title: Comparison of a modifiable cranial cup versus repositioning and cervical stretching for the early correction of deformational posterior plagiocephaly.
abstract: BACKGROUND
  Deformational occipital flattening is the most common cause of abnormal head shape. Current treatment calls for repositioning and cervical stretching in infants younger than 5 months. The authors assessed the effectiveness of a modifiable cranial cup compared to repositioning and cervical stretching to correct early deformational plagiocephaly.
  
  
  METHODS
  This nonrandomized, prospective clinical trial used historical controls. The treatment and control groups consisted of infants, younger than 4 months, referred for deformational posterior plagiocephaly. The control children were managed by repositioning and cervical stretching exercises. An adjustable concave cranial cup was used in the treated group. Infants were examined at the initial and final visits by a single examiner. Calvarial asymmetry was measured using a large cranial caliper. Active head rotation and degree of rotational asymmetry were estimated to the nearest 10 degrees.
  
  
  RESULTS
  There were no statistically significant differences between the control (n = 23) and treatment groups (n = 24) with respect to gestational age at birth, age at initial visit, initial head rotational asymmetry, initial transcranial difference, final head rotational asymmetry, and age at final evaluation. Mean time between initial and final evaluation was 56.3 days for the treatment group and 61.6 days for the control group. The mean transcranial difference decreased from 11.2 to 3.5 mm in the treatment group, and from 9.0 to 8.0 mm in the control group (p = 0.000).
  
  
  CONCLUSIONS
  The cranial cup, a modifiable concave resting surface, is significantly more effective than repositioning and physical therapy for correcting early deformational plagiocephaly.
authors.affiliation: Boston, Mass. From the Craniofacial Center, Department of Plastic Surgery, Children's Hospital, and Harvard Medical School.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
authors.forename: James
authors.initials: J
authors.lastname: Miller
authors.forename: John B
authors.initials: JB
authors.lastname: Mulliken
mesh_terms: D005081:Exercise Therapy; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D007223:Infant; D008297:Male; D009777:Occipital Bone; D009989:Orthotic Devices; D049068:Plagiocephaly, Nonsynostotic / Q000628:therapy*; D011446:Prospective Studies; D012886:Skull; D016683:Supine Position