Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Lam SW(1), Kwong YY(1)(2), Wang Y(2),Lau CP(3)
Affiliation :
(1)Prosthetic and Orthotic Department, Queen Elizabeth Hospital, (2)Prosthetic and Orthotic Department, Kowloon Hospital, (3)Prosthetic and Orthotic Department, Hong Kong Children's Hospital
Introduction :
Positional plagiocephaly, denoted the craniofacial deformity of growing skull by extrinsic forces in infants, characterized by the asymmetric head shape and either left or right occipitoparietal flattening. Common disorders were related to positional plagiocephaly in both motor and mental development, for instance, torticollis and cognitive development delay. Therefore, interventions are needed to the infants suffering from positional plagiocephaly on promoting skull development. Helmet therapy, the orthotic helmet for whole day use, was suggested as one of the preservative interventions to the patients. Different designs were proposed and investigated in the previous research, namely the passive and dynamic helmet. Yet, no direct comparison of the intervention outcomes between passive and dynamic helmet was investigated in the previous study. Lacking standard guideline in helmet fabrication and assessment was also noted for helmet therapy in literatures. To enhance the orthotic service on helmet therapy, evidence-based clinical study was done to compare the helmet designs effectiveness on patient with positional plagiocephaly.
Objectives :
This study aims to (1)compare the intermediate intervention outcomes of passive and dynamic helmet designs in clinical usage for 10 weeks usage, (2)improve the orthotic helmet service on patient with positional plagiocephaly for enhancement on patient compliance and (3)suggest a guideline on the assessment and prescription process
on helmet therapy.
Methodology :
Prospective study on passive and dynamic helmet subjects were done from May 2022 to June 2023 on infants aged 3 month-1 years old with level III-V in Argenta’s Classification in Kowloon Hospital and Hong Kong Children's Hospital. Skull scanning was done by Einscan Pro 2X 3D handheld scanner and computed in Rodin4D Neo, the orhtoic CAD/CAM software. 5mm polypropene helmet with 8mm plastazote paddings was prescribed according to the assigned helmet design. Three follow-up sessions were arranged for measurement and assessment on week 2, 6, 10 weeks after the helmet prescription respectively. The cranial vault asymmetry index (CVAI), cephalic ratio (CR) and head circumference were measured for intervention outcome. Independent 2 sample t-test with 0.05 level of significance was used on within-group and between-group evaluation for comparing helmets effectiveness.
Result & Outcome :
Total 18 subjects were recruited, with 9 subjects in each group each. The circumferential growth between initial - second follow up (week 6 after prescription) and initial - final follow up (week 10 after prescription) were noted in within passive and dynamic helmet group respectively (p≤0.002 and p<0.001 respectively). However, no significant difference were noted between-group comparison within the same follow-up sessions. Similar patterns were also noted in CVAI (p≤0.05 and p<0.005 respectively). It was also noted that no significant difference on CR in both within-group and between-group measurement.
This study illustrated that both helmet designs provided significant occipitoparietal growth development while with significant improvement on cranial deformity for at least 6 week usage. Furthermore, the factor of helmet design difference did not show the significant effect on intervention outcome. Thus, in order to provide a patient-center service in P&O clinical practice, orthotists and practitioners could decide the helmet from passive to dynamic design according to the patient condition and parental concern, for example, cosmetic concern and heat tolerance.
