Hanger releases findings that support cranial orthosis treatment in infants

Hanger, in collaboration with the Texas Children’s Hospital, has released new data supporting the efficacy of cranial remolding orthoses in the treatment of positional skull deformation in infants. The guidelines have been published in the Journal of Neurosurgery: Pediatics.

The findings are the product of a 7-year study conducted at the Texas Children’s Craniofacial Clinic. During that time, Jim Brookshier, CPO, LPO, used 3-D laser surface scanning to study more than 500 patients pre- and post-treatment to offer insights into the efficacy of orthotic intervention and factors related to treatment adherence, Hanger reported.

To examine the factors associated with adherence to recommended treatment among young patients with positional skull deformity, specifically positional plagiocephaly, the researchers conducted a retrospective chart review from a single institution from 2007 to 2014. They examined risk factors, treatment for positional head shape deformity and parent-reported adherence. They used univariate and multivariate analyses to determine the impact of patient clinical and demographic adherence characteristics. They also looked to examine the impact of these variables on the change in measured oblique diagonal difference on head-shape surface scanning both before and after treatment.

Overall, 991 infants aged younger than 1 year were evaluated for cranial positional deformity at the clinic. The most common conditions were occipital plagiocephaly (69.5%) and occipital brachycephaly (18.4%), as well as a combination of both deformities (12.1%). Recommended treatment included repositioning, physical therapy if indicated, or orthotic treatment with a customized cranial orthosis. Overall, 884 patients attended at least one follow-up appointment and 552 patients completed their treatment. These patients had pre- and posttreatment 2-D surface scanner evaluations. The average patient age was 6.2 months.

Repositioning or physical therapy was recommended as the first treatment in 54.8% of the 991 cases. Of those, 25.2% were moved to helmet therapy after 4 weeks to 8 weeks of no improvement. In all other cases, cranial orthosis was the starting treatment recommendation, as repositioning and physical therapy had already failed before the patients entered the program.

According to the researchers, the improvements in oblique diagonal difference were 36.7% for cranial orthosis; 33.5% for repositioning, physical therapy and cranial orthosis; and 15.1% for repositioning and physical therapy.

In addition, the researchers found that corrected age, insurance, diagnosis, recommended treatment, and distance to provider from patient’s residence were all factors associated with treatment completion. Patients with commercial insurance, those diagnosed with both brachycephaly and plagiocephaly, those recommended for treatment with cranial orthosis, and those living in proximity to the provider were more likely to complete treatment.

“Earlier age at presentation and type of treatment impact the degree of measured deformational head shape correction in positional plagiocephaly,” the researchers wrote. Adding the study “suggests that treatment with a custom [cranial orthosis] CO can result in more improvement in objective measurements of head shape.”

In addition, the researchers concluded that insurance type, degree of head shape deformity and types of recommended treatment can influence adherence rates to recommended treatments.

According to a Hanger statement, this was among the largest studies of its kind to be done on cranial orthosis outcomes, and is “another example of Hanger Clinic devoting long-term efforts to developing CPGs for the O&P industry.”


Lam S, et al. J Neurosurg Pediatr. 2017;doi:10.3171/2016.9.PEDS16278.


Lam S, et al. J Neurosurg Pediatr. 2017;doi:10.3171/2016.9.PEDS16275.


Disclosure: The researchers report no relevant financial disclosures.

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