| Comparative analysis of goal attainment for helmet
therapy versus conservative management for positional
plagiocephaly in infants |
Bjoern Vogt1 
, Ariane Deutschle1
, Gerog Gosheger2, Adrien Frommer1
, Andrea Laufer1
, Henning Tretow1, Robert Roedl1
, Gregor Toporowski1
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1Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany
2General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany |
Correspondence:
Gregor Toporowski, Email: Gregor.toporowski@ukmuenster.de
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Received: 17 May 2025 • Revised: 2 July 2025 • Accepted: 4 July 2025 |
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| Abstract |
Background
Positional plagiocephaly (PP) is a common
cranial asymmetry of infancy. Its treatment options
include conservative management and helmet therapy.
However, the efficacy of each, particularly at achieving a
normal cranial shape, remains uncertain.
Purpose
This study aimed to compare the efficacy of
conservative management and helmet therapy for PP.
Methods
We retrospectively analyzed 199 infants with
PP treated in 2015–2024. A total of 72 patients with a minimum
treatment duration of 90 days and minimum
plagiocephaly severity level of 2 (Children's Healthcare
Atlanta Plagiocephaly Severity Scale) were included. Of
them, 36 received conservative management and 36 received
helmet therapy. Each infant underwent three-dimensional
surface scanning of the cranium (StarScanner).
Results
The mean±standard deviation age at treatment
initiation was 31.9±6.6 weeks in the helmet group versus
21.0±5.7 weeks in the conservative management group
(P<0.001). The average treatment duration was 21.9
(interquartile range [IQR], 15.3–31.4) weeks vs. 20.6 (IQR,
14.1–26.6) weeks (P=0.171), respectively. The monthly
correction speed of the cranial vault asymmetry index
(CVAI) was comparable between groups (0.66±2.09 vs.
0.64±0.55, P=0.964). Plagiocephaly degree was reduced
to level 1 in 9 of 36 patients (25%) who received helmet
therapy versus 4 of 36 patients (11%) in the conservative
management group (P=0.220), whereas a reduction in
severity level was observed in 24 of 36 (67%) versus 15 of
36 (42%), respectively (P=0.058). In the helmet group, an
earlier treatment initiation was significantly associated
with a greater severity level reduction (r=-0.480, P=0.003).
A longer treatment duration showed a trend toward a
greater reduction in CVAI (r=0.331, P=0.052). In the conservative
management group, both earlier treatment initiation
(r=-0.537, P<0.001) and longer treatment duration
(r=0.381, P=0.022) correlated significantly with improved
outcomes.
Conclusion
Conservative management and helmet
therapy reduced cranial asymmetry with no significant
difference in correction speed. An early treatment initiation
was the strongest predictor of improvement, while
a longer treatment duration was associated with better
outcomes. A trend toward a greater reduction in severity
level was observed with helmet therapy, suggesting
its
potential benefits in more severe cases. |
| Key Words:
Plagiocephaly, non-synostotic, Orthotic devices,
Skull abnormalities, Infant, Physical therapy modalities |
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