ABSTRACT
In 1992, the American academy of paediatrics has recommended that infants be placed on their backs to sleep, because prone sleeping has been correlated with sudden infant death syndrome. Following this article, medical paediatric community has documented an exponential increase in the diagnosis of posterior cranial deformities, which were considered as the consequence of unrelieved pressure onto the occiput during infant sleep. These last 15 years, management of posterior positional plagiocephaly has evolved but is still not standardized; it varies according to local specificities, and medical or parental preferences. Treatment of deformational plagiocephaly includes preventive counseling, repositioning adjustments and exercises, physiotherapy, osteopathy, treatment by dynamic cranial orthosis. On extremely rare occasions, corrective surgery is proposed. This article aims at reviewing the epidemiologic, diagnostic, and various therapeutic options of posterior positional plagiocephaly.
Subject(s)
Plagiocephaly, Nonsynostotic , Sudden Infant Death/prevention & control , Supine Position , Age Factors , Craniosynostoses/diagnostic imaging , Exercise , Follow-Up Studies , Humans , Infant , Infant, Newborn , Orthotic Devices , Physical Therapy Modalities , Plagiocephaly, Nonsynostotic/etiology , Plagiocephaly, Nonsynostotic/therapy , Skull/diagnostic imaging , Sleep , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
PRINCIPLES: Since the recommendation that infants sleep in the supine position, there has been an increase in cases of posterior positional plagiocephaly. Even though this condition is a purely cosmetic problem, if it is severe it may affect the child psychologically. Positioning may help in mild or moderate cases, but more active treatment may be necessary in severe cases. METHODS: A prospective study of 260 children treated by dynamic orthotic cranioplasty for posterior positional plagiocephaly was conducted in Lausanne from 1995 to 2001. Construction of these cranial remodelling helmets is decribed in detail. RESULTS: The treatment lasted 3 months on average, was effective, well tolerated, and had zero morbidity. The ideal period for initiating this therapy is between the ages of 4 and 6 months. CONCLUSION: The remodelling helmet is a convincing option which can be recommended in infants with posterior positional plagiocephaly whose skull deformity is not satisfactorily corrected by physiotherapy. It should always be used before surgery is considered for patients with recognised positional plagiocephaly in the first year of life.
Subject(s)
Head Protective Devices , Orthotic Devices , Plagiocephaly, Nonsynostotic/therapy , Equipment Design , Female , Humans , Infant , Male , Supine Position , SwitzerlandABSTRACT
Rehabilitation of the hand after flexor tendon injuries in zone 2 is a challenge for both surgeons and therapists. Prevention of adherences is based on early controlled motion programs. Two different and therefore often complementary protocols are presented: 1. Kleinert: an active extension--passive flexion method; 2. Duran: a controlled passive method, as well as the splints required at this early stage of reeducation. The angles of flexion for the wrist and the metacarpal joints are discussed. When the splint is removed, active exercises and activities are proposed according to the interval from the operation and up to return to work. Static splints used to promote analytic movements, and dynamic ones used against stiffness are shown. Treatment of scar is also demonstrated.