Helmet therapy also known as cranial orthotic therapy, uses custom-made helmets to gently reshape the skull in infants with positional cranial deformities

• Mechanism of Action

  • Helmets provide passive, dynamic pressure, redirecting cranial growth toward flatter regions to achieve symmetry.
  • They do not apply force; instead, they allow the head to grow into the desired shape.

• Indications

  • Moderate to severe positional plagiocephaly not improving with repositioning and physiotherapy.
  • Age at initiation: Optimal between 4-6 months when skull growth is rapid and sutures remain open.
  • Ineffectiveness beyond 12-18 months due to reduced cranial plasticity.

• Process

  1. Custom helmet is made after a detailed 3D cranial scan.
  2. Helmet is worn for 23 hours per day, with adjustments made as the infant grows.
  3. Average duration of treatment: 3-6 months, depending on age and severity.

• Contraindications

  • Unmanaged craniosynostosis.
  • Poor parental adherence.
  • Medical comorbidities preventing consistent use.

Evidence and Efficacy

• Studies suggest helmets can improve cranial asymmetry in moderate to severe cases.

• Limitations:

  • Mild plagiocephaly often resolves without intervention.
  • Lack of significant long-term functional outcomes differentiating treated from untreated children with mild deformities.

• Controversies:

  • Some studies report no added benefit of helmets over repositioning techniques and physiotherapy.
  • Helmets can be costly and resource-intensive.

Adverse Effects

• Skin irritation or pressure sores.
• Discomfort or poor tolerance by the infant.
• Parental stress related to maintenance and adherence.

Adjunctive Measures

• Repositioning:
  • Encouraging supervised tummy time while awake.
  • Alternating head positions during sleep.
  • Minimizing prolonged time in car seats or swings.
• Physiotherapy:
  • Effective for torticollis and associated plagiocephaly.
  • Exercises to promote neck strength and mobility.

Role of the Neurologist

• Differentiation of positional plagiocephaly from craniosynostosis or other neurological conditions.
• Counseling families on treatment options and prognosis.
• Collaboration with orthotists, physiotherapists, and pediatric surgeons when required.

Conclusion

• Helmet therapy is a valuable tool in managing moderate to severe positional plagiocephaly when conservative measures fail.
• Early diagnosis and timely intervention are crucial for optimal outcomes.
• Multidisciplinary care ensures comprehensive management and support for families.