Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study.

PURPOSE: Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. METHODS: This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4-5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge. RESULTS: Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment. CONCLUSIONS: Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.

Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program.

PURPOSE: The aim of this study was to evaluate the results of a conservative intervention in infants with plagiocephaly according to their specific clinical profile. METHODS: Prospective clinical trial in which 104 infants with plagiocephaly accompanied or not by congenital or positional torticollis were referred to Early Care and Monitoring Unit (USAT) of San Cecilio Hospital in Granada, between 2009 and 2012. All the infants, grouped into three categories of severity, were included in the physiotherapy protocol until adequate craniofacial morphology and motor development were achieved. The study included an assessment of parents and infants. Parents were assessed with a questionnaire about the mother's medical history and birth-related issues. The assessment of infants included anthropometric measures, a positional assessment, the observation of the head, the assessment of severity, and motor development. RESULTS: Birth characteristics were similar in the total sample but showed different clinical profiles according to treatment aspects. More specifically, infants with severe plagiocephaly were referred to treatment later and spent more time in treatment; use of an orthotic helmet was also more prevalent in this category. There were also significant differences (P < 0.05) in the acquisition of specific gross motor skills depending on the severity of plagiocephaly. CONCLUSION: The findings suggest that the physiotherapy protocol presented is effective to correct plagiocephaly. Severity of plagiocephaly is a marker that should be taken into account when designing actions aimed at improving gross motor skill development.