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Positional Plagiocephaly and Helmet Therapy
Positional plagiocephaly is a type of head shape deformity (cephalic disorder) that presents in infants and results from forces on the head during its most rapid period of growth.
As the brain grows at a rapid pace in early development, the cranial bones are pushed outward. When growth is limited in one direction (such as lying on a flat surface), growth will continue in the areas of least resistance. This process of deformation occurs over time and results in an asymmetrical or flattened head shape.
Craniosynostosis is the other main type of head shape deformity. This is a rare birth defect where there is premature closure of the cranial sutures or growth plates.
How is head shape assessed and measured?
The team will assess for various head shape concerns and determine a plan of care.
No head is perfectly symmetrical so understanding the degree and type of asymmetry is important in determining if treatment is indicated.
Severity is determined by clinical appearance and head measurements:
1. Cranial Vault Asymmetry (CVA)—the difference between the right and left diagonals. This number indicates the degree of asymmetry. A helmet may be recommended if the CVA is greater than 0.8-1.0 cm.
2. Cephalic Index (CI)—the ratio of width to length. The normal range is 80 - 85%. A helmet may be recommended if the CI is greater than 90%.
Tummy Time
Cases of mild positional plagiocephaly can be addressed through repositioning techniques. This approach is most effective for infants less than 4 months of age. Repositioning techniques include:
Increasing tummy time
Varying positions in the crib
Limiting time, while awake, with contact on the back of the head (bouncy seats, swings)
When repositioning is not effective at improving head shape by 4 months, helmet therapy should be considered.
When is the Ideal Time to Start helmet therapy?
Cranial Growth Chart
Average rate of skull growth relative to age in months.
Treatment Options by Age
Cases of moderate to severe positional plagiocephaly are treated with helmet therapy. The ideal time to start therapy is 4 to 6 months, but therapy can still be effective for children beyond 6 months of age.
How Does Helmet Therapy Work?
A custom remolding helmet improves head shape by holding the prominent areas and guiding future growth of the flat areas into the space within the helmet. It does not squeeze or push the head.
The Cambio helmet by Orthotic Care Services is custom made for your child using a digital scanner that records head shape and is safe and extremely accurate.
How long is therapy?
Helmet therapy typically last 3 to 6 months.
How Successful is Helmet Therapy?
Helmet therapy improves head shape if:
There is head growth and
Helmet is worn consistently for 23 hrs. per day
What happens at the Fitting appointment?
The helmet will be ready for the fitting appointment 8 business days after the Patient Treatment Plan form is returned.
You will be contacted by one of our patient care coordinators to schedule your child's fitting appointment.
The fitting appointment will take place at one of our Orthotic Care Services clinics. This may be a different location from where you were evaluated.
The appointment will take 1.5 hours for a single child and 2-2.5 hours for twins. We will ensure proper fit, discuss care, break-in schedule, and donning instructions.
Follow-Up Schedule
We will see you every 2 to 3 weeks for follow-up appointments.
We will check the fit of the helmet, take measurements, assess the shape of your child's head, and make any necessary adjustments.
These appointments will take 30 minutes for a single baby and 45 minutes for twins.
Occasionally, adjustment appointments may be needed to address any skin irritations that occur.
The follow-up appointments will continue until the goals are met or until no more correction is possible.
Families may complete the process by returning for a quick re-assessment, measurements, and final scan to compare to the original scan.
