Physiotherapy reduces the risk of deformational plagiocephaly in infants who have a preferred head position when lying supine.
Summary of: van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, L'Hoir MP, Helders PJM, Engelbert RHH (2008) Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children with Positional Preference--A randomised controlled trial. Arch Pediatr Adolesc Med 162: 712-718 [Prepared by Penny Agent, CAP Editor]Commentary
Deformational plagiocephaly (DP), a frequently occurring pediatric condition, is characterised by changes in skull shape in the absence of craniosynostosis. The cranial sutures are open and normal, therefore conservative management, such as physiotherapy and helmet therapy, is frequently used to treat this condition. Despite anecdotal evidence that suggests that these forms of management are effective in reducing DP, there is a paucity of high quality evidence that underpins these two treatment methods (Bialocerkowski et al 2005). Therefore, this high quality randomised controlled trial makes a welcome addition to the evidence regarding the effectiveness of treatments for DP. It provides strong evidence that physiotherapy with advice to parents is more effective than advice alone in reducing DP. Moreover, these effects are maintained for at least six months following physiotherapy.
From a clinical standpoint, the physiotherapy delivered seems intuitive, as it addressed asymmetries associated with infant handling using counterpositioning and parental education as well as stimulating motor development. This program appears to be relatively easy to replicate in the clinical setting, as it does not require costly equipment or advanced pediatric physiotherapy skills. Potentially, this physiotherapy program could be delivered in hospital and community-based settings. This study, however, does not provide evidence regarding the effectiveness of each type of physiotherapy technique. Thus clinicians should use all of these techniques as a package of care.
Although it appears that physiotherapy tends to decrease DP, cost-benefit analyses should be undertaken to determine the economic as well as physical benefit of treating infants with physiotherapy compared to advice and other forms of conservative management. Moreover DP is not only a cosmetic disorder, as DP has been found to be associated with developmental difficulties (Miller and Claren 2000). Because its secondary effects may be long lasting and costly to treat, consideration needs to be given to programs that prevent this disorder from occurring.
Andrea Bialocerkowski
The University of Melbourne
References
Bialocerkowski A et al (2005) Develop Med Child Neurol 47: 563-570.
Miller RI, Claren SK (2000) Pediatr 105: e26.
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| Title Annotation: | Appraisal: Critically Appraised Papers |
|---|---|
| Author: | Agent, Penny |
| Publication: | Australian Journal of Physiotherapy |
| Article Type: | Report |
| Geographic Code: | 8AUST |
| Date: | Dec 1, 2008 |
| Words: | 380 |
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