Ann Rehabil Med.  2018 Oct;42(5):737-747. 10.5535/arm.2018.42.5.737.

Parents' Perspectives and Clinical Effectiveness of Cranial-Molding Orthoses in Infants With Plagiocephaly

  • 1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.


To investigate the clinical effectiveness of and parents' perspectives on cranial-molding orthotic treatment.
Medical charts were reviewed for 82 infants treated for plagiocephaly with cranial-molding orthoses in our clinic from April 2012 to July 2016 retrospectively. Infants who were clinically diagnosed with positional plagiocephaly and had a Cranial Vault Asymmetry Index (CVAI) of more than 3.5% were included. Pre- and post-treatment CVAI was obtained by three-dimensional head-surface laser scan. Parents' perceptions of good outcome (satisfaction) were evaluated with the Goal Attainment Scale (GAS). The GAS score assessed how much the parent felt that his or her initial goal for correcting the skull asymmetry was achieved after the treatment.
The compliance with cranial-molding orthoses was 90.2% (74 of 82 infants). There were 53 infants (65% of the 82 infants) who had adverse events with the cranial-molding orthoses during the study. Heat rash was found in 29 cases (35.4%) and was the most common adverse event. The mean GAS T-score was 51.9±10.2. A GAS T-score of 0 or more was identified for 71.6% of parents. The GAS T-score was significantly related to the age (p < 0.001), the initial CVAI, and the difference of CVAI during the treatment (p < 0.001).
Parents' perception of good outcome was correlated with the anthropometric improvement in cranialmolding orthotic treatment in infants with plagiocephaly. A high percentage of parents felt that the treatment met their initial goals in spite of a high occurrence of adverse events.


Orthotic devices; Plagiocephaly; Treatment outcome; Cephalymetry

MeSH Terms

Hot Temperature
Orthotic Devices*
Plagiocephaly, Nonsynostotic
Retrospective Studies
Treatment Outcome*


  • Fig. 1. (A) A cross-sectional plane through the sellion (SE) and both tragia (T) was set as the reference plane and designated the level 0 plane. The plane parallel to the level 0 plane that passed through the vertex of the head was designated as the level 10 plane. The portion of the cranium superior to the reference/level 0 plane was divided into 9 equally spaced cross-sectional planes, each parallel to the reference plane. (B) Cranial Vault Asymmetry Index (%) = long cranial diagonal (mm)-short cranial diagonal (mm)short cranial diagonal (mm)×100

  • Fig. 2. Age, duration of therapy, and hours of putting on cranial-molding orthoses versus GAS T-score. The GAS T-score was significantly related to the age. GAS, Goal Attainment Scale.

  • Fig. 3. Initial CVAI (left), terminal CVAI (center), difference of CVAI (right) from initiation and to termination versus GAS T-score. The initial CVAI and the difference of CVAI from the initiation to the termination of the treatment at level 3 and level 5 were significantly related to the GAS T-score. CVAI, Cranial Vault Asymmetry Index; GAS, Goal Attainment Scale.

  • Fig. 4. Age, duration of therapy, hours of putting on cranial-molding orthoses per day and initial Cranial Vault Asymmetry Index (CVAI) versus difference of CVAI from initiation and to termination (level 3). The difference of CVAI at level 3 and level 5 from the initiation to the termination of the treatment were significantly related to the age and the initial CVAI.


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