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Helmet Treatment of Deformational Plagiocephaly: The Relationship between Age at Initiation and Rate of Correction

Seruya, Mitchel M.D.; Oh, Albert K. M.D.; Taylor, Jonathan H.; Sauerhammer, Tina M. M.D.; Rogers, Gary F. M.D., J.D., M.B.A.

Plastic and Reconstructive Surgery: January 2013 - Volume 131 - Issue 1 - p 55e–61e
doi: 10.1097/PRS.0b013e3182729f11
Pediatric/Craniofacial: Original Articles
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Background: The purpose of this study was to evaluate the relationship between age at initiation of helmet therapy for deformational plagiocephaly and the rate of correction.

Methods: Infants treated for deformational plagiocephaly with a helmet orthosis between 2009 and 2010 were included. Patients were stratified prospectively by the age at which treatment was initiated: group 1, younger than 20 weeks (n = 26); group 2, 20 to 23.9 weeks (n = 59); group 3, 24 to 27.9 weeks (n = 82); group 4, 28 to 31.9 weeks (n = 62); group 5, 32 to 35.9 weeks (n = 45); group 6, 36 to 40 weeks (n = 29), and group 7, older than 40 weeks (n = 43). Pretreatment and posttreatment calvarial asymmetry was measured using direct anthropometry and reported as a transcranial difference.

Results: Three hundred forty-six infants were included; initial transcranial difference was equivalent on all paired-group comparisons. Duration of helmet therapy positively correlated with age at initiation (r = 0.89, p < 0.05). The rate of change in transcranial difference correlated negatively with age at treatment onset (r = –0.88, p < 0.05): group 1, 0.93 mm/week; group 2, 0.64 mm/week; group 3, 0.59 mm/week; group 4, 0.56 mm/week; group 5, 0.41 mm/week; group 6, 0.42 mm/week; and group 7, 0.42 mm/week). At the conclusion of therapy, all groups had improved calvarial symmetry, albeit less completely in groups 6 and 7.

Conclusions: The correction rate of plagiocephaly with helmet therapy decreases with increasing infant age; after 32 weeks, there is a slow and relatively constant rate of change. Improvement can still be achieved in infants older than 12 months.


Washington, D.C.

From the Department of Plastic and Reconstructive Surgery, Children's National Medical Center, and George Washington University School of Medicine.

Received for publication May 10, 2012; accepted July 20, 2012.

Presented at the 69th Annual Meeting of the American Cleft Palate and Craniofacial Association, in San Jose, California, April 17 through 21, 2012.

Disclosure: Mr. Taylor is an employee of Boston Brace. The remaining authors have no financial or commercial interests to disclose.

Gary F. Rogers, M.D., J.D., M.B.A.; Department of Plastic and Reconstructive Surgery, Children's National Medical Center, 111 Michigan Avenue NW, 4th Floor West Wing, Washington, D.C. 20010,

©2013American Society of Plastic Surgeons