The AAO Journal, 2025/06, 35(2):15. doi: 10.53702/i2375-5717-35.2.13, type of study: ,cr,

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

case report [736]
helmet therapy [3]
infants [211]
male [861]
OMT [3925]
osteopathic manipulative treatment [3946]
pediatrics [573]
plagiocephaly [57]

Abstract:

Introduction: Positional Plagiocephaly (PP) affects up to 47% of newborns and infants, characterized by asymmetric occipital flattening due to external forces, typically manifesting within the first few months of life. Conservative management includes caregiver education, repositioning, physical therapy, and helmet therapy (HT) for severe cases. While research supports individual use of osteopathic manual therapy (OMT) and HT, there is a paucity of data on their adjunctive use. This case examines the efficacy of combined OMT and HT in severe PP. Case: A 4-month-old male presented with concerning head shape. History revealed persistent supine positioning, preferential right-sided feeding, inability to tolerate tummy-time or meet motor milestones, and in utero breech presentation. Physical exam and anthropometric measurements revealed severe right-sided positional plagiocephaly. Osteopathic exam identified somatic dysfunctions (SD’s) in cranial, cervical, and thoracolumbar regions. Persistent craniocervical and thoracolumbar junction SD's were addressed at multiple visits. OMT aimed to address SD’s limiting active motion and tolerance to tummy time, normalize cranial bone motion, balance dural tension, and improve CSF flow. Results: After 7 OMT sessions over 2.25 months with 1.4 months of HT, Cranial Vault Asymmetry Index (CVAI) decreased from 12.9% (severe) to 6.16% (mild) and Argenta classification improved from type 5 to type 2. The infant also increased tummy-time tolerance (from 5-10 minutes to over 30 minutes), met all CDC 6-month motor milestones, and required HT for < 2 months. Discussion: This case highlights the successful use of OMT and HT in severe PP. Viewing the infant through an osteopathic lens allowed for the contributing factors of environment, birth history, and crown-to-coccyx somatic dysfunctions to be appreciated and simultaneously addressed. These results underscore the value of combined therapy and encourage further research.