Helmet treatment in Australia (Melbourne)

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Dear and other members,

First let me apologise in advance if this posting is inappropriate to this

list serve. My primary interest in plagiocephaly is as a treating

orthotist. I have been signed on to this listserve for about four weeks

now, and originally joined to research what scientific papers were

available to support or discredit the use of moulding helmets for the

treatment of plagiocephaly.

The Royal Children's Hospital in Melbourne has been using helmets to

correct many of the different forms of plagiocephaly for quite some time,

certainly from before I started here, eight years ago.

We follow most of the basic principals as outlined by Clarren in 1979, so

the helmets/bands we use are fairly similar to those used by CT and

Orthomerica.

Our aim is not to " squash " the head into shape, but rather to constrict

growth on the areas of prominence, and direct it toward the areas which are

flattened. There are two crucial criteria for the effectiveness of helmet

remodelling; plasticity of the skull bones, and increasing head size.

Around the age of nine months, about the same time that the fontanelles

begin to close, the bones in the skull change from a honeycomb structure,

to a strong laminated sheet structure. This laminated bone is MUCH harder

to remodel than the honeycomb structure. (it is about 3-5 times stronger,

depending on the individual) This is the reason that treatment started

after nine months of age is often less successful, and always takes longer.

The other factor is best explained by looking at growth charts. , if

you look in your yellow health care folder (maternal health care book) you

will find a growth chart of head circumference. You may want to go grab

that now if you know where it is. It's much easier to see on a chart than

in a sentence. What it says is that in the first 12 months the averarge

head circumference, measured over the eyebrows and above the ears goes from

36cm to 46cm in the first twelve months, with the steepest part of that

curve (ie fastest growth) from birth to eight months, and then up to 49cm

by two years of age. This helps to explain why helmet treatment works best

for younger infants. Their heads are expanding so rapidly that they

quickly change shape as directed by the helmet.

By the age of 20 mths Harley's head will be growing very slowly, and won't

have much more growth to go. Depending on the degree of his plagiocephaly

even if you could direct the growth of the skull bones, his head may never

grow enough to acheive a symmetrical shape. While I have treated children

up to about the age of 14mths, the results are never as good as those

treated before the age of six mths. I don't know of anyone who is

experienced in cranial remodelling who is either writing or accepting

referrals for children over the age of 18mths, and even then we would

always explain that it there is a high likelihood that the treatment will

be unsuccessful.

Other centres may have different protocols to us, but I'm not aware of any

that do. If anyones experience has been different to this, I'd be quite

happy to talk to them about it.

I realise that this is not what you really wanted to hear, but it may (?)

help you resolve issues which you have about whether treatment now would

make a difference or not, rather than just having someone say " it's too

late, bad luck " .

I hope this helps

Regards,

Rod Lawlor