Explorando o impacto do tratamento osteopático sobre as assimetrias cranianas associadas à plagiocefalia não-sinostótica em lactentes

Resumo

Objectivos

Documentar a evolução das assimetrias cranianas em lactentes com sinais de plagiocefalia occipital não-sintótica (NSOP) que deveriam ser submetidos a um tratamento de quatro tratamentos osteopáticos (além das recomendações de posicionamento padrão), bem como determinar a viabilidade de utilizar essa metodologia para conduzir Um ensaio clínico randomizado que investiga o impacto da intervenção osteopática em lactentes com NSOP.

Desenho de estudo

Projeto piloto de padronização clínica com desenho pré-pós, em que participaram 12 crianças. Dez crianças apresentaram um Índice de Diferença do Diâmetro Oblíquo (ODDI) acima de 104% e cinco delas tiveram uma Asimetria de Vaso Craniano moderada a grave (CVA) (acima de 12 mm).

Intervenções

Os bebês receberam quatro tratamentos osteopáticos em intervalos de 2 semanas.

Medidas de saída principais

As medidas antropométricas, plagiocefalométricas e qualitativas foram administradas pré-intervenção (T1), durante o terceiro tratamento (T2) e duas semanas após o quarto tratamento (T3).

Resultados

Os participantes mostraram uma diminuição significativa na AVC (p = 0,02), assimetria de base de crânio (SBA) (p = 0,01), assimetria de abóbada transcraniana (TCVA) (p <0,003) entre a primeira e a terceira avaliação.

Conclusões

Estes achados clínicos suportam a hipótese de que os tratamentos osteopáticos contribuem para a melhoria das assimetrias cranianas em lactentes menores de 6,5 meses com características NSOP.

Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants

Sylvie Lessard

Affiliations

·Collège d’Études Ostéopathiques de Montréal, 7400, boul. Saint-Laurent bureau 211, Montréal, Qc, H2R 2Y1 Canada

Isabelle Gagnon

Affiliations

·School of Physical and Occupational Therapy, McGill University, 3630 promenade Sir William Osler, Montreal, Qc, H3G 1Y5 Canada

·Trauma and Child Development Programs, Montreal Children’s Hospital, 2300 Tupper, Montreal, Qc, H3H 1P3 Canada

Correspondence

·Corresponding author. McGill University Health Center-Montreal Children’s Hospital, Trauma Program, 2300 Tupper, Montreal, Canada H3H 1P3. Tel.: +1 514 412 4400x22001; fax: +1 514 412 4398.

Nathalie Trottier

Affiliations

·Collège d’Études Ostéopathiques de Montréal, 7400, boul. Saint-Laurent bureau 211, Montréal, Qc, H2R 2Y1 Canada

Published Online: March 08, 2011

DOI: https://dx.doi.org/10.1016/j.ctcp.2011.02.001

Figures

Fig. 1

Characteristic shape of plagiocephaly in a 2 month-old infant.

Fig. 2

Frontal (A) and lateral (B) views of the main measurements and anthropometric landmarks used to quantify asymmetries in NSOP, adapted from Kolar and Salter (1997).³⁴x34Kolar, J.C. and Salter, E.M. Craniofacial anthropometry: practical measurement of the head and face for clinical, surgical and research use. Charles C Thomas, Sprinfield, IL; 1997

Abstract

Objectives

To document the evolution of cranial asymmetries in infants with signs of nonsynostotic occipital plagiocephaly (NSOP) who were to undergo a course of four osteopathic treatments (in addition to the standard positioning recommendations) as well as to determine the feasibility of using this methodology to conduct a randomized clinical trial investigating the impact of osteopathic intervention for infants with NSOP.

Design

Pilot clinical standardization project using pre-post design in which 12 infants participated. Ten infants presented an initial Oblique Diameter Difference Index (ODDI) over 104% and five of them had an initial moderate to severe Cranial Vault Asymmetry (CVA) (over 12 mm).

Interventions

Infants received four osteopathic treatments at 2-week intervals.

Main outcome measures

Anthropometric, plagiocephalometric as well as qualitative measures were administered pre-intervention (T1), during the third treatment (T2) and two weeks after the fourth treatment (T3).

Results

Participants showed a significant decrease in CVA (p=0.02), Skull Base Asymmetry (SBA) (p=0.01), Trans-Cranial Vault Asymmetry (TCVA) (p<0.003) between the first and third evaluations.

Conclusions

These clinical findings support the hypothesis that osteopathic treatments contribute to the improvement of cranial asymmetries in infants younger than 6.5 months old presenting with NSOP characteristics.

Keywords:

Anthropometrics, Deformational plagiocephaly, Cranial asymmetry, Osteopathy, Nonsynostotic plagiocephaly

See all References34 Skull Base Asymmetry (SBA), sn-t R/L: Difference of measurements between the subnasale (sn) landmark (junction of the septum nasal and skin of superior lip in the midline) and the tragus (t) (located at the notch above the tragus of the ear, the cartilaginous projection in front of the external auditory canal, where the upper edge of the cartilage disappears into the skin of the face). Cranial Vault Asymmetry (CVA), fzR-euL, fzL-euR: Difference of measurements between frontozygomaticus (fz) (most lateral point on the frontozygomatic suture) and eurion (eu) (most lateral point on the head in the parietal region). Trans-cranial vault asymmetry (TCVA), fzR-ocpL, fzL-ocpR.¹x1Mulliken, J., Woude, D.V., Hansen, M., Labrie, R., and Scott, R. Analysis of posterior plagiocephaly: deformational versus synostotic. Plastic Reconstruction Surgery. 1999; 103: 371–380

CrossRef | PubMed | Scopus (145)See all References^, 14x14Moss, S.D. Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head?. Journal of Neurosurgery. 1997; 87: 667–670

CrossRef | PubMedSee all References^, 24x24Ripley, C., Pomatto, J., Beals, S., Joganic, E., Manwaring, K., and Moss, S. Treatment of positional plagiocephaly with dynamic orthotic cranioplasty. Journal of Craniofacial Surgery. 1994; 5: 150–159

CrossRef | PubMedSee all References^, 39x39Fish, D. Clinical evaluation processes and procedures for orthotic treatment of infants with deformational plagiocephaly. Journal of Prothetics and Orthotics. 2004; 16: 24–27

CrossRefSee all References Difference of measurements of the longer and the shorter oblique diameter (from the frontozygomaticus-occipital prominence/flatness).

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