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Understanding the Treatment Cranial Remolding Helmets

Chrysta Irolla, MS, MSPO, CPOCorin Shirley, MSPO, COUCSF Orthotic & Prosthetic Center

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Cranial Anatomy & Deformation

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Infant Cranial Anatomy

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Netter FH. Atlas of human anatomy. Summit, N.J.: Ciba-Geigy, 1994.

Newborn Cranial Anatomy

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Types

3/28/18https://www.oplabs.net/services/cranial-remodelling-helmets5

▪ Plagiocephaly:

• Trapezoidal shape

• Positional or Unicornal/Unilamdoidal Synostosis

▪ Brachycephaly:

• Wide head shape

• Positional or Coronal Synostosis

▪ Scaphocephaly:

• Narrow head shape

• Positional or Sagittal Synostosis

Etiology

▪ Unknown

▪ Intrauterine positioning

▪ Environmental positioning

▪ Pre-natal/neonatal Factors:

• Premie

• Torticollis

• Hypotonia

• Low birth weight

• First born

• Multiple births

• Prolonged labor

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Torticollis

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Torticollis Repositioning

http://ossekeag.ca/family-matters-benefits-pediatric-massage/

Incidence and Prevalence:

▪ Back to Sleep Program (1992) for SIDS

▪ Age dependent with deformation occurring

primarily from 0-6 months of age

▪ 2:1 (Males: Females)

▪ 2x more common to have right side

flattening

▪ 80-90% of torticollis patients have

positional plagiocephaly

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Cranial Helmet Treatment

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Effectiveness

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▪ Does helmet therapy really work?

• Objective: hold prominent sides of the head and allow room for flattened region to grow

• Only works if patient GROWS

▪ Orthomerica STARband

• Compliance

• Age

• Circumference Percentile

• Fit

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Effectiveness

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84 patient’s comparing a helmet group to a no helmet group beginning at 5 months and ending at 12 months of age.

“No conclusive evidence that a significant or clinically meaningful difference in improvement of skull shape was found at the 24-month follow-up between the two groups”

MD Assessment ▪ Changes with repositioning & PT

▪ Developmental milestones

▪ Preferential positioning

▪ Gestational age

▪ Birth complications

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Treatment Timeline

▪ 0-3 months:

• Observation

• Repositioning - “Tummy Time”

• Physical Therapy for Torticollis

• Surgery if necessary

▪ 4-12 months: Cranial Remolding Helmet

▪ > 12 months: treatment is less effective

▪ 18 months: end of treatment

3/28/1814 http://ossekeag.ca/family-matters-benefits-pediatric-massage/

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Cranial Helmet Initial Evaluation

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Initial Evaluation

▪ History

• Repositioning

• Physical therapy

• Delivery/pregnancy complications

▪ Visual assessment of head shape

▪ Shape Capture:

• Laser scan to create 3-D image for measurements

• Hand Measurements

• Casting

▪ Educate family on treatment process (~6-8 appointments)

▪ Submit for insurance authorization

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Plagiocephaly Signs

▪ Parallelogram Shape

▪ Frontal protuberance & ipsilateral occipital flattening

▪ Facial asymmetry

▪ Ear Position

▪ Unilateral bald spot

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Deformational Plagiocephaly Severity

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Mild DP. Moderate DP. Severe DP.

Severity scale developed by Plank is 2004 is primarily based upon clinical presentation of

deformity rather than linear measurements.

Brachycephaly Signs

▪ Wide width

▪ Symmetric posterior flattening

▪ Frontal bossing

▪ Midline bald spot

▪ Increased cranial vault

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Preparing the Scan

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Process of Scanning

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Initial Evaluation Scan

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Measurements

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Head

Circumference

24

Measurements

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WHO Cranial Growth Trends:

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Helmet Preparation

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Cons Pros

Skin Irritation It Works!

Sweat Protective

Smell Customizable

Sleep Adjustment

Helmet Types

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▪ Copolymer

• Bivalved

• Side Opening

▪ Surlyn (clear material)

• Bi-valved

• Side Opening

Order the Helmet

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▪ Send scan to Orthomerica

▪ Orthomerica STARband

• 5/32” copoly shell

• ½” pelite line

• Stop gap foam insert

• Velcro Closure

‒ Opposite side of flattening

‒ Chafe attachment anterior to opening

• Finished trimlines

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Cranial Helmet Fitting

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Fitting Appointment

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▪ 1-2 Hour appointment

▪ Trim lines are adjusted to the proper length:

• Above the eyebrow

• Around the ears

▪ Helmet motion checked

• Rotation

• Forward tilt

▪ Contact areas are confirmed

Contact & Relief Areas

▪ DP: Restricting growth in longer diagonal and allowing growth in the flattened regions.

▪ Brachycephaly: Allow posterior growth while restricting anterior and lateral growth

▪ Scaphocephaly: Allow lateral growth while maintaining the anterior and posterior shape

▪ Rarely correction of ear positioning

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Brachycephaly

Plagiocephaly

Donning the Helmet

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Break-in Schedule & Maintenance

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▪ Remove for fevers

▪ Wash daily

▪ Layer less of clothing for heat adjustment

▪ All red marks should go away within 1 hour

▪ If skin irritation discontinue use until an adjustment is made

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Follow-up Appointment

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1 Week Follow-up

▪ Talk with family ▪ Assess redness:

• Duration

• Intensity

▪ Make adjustments when:

• Redness lasts >1 hour after helmet removal

• Skin is compromised

▪ Check to make sure there isn't excessive A-P tilt or rotation

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Routine Follow-ups

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End of Treatment

▪ Clinically

• DP: Asymmetry is < 5mm

• Brachycephaly: Cephalic ratio < 87%

▪ Efficacy of the helmet significantly reduces after 15 months of age

▪ Parents make the final determination

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Takeaways

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▪ Helmets are;

• A commitment

• Optional for cosmetic correction

‒ Quantitative Measurements

‒ Qualitative

▪ Parent decides when treatment ends

QUESTIONS?

Routine Follow-ups

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