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BACKGROUND: The purpose of this study was to evaluate the relationship between age at initiation of helmet therapy for deformational plagiocephaly and the rate of correction.
METHODS: Infants treated for deformational plagiocephaly with a helmet orthosis between 2009 and 2010 were included. Patients were prospectively stratified by the age treatment was initiated - Group 1: under 20 weeks (N=26); Group 2: 20-24 weeks (N=59); Group 3: 24-28 weeks (N=82); Group 4: 28-32 weeks (N=62); Group 5: 32-36 weeks (N=45); Group 6: 36-40 weeks (N=29); Group 7: greater than 40 weeks (N=43). Pre and post treatment calvarial asymmetry was measured using direct anthropometry and reported as a transcranial difference (TCD).
RESULTS: 346 infants were included; initial TCD was equivalent on all paired-group comparisons. Duration of helmet therapy positively correlated with age at initiation (r = 0.89, p < 0.05). The rate of change in TCD negatively correlated with age at treatment onset (r = -0.88, p < 0.05): Group 1, 0.93 mm/week; Group 2: 0.64 mm/week; Group 3: 0.59 mm/week; Group 4: 0.56 mm/week; Group 5: 0.41 mm/week; Group 6: 0.42 mm/week; Group 7: 0.42 mm/week). The decrease in the rate of correction of calvarial asymmetry mirrored a logarithmic decline in head circumference growth (Figure). At the conclusion of therapy, all groups had improved calvarial symmetry, albeit less completely in groups 6 and 7.
CONCLUSIONS: The correction rate of plagiocephaly with helmet therapy decreases with increasing infant age; after 32 weeks, there is a slow and relatively constant rate of change. Improvement can still be achieved in infants older that 12 months of age.