Article: Iñaki Pastor-Pons, César Hidalgo-García, María Orosia Lucha-López, Marta BarrauLalmolda, Iñaki Rodes-Pastor, Ángel Luis Rodríguez-Fernández, José Miguel Tricás-Moreno. Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial. Ital J Pediatr. 2021 Feb 25;47(1):41.
Study Design: Randomized Controlled Trial Abstract: Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample.
Thirty-four children with PP and less than 28-week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen’s d.
All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study.
The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program.
NIH Risk of Bias Score: 13/14 (Low Risk of Bias) Key Findings of the Study: 1. The addition of manual therapy to a caregiver educational program is associated with increased active cervical rotation range of motion after 10 weeks of treatment in infants with positional plagiocephaly.
Key Findings of the Study:
1. The addition of manual therapy to a caregiver educational program is associated with increased active cervical rotation range of motion after 10 weeks of treatment in infants with positional plagiocephaly.
2. No outcome differences in neuromotor development were found by adding manual therapy to a caregiver educational program after 10 weeks of treatment in infants with positional plagiocephaly.
3. Static photography measuring the head position of children showed good reliability comparable to other studies of children with torticollis in which photography was used to measure range of motion.
Reviewer Summary:
This study examined the effects of manual therapy in infants with positional plagiocephaly. The aims were two-fold, assessing the effect of manual intervention on both active cervical rotation and neuromotor development in 34 infants. The control group received an educational program for caregivers, while the intervention group received ten sessions of manual therapy in addition to the program.
Mobilizations targeted the occiput, atlas, and axis with the goal of restoring motion. The increase in right rotation was notably larger in the intervention group than the increase in left rotation potentially due to a lower baseline for right rotation measures. While there is no significant increase between groups for left rotation, there is a significant increase for right and total cervical rotation. Therefore, mobilizations addressing the upper cervical spine should be considered as a primary treatment option and feasible alternative to more risky interventions like surgery or chiropractic manipulation.
No long-term data was collected, and therefore, outcomes greater than 10 weeks cannot be analyzed at this time.
