Helmet therapy

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The term helmet therapy refers to a conservative (non-surgical) treatment of children's skull deformities.

Causes of skull deformities in infants

Head deformities in infants can be bony or non-bony.

Bony (synostotic) causes

Childlike skull deformities can arise from premature bony closure of the skull sutures (premature suture synostoses) . The frequency is given as about 1: 2,500 births. Such early ossification can lead to very different, sometimes bizarre skull shapes and also occurs in the context of circumscribed malformation syndromes (e.g. Crouzon syndrome , Apert syndrome ). With these syndromes, head deformations are present from birth and become more and more pronounced afterwards. Surgical correction is usually unavoidable in such cases.

Non-osseous (non-synostotic) causes

In the case of non-synostotic deformations that occur more frequently, the skull sutures are still open , depending on the age. Their ossification does not occur prematurely, so that the brain never runs out of space. The deformation is caused by external influences, e.g. B. Tightness in the womb in twin births, childbirth or storage conditions ( positional plagiocephaly ). Since 1994, numerous pediatric associations around the world have recommended that children be positioned on their backs in order to avoid sudden infant death syndrome. Positioning babies too one-sidedly is the main cause of non-osseous deformations. Muscular imbalances in the neck area can lead to constrained postures, e.g. B. a torticollis . Such constrained postures can in turn have a deforming effect on the child's skull growth. In extreme cases, this can lead to a displacement of the skull base, which can be recognized by the different position of the ears and other facial asymmetries. Uneven head growth can also affect jaw growth.

Known risk factors for the development of a positional plagiocephalus are:

  • male gender
  • firstborn child
  • one-sided sleeping and feeding posture
  • Location of the cot
  • Lie on your stomach less than three times a day
  • delayed motor development

Diagnosis

Due to the visible deformations, in most cases a diagnosis can be made without invasive examinations, such as taking x-rays . A synostotic deformation can be recognized from a bird's eye view of a trapezoidal head shape. On the other hand, a position-related head deformation can be recognized by a parallelogram- shaped displacement.

therapy

Helmet therapy. Before
Helmet therapy. After

For the treatment of the very rare premature ossification of the cranial sutures in babies, a premature suture synostosis , an early surgical correction is possible as a therapeutic measure.

In contrast to this, the frequent position-related deformities can first be treated with intensive physiotherapeutic exercise treatments. Since the skull grows imperceptibly, a therapy period of at least two months with a physiotherapist is mandatory (this is prescribed by the pediatrician). With the so-called "tummy time" (time on the stomach), parents can also contribute to normalizing the deformation of the skull: the awake infant is placed on the stomach on the stomach of one of the parents and playfully encouraged to raise its head to make eye contact. During this exercise, the neck, neck and shoulder muscles are strengthened several times a day and the back of the head is relieved. The affected children in particular cannot get used to the prone position that is important to them at first. The sleeping baby is of course only placed on its back. In parallel to these efforts, it is important to change the position of the cot and interesting objects in the nursery so that the infant has to take different positions than usual in order to get these interesting things into his field of vision. This also puts strain on the back of the head in other places than before.

This makes it clear that a pre-existing asymmetry of position or preferred posture can lead to a deformation of the skull. On the other hand, however, the flattening of the skull - once it has arisen - can promote the development of a tonus asymmetry (i.e. muscle tension that is not on the same side in individual muscle groups) and one-sided increased children's reflexes. An increase in the so-called asymmetric-tonic neck reflex (ATNR) is seen here in particular. This neuromuscular imbalance can maintain the positional plagiocephalus as long as the child is mainly lying on the back. Many of these children are then diagnosed with "muscular torticollis" or " KISS syndrome " and undergo treatment ("straightening", craniosacral therapy ) that is inadequate for the position-related skull deformity .

If, despite this package of measures, the shape of the skull does not change by the 5th to 6th month of life, head helmet therapy can be started after consulting the pediatrician. This uses the child's own head growth. The correction of the skull deformity does not succeed by pressing in the pronounced areas, but rather by preventing these areas from growing. At the same time, the child's own head growth is used for flattened areas. The helmet or head orthotic is made of lightweight plastic and is made according to the ideal head shape of the child.

Head growth is not restricted during treatment. Contact the prescriber in the event of soreness and pressure points (often in the area of ​​the rivets or fasteners). Overall, the head growth strictly follows the natural (percentile) course. Since growth is greatest in the first 15 months of a person's life, helmet therapy should be carried out in this first phase of life . Strong deformities can ideally be remedied in the first six months of life.

The head helmet must be worn 23 hours a day to be successful. In the free hour it has to be cleaned thoroughly every day. Side effects such as sore skin or necrosis have been described. The treatment lasts between eight weeks and eight months, depending on the severity and age of the child at the start of treatment. Proponents of helmet therapy claim that once a result is achieved, it will last a lifetime.

costs

  • The therapy costs amount to € 1,300–2,500 for helmet therapy. If head prostheses made of carbon fiber reinforced plastic ("carbon") are used instead of polyurethane , the costs can also be higher.
  • Treatment with dynamic head prostheses ("helmet therapy") is not included in the service specifications of the statutory German health insurance companies. The transfer of services must be applied for and decided individually.
  • So far there is no supreme court ruling regarding the obligation to assume the costs by the health insurance companies.
  • The statutory health insurance companies are not allowed to reimburse the costs for a head helmet retrospectively - in accordance with the requirements in Book Five of the Social Security Code , if the parents bought it themselves. The costs can only be claimed retrospectively if it can be proven that the health insurance company refused to cover the costs.

Critical rating

Guideline recommendations from medical societies for the treatment of congenital or acquired skull deformities do not yet exist. A statement by pediatric medical societies from 2012 summarizes the as yet unexplained aspects of the treatment method without making a recommendation for helmet therapy. In the medical discussion, the effectiveness and the cost-benefit ratio of helmet therapy are the subject of controversial discussion. Based on the current state of knowledge, a differentiated application of the available conservative and surgical treatment methods according to the type, severity and course of the skull deformities seems to be the most sensible therapeutic approach.

literature

  • Christoph Blecher: Not everything grows out. In: Austrian midwife newspaper. 02 (2008), pp. 22-24.
  • LC Argenta, LR David, J. Thompson: Clinical Classification of positional plagiocephaly. In: J Craniofac Surg. 15 (4), 2004 May, p. 705.
  • JF Martinez-Lage, AM Ruiz-Espejo, A. Gilabert, MA Perez-Espejo, E. Guillen-Navarro: Positional skull deformities in children: skull deformation without synostosis. In: Childs Nerv Syst. 22 (4), 2006 Apr, pp. 368-374.
  • LC Argenta, LR David, JA Wilson, WO Bell: An increase in infant cranial deformity with supine sleeping position. In: J Craniofac Surg. 7 (1), 1996 Jan, pp. 5-11.
  • P. Hummel, D. Fortado: Impacting infant head shapes. In: Adv Neonatal Care. 5 (6) 2005, Dec, pp. 329-340.
  • ML Cunningham, CL Heike: Evaluation of the infant with an abnormal skull shape. In: Curr Opin Pediatr . 19 (6), 2007 Dec, pp. 645-651.
  • Moldings helmets for the treatment of children's skull deformities - testing the therapeutic benefit . Social medicine expert group “Aids and Medical Devices” SEG 5, September 2, 2005, MDK - MDS 2005.
  • D. Karch, E. Boltshauser, G. Gross-Selbeck, J. Pietz, HG. Schlack: Manual medical treatment of the KISS syndrome and Atlas therapy according to Arlen's opinion of the Society for Neuropediatry eV Commission on treatment methods for developmental disorders and cerebral movement disorders , 1998 (last accessed on May 29, 2014)
  • Efterpi Tourountza-Schefels, Joerg Schefels: Skull deformations in infancy. In: The midwife. 22, Thieme Verlag, 2009, pp. 99-101.
  • RS Stücker: The infant asymmetry associated with plagiocephalus. In: Z Orthop accident. 147, Thieme Verlag, 2009, pp. 503-512.
  • Renske M van Wijk et al: Helmet therapy in infants with positional skull deformation: randomized controlled trial. On: British Medical Journal (BMJ) . May 1, 2014 (last accessed May 29, 2014)
  • C. Blecher, C. Kunz, J. Mayr, K. Schwenzer-Zimmerer: Helmet therapy: conservative head modeling. Treatment of position-related head deformities. In: The maxillofacial surgeon. Volume 5, Issue 4, November 2012, pp. 289-296.

Web links

Individual evidence

  1. ↑ T. Rosenbaum, P. Borusiak, T. Schweitzer, S. Berweck, A. Sprinz, H. Strasbourg, J. Klepper: Dynamische Kopforthesen ("Helmtherapie") . (Opinion of the joint therapy commission of the Society for Neuropediatrics and the German Society for Social Pediatrics and Adolescent Medicine 2012) (last accessed on May 29, 2014).
  2. ^ Renske M van Wijk et al: Helmet therapy in infants with positional skull deformation: randomized controlled trial. In: British Medical Journal (BMJ) . May 1, 2014 (last accessed May 29, 2014).
  3. ↑ Lisa Harmann: Newborns: This helps against a deformed baby head. In: SPIEGEL online. May 28, 2014 (last accessed May 29, 2014).