title: Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Positional Plagiocephaly: The Role of Physical Therapy.
abstract: BACKGROUND
  Evidence-based guidelines are not currently available for the treatment of positional plagiocephaly and, in particular, for the use of physical therapy for treatment.
  
  
  OBJECTIVE
  To answer the question: "does physical therapy provide effective treatment for positional plagiocephaly?" Treatment recommendations are created based on the available evidence.
  
  
  METHODS
  The PubMed and the Cochrane Library were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and recommendations were made based on the quality of the literature (Levels I-III).
  
  
  RESULTS
  Three studies met criteria for inclusion. Two randomized, controlled trials (Class I and Class II) and 1 prospective study assessing plagiocephaly as a secondary outcome measure (Class III) were included.
  
  
  CONCLUSIONS
  Within the limits of this systematic review, physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly. There is no significant difference between physical therapy and a positioning pillow as a treatment for positional plagiocephaly. However, given the American Academy of Pediatrics' recommendation against soft pillows in cribs to ensure a safe sleeping environment for infants, physical therapy must be recommended over the use of a positioning pillow. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_4.
authors.affiliation: *Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; ‡Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center; Le Bonheur Children's Hospital; Memphis, Tennessee; §Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ∥Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; #Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; **St. Louis Cleft-Craniofacial Center, SSM Health Cardinal Glennon Children's Hospital at Saint Louis University, Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri; ‡‡Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; §§Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶¶Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‖‖Advocate Children's Hospital, Oak Lawn, Illinois; ##Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Goryeb Children's Hospital of Atlantic Health Systems Morristown, New Jersey.
authors.forename: Lissa C
authors.initials: LC
authors.lastname: Baird
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Flannery
authors.forename: David F
authors.initials: DF
authors.lastname: Bauer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Beier
authors.forename: Susan
authors.initials: S
authors.lastname: Durham
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Lin
authors.forename: Catherine
authors.initials: C
authors.lastname: McClung-Smith
authors.forename: Laura
authors.initials: L
authors.lastname: Mitchell
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Nikas
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Tamber
authors.forename: Rachana
authors.initials: R
authors.lastname: Tyagi
authors.forename: Catherine
authors.initials: C
authors.lastname: Mazzola
mesh_terms: D006801:Humans; D007223:Infant; D019317:Evidence-Based Medicine; D000069471:Neurosurgeons / Q000458:organization & administration; D026741:Physical Therapy Modalities; D049068:Plagiocephaly, Nonsynostotic / Q000628:therapy