The Journal of the American Osteopathic Association, 2018/11, 118(11):e158-e159. doi: 10.7556/jaoa.2018.163, type of study: ,cs,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

case series [63]
children [321]
cranio-sacral osteopathy [231]
cranium [85]
infants [211]
pediatrics [573]
plagiocephaly [57]

Abstract:

Hypothesis: The application of OMT, with emphasis on osteopathic cranial manipulative medicine (OCMM), will improve the cranial bone symmetry of children diagnosed with plagiocephaly. Background: Estimates of the occurrence of plagiocephaly, infants with a cranial bone deformity, vary widely. One source reports that plagiocephaly is considered a “rare disease,” occurring in fewer than 200,000 individuals in the US.1 However, a multisite clinical trial reported, “Of the 440 infants assessed, 205 were observed to have some form of plagiocephaly. The incidence of plagiocephaly in infants at 7 to 12 weeks of age was estimated to be 46.6%. Of all infants with plagiocephaly, 63.2% were affected on the right side and 78.3% had a mild form.”2 A study from the UCSD Medical School's Dysmorphology Clinic reported, “Seventy-three percent of newborns had at least 1 asymmetry, (10% had more than 1) … . Forty-two percent of infants had facial asymmetry, 62% had head asymmetry, and 13% had mandible asymmetry.”3 In 1966, Frymann reported that 88% of the 1250 newborns had some identifiable mal-alignment in the form of cranial bone strain patterns.4 Methods: Osteopathic physicians at the Osteopathic Center for Children, San Diego, conducted a case series study to investigate the impact of OCMM on 17 infants with diagnosed plagiocephaly. Materials: We measured head asymmetry using anthropometric caliper and photographic measurement instruments to determine cranial vault asymmetry and calculate the cranial vault asymmetry index (CVAI). The measurements were made at initial visit and then after 5 to 6 cranial OMM visits. OCMM sessions focused on cranial base, occipito-mastoid suture, and temporal bones. Results: Pre- to posttest comparisons showed reduced skull asymmetry, decreased occipital flattening, and increased circumference and cranial vault index (CVAI). Mean baseline CVAI was 6.1% (grade 3 severity), and mean follow-up CVAI was 3.2% (grade 1 severity). Paired t tests revealed statistically significant differences in CVAI (P<.01) and severity grades (P<.01). No adverse events were reported. Conclusion: Our findings support our hypothesis that OCMM is successful in reducing cranial abnormalities and is a gentle, low-risk treatment for pediatric plagiocephaly.