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A prospective randomized trial on preventative methods for positional head deformity: physiotherapy versus a positioning pillow
Wilbrand J-F, Seidl M, Wilbrand M, Streckbein P, Bottger S, Pons-Kuehnemann J, Hahn A, Howaldt H-P
The Journal of Pediatrics 2013 Jun;162(6):1216-1221
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the impact of stretching exercises versus available bedding pillows on positional head deformities. STUDY DESIGN: Fifty children aged 5 months or younger with positional head deformity were included in this prospective clinical trial (n = 20 plagiocephaly, n = 10 brachycephaly, n = 20 combination). A random distribution was performed for treatment with the bedding pillow alone (n = 25) or with stretching exercises (n = 25) for 6 weeks. Anthropometric caliper measurements were done before and after that interval. Cranial vault asymmetry index (CVAI) and cranial index (CI) were calculated and analyzed using a descriptive statistical general linear model. RESULTS: CVAI in the stretching group was 2.09% for plagiocephaly and 2.34% for combined head deformities. Using the bedding pillow, CVAI was 3.01% in plagiocephal children and 2.86% for combined head deformity. The CI in the stretching group was 0.94% for isolated brachycephal children and 2.24% for combined head deformity. CI in the pillow group was 3.63% for brachycephaly and 3.23% in children with combined head deformities, respectively. CONCLUSIONS: Bedding pillows and stretching exercises both resulted in improvements in positional cranial deformation. For children with combined plagiocephaly and brachycephaly, improvement in cranial asymmetry was slightly greater when using bedding pillows versus stretching.

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