Impact of severity and therapy onset on helmet therapy in positional plagiocephaly

Abstract Although helmet therapy is a widely established method in the treatment of positional plagiocephaly, therapeutic regimens remain contentious, especially regarding starting age. Hence, this study investigated the impact of starting age and severity on the effectiveness of helmet therapy. A total of 213 pediatric patients treated for positional plagiocephaly with an orthotic device were enrolled in this study. Pre- and post-treatment calvarial asymmetry was measured according to the Cranial Vault Asymmetry Index (CVAI) using 3D-Photogrammetry. Patients were classified by age at which treatment was started: Group 1 was comprised of patients younger than 24 weeks (n = 82); Group 2, those aged 24–32 weeks (n = 75); Group 3, those aged >32 weeks (n = 56). Additionally, groups were categorized by severity (mild: CVAI 3–7%; moderate: CVAI 7–12%; severe: CVAI > 12%). Mean initial CVAI was 9.8%, which reduced to 5.4% after helmet treatment. Group 1 (