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European Journal of Pediatrics
Published in: European Journal of Pediatrics 3/2006

01-03-2006 | Original Paper

Plagiocephalometry: a non-invasive method to quantify asymmetry of the skull; a reliability study

Authors: Leo A. van Vlimmeren, Tim Takken, Léon N. A. van Adrichem, Yolanda van der Graaf, Paul J. M. Helders, Raoul H. H. Engelbert

Published in: European Journal of Pediatrics | Issue 3/2006

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Abstract

Deformational plagiocephaly (DP) in newborns and very young children is a common problem in daily practice. The intrarater and interrater reliability of plagiocephalometry (PCM), a new, non-invasive, inexpensive instrument to assess and quantify the asymmetry of the skull, is evaluated at the outpatient Department of Physical Therapy of the Bernhoven Hospital at Veghel, The Netherlands. Using a thermoplastic material to mould the outline of the infant’s skull, a reproduction of the skull shape is performed on paper, allowing for accurate cephalometric measurements. Fifty children (aged 0–24 months), with or without positional preference of the head, and with or without DP, were measured three times by two separate, experienced pediatric physical therapists. Intraclass correlation coefficients (ICC) regarding the measurements of the drawn lines were all above 0.92 (intrarater reliability) and 0.90 (interrater reliability). The ICCs of the plagiocephaly indicators ear deviation (ED), antero-sinistra−antero-dextra (ASAD), postero-dextra−postero-sinistra (PDPS) and oblique diameter difference (ODD) were 0.88, 0.57, 0.92 and 0.96, respectively, for the intrarater reliability and 0.90, 0.65, 0.94 and 0.96, respectively, for the interrater reliability. The ICCs of the two indices oblique diameter difference index (ODDI) and cranial proportional index (CPI) were 0.97 and 0.96, respectively, for the intrarater reliability and 0.95 and 0.92, respectively, for the interrater reliability. The limits of agreement according to Bland Altman, comprising 95% of the differences between two measurements (2 sd), were 4.3 mm (ED), 5.9 mm (ASAD), 3.0 mm (PDPS), 3.4 mm (ODD), 2.7% (ODDI) and 4.5% (CPI) for the intrarater reliability, and 3.7 mm (ED), 5.2 mm (ASAD), 2.4 mm (PDPS), 3.3 mm (ODD), 2.9% (ODDI) and 5.8% (CPI) for the interrater reliability. Conclusion: We conclude that PCM is an easy-to-apply, non-invasive and reliable measurement instrument to assess skull asymmetry with good clinical accuracy and low application costs. PCM might serve as an instrument to be used in all levels of care for children with DP, and might provide information concerning the natural course of DP, as well as the assessment of the effects of conservative treatment strategies on DP.
Literature
1.
Argenta LC, Davis LR, Wilson JA, Bell WO (1996) An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 7:5–11PubMedCrossRef
2.
Argenta L, David L, Thompson J (2004) Clinical classification of positional plagiocephaly. J Craniofac Surg 15:368–372PubMedCrossRef
3.
Balan P, Kushnerenko E, Sahlin P, Huotilainen M, Näätänen R, Hukki J (2002) Auditory ERPs reveal brain dysfunction in infants with plagiocephaly. J Craniofac Surg 13:520–525PubMedCrossRef
4.
Besson A, Pellerin P, Doual A (2002) Study of asymmetries of the cranial vault in plagiocephaly. J Craniofac Surg 13: 664–669PubMedCrossRef
5.
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMed
6.
Boere-Boonekamp MM, van der Linden-Kuiper LT (2001) Positional preference: prevalence in infants and follow-up after two years. Pediatrics 107:339–343PubMedCrossRef
7.
Bredenkamp JK, Hoover LA, Berke GS, Shaw A (1990) Congenital muscular torticollis: a spectrum of disease. Arch Otolaryngol Head Neck Surg 116:212–216PubMed
8.
Bridges SJ, Chambers TL, Pople IK (2002) Plagiocephaly and head binding. Arch Dis Child 86:144–145PubMedCrossRef
9.
Bruneteau RJ, Mulliken JB (1992) Frontal plagiocephaly: Synostotic, compensational, or deformational. Plast Reconstr Surg 89:21–33PubMed
10.
Canale ST, Griffin DW, Hubbard CN (1982) Congenital muscular torticollis. A long-term follow-up. J Bone Joint Surg 64:810–816PubMed
11.
Captier G, Leboucq N, Bigorre M, Canovas F, Bonnel F, Bonnafe A, Montoya P (2003) Plagiocephaly: morphometry of skull base asymmetry. Surg Radiol Anat 25:226–233PubMedCrossRef
12.
Carson BS, Munoz D, Gross G, VanderKolk CA, James CS, Gates J, North M, McKnight M, Guarnieri M (2000) An assistive device for the treatment of positional plagiocephaly. J Craniofac Surg 11:177–183PubMedCrossRef
13.
Chang PY, Chien YW, Huang FY, Chang NC, Perng DB (2001) Computer-aided measurement and grading of cranial asymmetry in children with and without torticollis. Clin Orthod Res 4:200–205PubMedCrossRef
14.
Clarren SK, Smith DW, Hanson JW (1979) Helmet treatment for plagiocephaly and congenital muscular torticollis. J Pediatr 94:43–46PubMed
15.
Clarren SK (1981) Plagiocephaly and torticollis: etiology, natural history, and helmet treatment. J Pediatr 98:92–95PubMedCrossRef
16.
Davis BE, Moon RY, Sachs HC, Ottolini MC (1998) Effects of sleep position on infant motor development. Pediatrics 102:1135–1140PubMedCrossRef
17.
Fenichel GM (1993) Disorders of cranial volume and shape. In: Clinical pediatric neurology, 2nd edn. Saunders, Philadelphia, Pennsylvania, pp 375–378
18.
van Genderen FR, De Bie RA, Helders PJM, Van Meeteren NLU (2003) Reliability research: towards a more clinically relevant approach. Phys Ther Rev 8:169–176CrossRef
19.
Golden KA, Beals SP, Littlefield TR, Pomatto JK (1999) Sternocleidomastoid imbalance versus congenital muscular torticollis: their relationship to positional plagiocephaly. Cleft Palate Craniofac J 36:256–261PubMedCrossRef
20.
Graham JM Jr, Gomez M, Halberg A, Earl DL, Kreutzman JT, Cui J, Guo X (2005) Management of deformational plagiocephaly; repositioning versus orthotic therapy. J Pediatr 146:258–262PubMedCrossRef
21.
Hunt CE, Puczynski MS (1996) Does supine sleeping cause asymmetric heads? Pediatrics 97:127–129
22.
Hutchison BL, Thompson JM, Mitchell EA (2003) Determinants of nonsynostotic plagiocephaly: a case–control study. Pediatrics 112:e316PubMedCrossRef
23.
Hutchison BL, Hutchison LA, Thompson JM, Mitchell EA (2004) Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics 114:970–980PubMedCrossRef
24.
Jantz JW, Blosser CD, Fruechting LA (1997) A motor milestone change noted with a change in sleep position. Arch Pediatr Adolesc Med 151:565–568PubMed
25.
Kane AA, Mitchell LE, Craven KP, Marsh JL (1996) Observations on a recent increase in plagiocephaly without synostosis. Pediatrics 97:877–885PubMed
26.
Kattwinkel J, Brooks J, Keenan MJ, Malloy M (1996) Positioning and sudden infant death syndrome (SIDS): update. American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Pediatrics 98:1216–1218
27.
Kelly KM, Littlefield TR, Pomatto JK, Manwaring KH, Beals SP (1999) Cranial growth unrestricted during treatment of deformational plagiocephaly. Pediatr Neurosurg 30:193–199PubMedCrossRef
28.
Littlefield TR, Beals SP, Manwaring KH, Pomatto JK, Joganic EF, Golden KA, Ripley CE (1998) Treatment of craniofacial asymmetry with dynamic orthotic cranioplasty. J Craniofac Surg 9:11–17PubMedCrossRef
29.
Littlefield TR, KM Kelly, JK Pomatto, Beals SP (1999) Multiple-birth infants at higher risk for development of deformational plagiocephaly. Pediatrics 103:565–569PubMedCrossRef
30.
Littlefield TR, Kelly KM, Pomatto JK, Beals SP (2002) Multiple-birth infants at higher risk for development of deformational plagiocephaly: II. Is one twin at greater risk? Pediatrics 109:19–25PubMedCrossRef
31.
Loveday BP, de Chalain TB (2001) Active counterpositioning or orthotic device to treat positional plagiocephaly? J Craniofac Surg 12:308–313PubMedCrossRef
32.
Miller RI, Clarren SK (2000) Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 105:E26PubMedCrossRef
33.
Moss SD (1997) Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head? J Neurosurg 87:667–670PubMed
34.
Mulliken JB, Vander Woude DL, Hansen M, LaBrie RA, Scott RM (1999) Analysis of posterior plagiocephaly: deformational versus synostotic. Plast Reconstr Surg 103:371–380PubMedCrossRef
35.
Najarian SP (1999) lnfant cranial molding deformation and sleep position: implications for primary care. J Pediatr Health Care 13:173–177PubMedCrossRef
36.
O’Broin ES, Allcutt D, Earley MJ (1999) Posterior plagiocephaly: proactive conservative management. Br J Plast Surg 52:18–23PubMedCrossRef
37.
Peitsch WK, Keefer CH, LaBrie RA, Mulliken JB (2002) Incidence of cranial asymmetry in healthy newborns. Pediatrics 10:e72CrossRef
38.
Persing JA (2001) Discussion: Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg 108:1499–1500CrossRef
39.
Persing JA, James H, Swanson J, Kattwinkel J (2003) Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics 112:199–202PubMedCrossRef
40.
Pollack IF, Losken HW, Fasick P (1997) Diagnosis and management of posterior plagiocephaly. Pediatrics 99:180–185PubMedCrossRef
41.
Portney LG, Watkins MP (2000) Foundations of clinical research: applications to practice, 2nd edn. Prentice Hall, Upper Saddle River, New Jersey
42.
Rekate HL (1998) Occipital plagiocephaly: a critical review of the literature. J Neurosurg 89:24–30PubMed
43.
Ripley CE, Pomatto J, Beals SP, Joganic EF, Manwaring KH, Moss SD (1994) Treatment of positional plagiocephaly with dynamic orthotic cranioplasty. J Craniofac Surg 5:150–159PubMedCrossRef
44.
St John D, Mulliken JB, Kaban LB, Padwa BL (2002) Anthropometric analysis of mandibular asymmetry in infants with deformational posterior plagiocephaly. J Oral Maxillofac Surg 60:873–877CrossRef
45.
Teichgraeber JF, Ault JK, Baumgarter J, Waller A, Messersmith M, Gateno J, Bravenec B, Xia J (2002) Deformational posterior plagiocephaly: diagnosis and treatment. Cleft Palate Craniofac J 39:582–586PubMedCrossRef
46.
Turk AE, McCarthy JG, Thorne CH, Wisoff JH (1996) The “back to sleep campaign” and deformational plagiocephaly: Is there cause for concern? J Craniofac Surg 7:12–18PubMedCrossRef
47.
Visscher F, van der Graaf T, Spaans M, van Lingen RA, Fetter WP (1998) Prone position favorable for motor development of infants (in Dutch). Ned Tijdschr Geneeskd 142:2201–2205PubMed
48.
Vles JS, Colla C, Weber JW, Beuls E, Wilmink J, Kingma H (2000) Helmet versus nonhelmet treatment in nonsynostotic positional posterior plagiocephaly. J Craniofac Surg 11:572–574PubMedCrossRef
49.
van Vlimmeren LA, Helders PJ, van Adrichem LN, Engelbert RH (2004) Diagnostic strategies for the evaluation of asymmetry in infancy–a review. Eur J Pediatr 163:185–191PubMedCrossRef
50.
van Vlimmeren LA, Helders PJ, van Adrichem LN, Engelbert RH (2005) Torticollis and plagiocephaly in infancy: therapeutic strategies—a review. Ped Rehab (in press)
Metadata
Title
Plagiocephalometry: a non-invasive method to quantify asymmetry of the skull; a reliability study
Authors
Leo A. van Vlimmeren
Tim Takken
Léon N. A. van Adrichem
Yolanda van der Graaf
Paul J. M. Helders
Raoul H. H. Engelbert
Publication date
01-03-2006
Publisher
Springer-Verlag
Published in
European Journal of Pediatrics / Issue 3/2006
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-005-0011-1

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