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Palpatory diagnosis of plagiocephaly

Authors:
  • Midwestern University, Chicago, United States
  • Midwestern University, Chicago College of Osteopathic Medicine

Abstract

Introduction: The term plagiocephaly, from the Greek plagios (oblique) and kephalê (head), means distortion of the head, and refers clinically to cranial asymmetry. Cranial Osteopathy, since it was first proposed, has focussed upon the diagnosis and treatment of birth trauma and cranial asymmetries, and consequently specific therapy for plagiocephalic deformities has been described. Osteopathic manipulation also has been proposed as a treatment for torticollis, a condition associated with plagiocephaly. For these reasons, we decided to look at the mechanics of the occipital bone and the adjacent atlas and bones of the cranial base, in relation to functional plagiocephaly. Methods: The records of 649 children seen in an osteopathic practice in Lyon, France, were reviewed retrospectively, in compliance with the legal requirements of the Commission Nationale de l'Informatique et des Libertés (CRIL) and the Helsinki accord, for gender, age at presentation, birth history, obstetrical data (breech presentation, vacuum extraction, forceps delivery or Caesarean section), presenting complaint, side of posterior plagiocephaly, side of frontal plagiocephaly, torticollis, motion pattern of the occipital bone upon the atlas, and motion pattern of the spheno-occipital synchondrosis. Results: We found significant correlations between plagiocephaly (right/left) and primipara (P=0.024), use of forceps (P=0.055) and extractor suction (P=0.055). Correlations were also found between flattening of the occiput (right/left) and lateral strain of the spheno-occipital synchondrosis (P=0.002) and between plagiocephaly (right/left) and occipito-atlantal motion (P=0.000). Conclusion: We found a significant correlation between the lateral strain pattern of the spheno-occipital synchondrosis and plagiocephaly and between rotational dysfunction of the occiput upon the atlas and the side of posterior plagiocephaly. We suggest that thorough neonatal osteopathic examination can identify individuals predisposed to develop posterior plagiocephaly.
... The term Plagiocephaly derives from the Greek plagios (oblique) and kephalè (head) which means head distortion and clinically refers to asymmetries of the head [11]. Plagiocephaly is a quantitative descriptive morphological adaptation of cranial asymmetries involving the splanchnocranium in particular, the viscerocranium and the functionality of the organs there included [12]. ...
... As is well known, the development of the skeletal structure and motor control follow a top-down pattern: the articular Study on a Population of Children with ASD limitations of the upper districts can compromise the development of later more evolved functions [18][19][20][21]. During the first months of life, the effects of plagiocephaly are mainly highlighted at the craniofacial level, involving many important functions of neurodevelopment, such as vision, balance, sensoriality, orientation of the head in space, sucking, swallowing, breathing, mucus drainage in the middle ear [10,11]. If there is no alternation of postures and the newborns are always positioned in the same way, the cranial bones, both those of the vault and the cranial base, malleable in the newborn and infant, are deformed. ...
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The discipline of osteopathy is a whole person approach that incorporates medical and scientific knowledge using an array of manipulative techniques for diagnosis and treatment of several types of diseases (WHO). The ostheopathic examination allows to locate somatic dysfunctions which are the hallmarks of health imbalance caused by stressful events, external or internal to the body, such as trauma and / or other pathologies. The objective of osteopathic treatment is to improve posture and motor skills, which are the prerequisites for a balanced and harmonious development of the body. The osteopathic evaluation of children with autism spectrum disorder allows the identification of dysfunctional aspects at a somatic level that can enrich the understanding of the child's health and behavior, starting from the structure / function relationship, including craniofacial dimorphisms and plagiocephaly. The present exploratory research has made it possible to detect the presence of signs of plagiocephaly in about half of a sample of 250 preschool and school age children with autism spectrum disorder; the 48% of these, shows signs of craniofacial dysmorphism, which indicates a continuous morphostructural adaptation not yet sufficiently considered as an interferent element in the overall development of the child. The observed incidence is consistent with the incidence of plagiocephaly in the pediatric population and supports the hypothesis that in children with autism spectrum disorder it may be useful to integrate the osteopathic expertise with the other health professionals involved in the diagnostic and therapeutic process. The authors conclude that osteopathic observation can contribute to the definition of the functioning profile of the children with autism spectrum disorder and their needs, in a global perspective of taking charge and individualization of care.
... Lagerungsbedingte Kopfasymmetrien treten bei männlichen Säuglingen deutlich häufiger auf [10,30,31,[48][49][50][51][52][53][54]. In der Literatur wird das Verhältnis von männlichen zu weiblichen Patienten zwischen 3:1 und 3:2 angegeben [39,48,52,[55][56][57]. ...
Thesis
Der lagerungsbedingte Plagiozephalus (LP) stellt die häufigste Schädeldeformation bei Kleinkindern dar. Ursachen, Risikofaktoren und die Wirksamkeit konservativer Therapieverfahren wurden in einer Vielzahl von Veröffentlichungen dargestellt. Untersuchungen zur Langzeitstabilität des Helmtherapieerfolges und die Auswirkungen eines LP auf das stomatognathe System bei Kleinkindern sind hingegen selten. Die vorliegende kontrollierte, prospektive Längsschnittstudie stellt die erste 3D- Untersuchung dar, die belegt, dass die Kopforthesentherapie bei Patienten mit LP zu besseren Langzeitergebnissen im Vergleich zu anderen Therapieoptionen führt. Auch nach Abschluss der Kopforthesentherapie ist eine weitere Verbesserung der Kopfform zu beobachten. Bei Patienten mit LP besteht zudem grundsätzlich ein höheres Risiko für laterale Kreuzbisse, die bevorzugt auf der kontralateralen Seite in Relation zur abgeflachten Hinterhauptseite auftreten. Gesichtsasymmetrien treten häufiger bei Patienten mit LP auf, bei denen keine Kopforthesentherapie durchgeführt wurde. Folglich stellt die Kopforthesentherapie eine geeignete Therapieoption für Säuglinge mit LP dar, um sowohl die Schädelasymmetrie als auch das Auftreten dentofazialer Asymmetrien zu reduzieren.
... Many intrinsic and extrinsic factors can play a role before, during and after childbirth. Besides being associated with lying supine, the development of plagiocephaly is linked to gestational diabetes [9], male sex [10,11], maternal age [12], skull circumference [12], prematurity [13], primiparity [10,11], brachiocephaly [9,10], intrauterine constraints [14], prolonged labor [14], multiple births [14], improper fetal position during birth [14], use of obstetrical forceps or a suction cup [15], lengthy hospital stay [16], congenital torticollis [6,17], head positional preference [10][11][12]18], infant being awake in a prone position less than 3 times a day [10] and delayed motor milestone acquisition [10]. ...
Article
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Background Positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. Methods Thirty-four neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (− 10 cm to + 10 cm). Results CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40% compared with 0.34 ± 1.72% in the control group ( p = 0.000). CI did not present significant differences between groups. Manual therapy led to a more positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p = 0.004). Conclusion Manual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program. Trial registration Trial registration number: NCT03659032 ; registration date: September 1, 2018. Retrospectively registered.
... Also the suction force of a vacuum delivery or the resulting damaged area of an associated cephalic hematoma, can cause nociceptive activation and can lead to peripheral and central sensitization [32]. These are a few examples from a long list of putative factors causing sensitization of the brain stem in babies [33]. ...
... The main reasons for consultation are musculoskeletal and postural problems (es. plagiocephaly, and torticollis), and gastrointestinal functional disorders [36][37][38][39][40][41]. ...
... sex [10,11], maternal age [12], skull circumference [12], prematurity [13], primiparity [10,11], brachiocephaly [9,10], intra-uterine constraints [14], prolonged labor [14], multiple births [14], improper fetal position during birth [14], the use of obstetrical forceps or a suction cup [15], lengthy hospital stay [16], congenital torticollis [6,17], head orientation preference [10][11][12]18], infant being awake in a prone position less than 3 times a day [10] and delayed motor milestone acquisition [10]. ...
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Background: positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. Methods: 34 neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (-10 cm to +10 cm). Results: CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40 % compared with 0.34 ± 1.72% in the controls (p=0.000). CI changes did not present any significant differences between the 2 groups. Manual therapy increased positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p= 0.004). Conclusion: manual therapy plus caregiver education program improved cranial symmetry and parents’ satisfaction more effectively than solely caregiver education program. Trial registration: trial registration number: NCT03659032; registration date: September 1, 2018. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03659032?term=NCT03659032&cond=Plagiocephaly&draw=2&rank=1
... Early osteopaths maintain that an infantile scoliosis which arises early (between 0 and 3 years) is not the result of gravity during walking [12]. Rather it has to do with forces that have worked on the body during pregnancy, birth or the postnatal period. ...
... Early osteopaths maintain that an infantile scoliosis which arises early (between 0 and 3 years) is not the result of gravity during walking [12]. Rather it has to do with forces that have worked on the body during pregnancy, birth or the postnatal period. ...
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With few exceptions, congenital anomalies may be subdivided into 'malformations', which arise during the embryonic period as a result of primary errors in morphogenesis, and 'deformations', which arise in later fetal life and are alterations in the form or structure of a previously normally formed part. The great majority of deformations involve the musculoskeletal system and have been called the congenital postural deformities. Since 1959 a number of clinical, radiologic and pathologic studies have been undertaken respecting the etiology of these deformities. The present paper reviews this work and the evidence in support of the mechanical theory. This theory states that congenital postural deformities are caused by intra uterine moulding; that while the pressure required to produce such moulding may occasionally arise intrinsically because of muscle imbalance secondary to neuromuscular disease, in most cases it is of extrinsic origin, arising in the later weeks of pregnancy as the volume of amniotic fluid diminishes and the still plastic and rapidly growing fetus becomes constrained within the uterus. All parts of the infant may be affected, the most important deformities being the various forms of talipes, congenital sternomastoid torticollis, congenital postural scoliosis, and congenital dislocation of the hip. Less common or less important deformities include congenital bowing of the legs, congenital genu recurvatum, deformities of the upper limbs and thorax, the Potter's or compression facies, congenital plagiocephaly and dolichocephaly, retrognathia and mandibular asymmetry, and facial, radial, obturator and sciatic neuropraxias. Some cases of mid line cleft palate, multiple congenital arthrogryposis, and syndactyly also appear to have a mechanical origin.
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Plagiocephaly usually originates in late fetal life through aberrant constraint of the fetal head and is often associated with sternocleidomastoid torticollis. In some patients the obligue head shape may become a permanent, cosmetic disability. Individually fitted plastic helmets, similar in style to football helmets, have been successfully used to remold the deformed heads of four infants. Each helmet is designed to fit snugly against the prominent aspects of the infants' cranium and to be loose fitting where the head is shallow. As the brain grows, the head is molded to fit the helmet and thus acquires a more usual shape. The treatment has been safe and effective. When torticollis is persistent after the initiation of treatment, rubber straps can be fixed to the outside of the helmet and attached to the side rails of the crib. While the infant sleeps, the straps can be tightened to stretch the shortened sternocleidomastoid muscle.