title: Effectiveness of conservative therapy and helmet therapy for positional cranial deformation.
abstract: BACKGROUND
  The authors investigated the effectiveness of conservative (repositioning therapy with or without physical therapy) and helmet therapy, and identified factors associated with treatment failure.
  
  
  METHODS
  A total of 4378 patients evaluated for deformational plagiocephaly and/or deformational brachycephaly were assigned to conservative (repositioning therapy, n = 383; repositioning therapy plus physical therapy, n = 2998) or helmet therapy (n = 997). Patients were followed until complete correction (diagonal difference <5 mm and/or cranial ratio <0.85) or 18 months. Rates of correction were calculated, and independent risk factors for failure were identified by multivariate analysis.
  
  
  RESULTS
  Complete correction was achieved in 77.1 percent of conservative treatment patients; 15.8 percent required transition to helmet therapy (n = 534), and 7.1 percent ultimately had incomplete correction. Risk factors for failure included poor compliance (relative risk, 2.40; p = 0.009), advanced age (relative risk, 1.20 to 2.08; p = 0.008), prolonged torticollis (relative risk, 1.12 to 1.74; p = 0.002), developmental delay (relative risk, 1.44; p = 0.042), and severity of the initial cranial ratio (relative risk, 1.41 to 1.64; p = 0.044) and diagonal difference (relative risk, 1.31 to 1.48; p = 0.027). Complete correction was achieved in 94.4 percent of patients treated with helmet therapy as first-line therapy and in 96.1 percent of infants who received helmets after failed conservative therapy (p = 0.375). Risk factors for helmet failure included poor compliance (relative risk, 2.42; p = 0.025) and advanced age (relative risk, 1.13 to 3.08; p = 0.011).
  
  
  CONCLUSIONS
  Conservative therapy and helmet therapy are effective for positional cranial deformation. Treatment may be guided by patient-specific risk factors. In most infants, delaying helmet therapy for a trial of conservative treatment does not preclude complete correction.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Chicago and Park Ridge, Ill. From the Ann and Robert H. Lurie Children's Hospital of Chicago; the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine; and the Advocate Medical Group, Lutheran General Hospital.
authors.forename: Jordan P
authors.initials: JP
authors.lastname: Steinberg
authors.forename: Roshni
authors.initials: R
authors.lastname: Rawlani
authors.forename: Laura S
authors.initials: LS
authors.lastname: Humphries
authors.forename: Vinay
authors.initials: V
authors.lastname: Rawlani
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicari
mesh_terms: D002508:Cephalometry; D003398:Craniosynostoses / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006260:Head Protective Devices; D006801:Humans; D007223:Infant; D008297:Male; D010349:Patient Compliance; D026741:Physical Therapy Modalities; D049068:Plagiocephaly, Nonsynostotic / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome