Abstract
BackgroundPositional 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.MethodsThirty-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).ResultsCVAI 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).ConclusionManual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program.Trial registrationTrial registration number: NCT03659032; registration date: September 1, 2018. Retrospectively registered.
Highlights
Study population A total of 34 subjects were included in the study.Seventeen were assigned to the pediatric integrative manual therapy (PIMT) group and 17 to the control group
There was a significant increase in cranial length in the PIMT group (7.57 ± 2.33 cm) in contrast with the control group (4.25 ± 2.47 cm) (p = 0.001)
cranial vault asymmetry index (CVAI) decreased more in the PIMT group (− 3.72 ± 1.40%) in contrast with the control group (− 0.34 ± 1.72%) (p = 0.000)
Summary
Head and neck asymmetries are very common in typical healthy newborns [1]. Within these asymmetries, positional plagiocephaly (PP) is a general term describing cranial distortion from pre- or postnatal forces on the infant head [2, 3]. 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]
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