Guidelines

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients with Positional Plagiocephaly

Mandeep S. Tamber, Dimitrios Nikas, Alexandra Beier, Lissa C. Baird, David F. Bauer, Susan Durham, Paul Klimo, Alexander Y. Lin, Catherine Mazzola, Catherine McClung-Smith, Laura Mitchell, Rachana Tyagi, Ann Marie Flannery

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

BACKGROUND: No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional plagiocephaly. OBJECTIVE: To address the clinical question: "Does helmet therapy provide effective treatment for positional plagiocephaly?" and to make treatment recommendations based on the available evidence. METHODS: The US National Library of Medicine Medline database and the Cochrane Library were queried by 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, based on the quality of the literature, recommendations were made (Levels I-III). RESULTS: Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II). CONCLUSION: There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter-5.

Original languageEnglish (US)
Pages (from-to)E632-E633
JournalNeurosurgery
Volume79
Issue number5
DOIs
StatePublished - Nov 1 2016

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Nonsynostotic Plagiocephaly
Head Protective Devices
Orthotic Devices
Guidelines
Therapeutics
Medical Subject Headings
National Library of Medicine (U.S.)
Libraries
Randomized Controlled Trials
Retrospective Studies
Head
Databases
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Guidelines : Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients with Positional Plagiocephaly. / Tamber, Mandeep S.; Nikas, Dimitrios; Beier, Alexandra; Baird, Lissa C.; Bauer, David F.; Durham, Susan; Klimo, Paul; Lin, Alexander Y.; Mazzola, Catherine; McClung-Smith, Catherine; Mitchell, Laura; Tyagi, Rachana; Flannery, Ann Marie.

In: Neurosurgery, Vol. 79, No. 5, 01.11.2016, p. E632-E633.

Research output: Contribution to journalReview article

Tamber, MS, Nikas, D, Beier, A, Baird, LC, Bauer, DF, Durham, S, Klimo, P, Lin, AY, Mazzola, C, McClung-Smith, C, Mitchell, L, Tyagi, R & Flannery, AM 2016, 'Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients with Positional Plagiocephaly', Neurosurgery, vol. 79, no. 5, pp. E632-E633. https://doi.org/10.1227/NEU.0000000000001430
Tamber, Mandeep S. ; Nikas, Dimitrios ; Beier, Alexandra ; Baird, Lissa C. ; Bauer, David F. ; Durham, Susan ; Klimo, Paul ; Lin, Alexander Y. ; Mazzola, Catherine ; McClung-Smith, Catherine ; Mitchell, Laura ; Tyagi, Rachana ; Flannery, Ann Marie. / Guidelines : Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients with Positional Plagiocephaly. In: Neurosurgery. 2016 ; Vol. 79, No. 5. pp. E632-E633.
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title = "Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients with Positional Plagiocephaly",
abstract = "BACKGROUND: No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional plagiocephaly. OBJECTIVE: To address the clinical question: {"}Does helmet therapy provide effective treatment for positional plagiocephaly?{"} and to make treatment recommendations based on the available evidence. METHODS: The US National Library of Medicine Medline database and the Cochrane Library were queried by 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, based on the quality of the literature, recommendations were made (Levels I-III). RESULTS: Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II). CONCLUSION: There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter-5.",
author = "Tamber, {Mandeep S.} and Dimitrios Nikas and Alexandra Beier and Baird, {Lissa C.} and Bauer, {David F.} and Susan Durham and Paul Klimo and Lin, {Alexander Y.} and Catherine Mazzola and Catherine McClung-Smith and Laura Mitchell and Rachana Tyagi and Flannery, {Ann Marie}",
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T2 - Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients with Positional Plagiocephaly

AU - Tamber, Mandeep S.

AU - Nikas, Dimitrios

AU - Beier, Alexandra

AU - Baird, Lissa C.

AU - Bauer, David F.

AU - Durham, Susan

AU - Klimo, Paul

AU - Lin, Alexander Y.

AU - Mazzola, Catherine

AU - McClung-Smith, Catherine

AU - Mitchell, Laura

AU - Tyagi, Rachana

AU - Flannery, Ann Marie

PY - 2016/11/1

Y1 - 2016/11/1

N2 - BACKGROUND: No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional plagiocephaly. OBJECTIVE: To address the clinical question: "Does helmet therapy provide effective treatment for positional plagiocephaly?" and to make treatment recommendations based on the available evidence. METHODS: The US National Library of Medicine Medline database and the Cochrane Library were queried by 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, based on the quality of the literature, recommendations were made (Levels I-III). RESULTS: Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II). CONCLUSION: There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter-5.

AB - BACKGROUND: No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional plagiocephaly. OBJECTIVE: To address the clinical question: "Does helmet therapy provide effective treatment for positional plagiocephaly?" and to make treatment recommendations based on the available evidence. METHODS: The US National Library of Medicine Medline database and the Cochrane Library were queried by 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, based on the quality of the literature, recommendations were made (Levels I-III). RESULTS: Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II). CONCLUSION: There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter-5.

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DO - 10.1227/NEU.0000000000001430

M3 - Review article

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