and is laborious and time consuming. Skully Care was developed as a faster and user- and child-friendly craniofacial measuring method. Skully Care (SC) is an application on a mobile phone which analyzes the shape of the skull by making a standardized picture from above. The picture is analyzed digitally and shape and severity of the deformity is established.

1. Van Vlimmeren LA et al.Eur J Pediatr 2006; 165(3):149-57
2. Van Adrichem LNA et al. J Craniofac Surg 2008; 19(1);15-21
3. Van Vlimmeren LA et al. Arch Pediatr Adolesc Med 2008; 162(8);712-8
4. Van Wijk RM et al. BMJ 2014; 348:g2741

Purpose: Validation of Skully Care as a craniofacial measuring device by comparing it to plagiocephalometry. Validation is performed on newborns and young children in physical therapy practices.

Methods: The study was performed by 3 paediatric physiotherapists on children with positional skull deformations. Skully Care was compared with plagiocephalometry. Plagiocephalometry with a thermoplastic strip was the standard method of analysis. During the same visit standardised Skully Care pictures were made with a mobile phone. In 60 skull shape analysis the CVAI (Skully Care) was compared with the ODDI (PCM) as parameter of plagiocephaly and the CI (Skully Care) with the CPI (PCM) as parameter of brachycephaly. A two-tailed Pearson Correlation test was performed with IBM SPSS Statistics 26.

Results: 14 skull shape analysis were done in girls, 46 in boys. The mean age was 4.6 month (range 1.1 – 11.0; sd = 2.3). CVAI (SC) mean value was 6.33 (range 0.15 – 13.47; sd = 3.19) and ODDI mean value was 106.9 (range 100.1 – 114.8; sd = 3.9). Pearson correlation test showed a strong correlation of 0.849 between CVAI and ODDI (p < 0.01; two tailed).
CI (SC) mean value was 90.4 (range 74.5 – 103.8; sd = 6.3) and CPI mean value was 89.9 (range 72,0 – 103.8; sd = 6.6). Pearson correlation test showed a very strong correlation of 0.938 between CI and CPI (p < 0,01; two tailed).

Conclusion(s): This study proves that Skully care (SC) is a reliable method for analysis of positional skull deformities. The measurements are in agreement with plagiocephalometry (PCM), the golden standard for analysis of positional skull deformations in daily physical therapy practice. The combination of simplicity, reliability and validity, but also speed and user and child convenience makes it a promising craniofacial measuring method in daily practice. Routine daily application should be further investigated.

Implications: Skully Care is the modern successor of analyzing positional skull deformities.

Funding, acknowledgements: None

Keywords: positional skull deformation, photography with smartphone, plagiocephalometry

Topic: Paediatrics

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: According to the Netherlands law no ethics approval is needed if the study gives no or minimal imposition to the person.