Chiropractic care for the cervical spine as a treatment for plagiocephaly: a prospective cohort study

Introduction Plagiocephaly is a term used to describe an asymmetry in the shape of the skull. Non-synostotic plagiocephaly describes a flattening of the skull that evolves into two types of shape deformities (Figure 1). Firstly, the posterior-lateral Background: Plagiocephaly is a condition that affects the shape of the skull in infants. The research has suggested that there is a growing association between plagiocephaly and developmental delay later in infancy extending into childhood. Plagiocephaly is an increasingly common condition in society which often presents to a chiropractic practice. There have been no studies prospectively investigating the outcome of chiropractic care on a group of infants with plagiocephaly. Objectives: To observe any change in head deformation measurements in a single cohort group of infants aged 0-12 months old presenting to a chiropractic clinic and receiving chiropractic care over a course of six weeks. Setting: This single cohort observational study took place at a chiropractic teaching clinic between February and July 2015, on the south coast of England. Methods: Infants presenting to the chiropractic clinic with the complaint of plagiocephaly were measured from the external occipital protuberance (EOP) to the anterior ear both right and left sides during their routine course of treatment. These measurements were re-examined at the end of their course of care or at six weeks after presentation, which ever occurred first. Results: A total of 64 infants were included. The mean change in the plagiocephaly measurement was a reduction of 1.13cm ± 0.89cm, p= 0.00, 95%CI (-1.36 to -0.92cm). Overall, 20 out of the 64 participants showed a full resolution of plagiocephaly, with a final measurement below 0.4cm difference in occipital measurement side to side, which is considered normal. No adverse events were reported for any of the infants. Conclusions: Overall, there was both a statistically and clinically significant reduction in plagiocephaly measurement for this cohort of infants after a course of chiropractic care. As this was an observational study, this cannot be interpreted as cause and effect. However, these results encourage further research, particularly a RCT to investigate the effect of chiropractic care on plagiocephaly in infants. Figure 1: A comparison of the two different head asymmetries in positional plagiocephaly, amended with permission from Saich and Laker 2014.37 occiput can appear flattened, termed plagiocephaly and secondly a uniform flattening across the back of the occiput is termed brachycephaly.1 The cause of plagiocephaly is exposure of the cranium to external compressive forces while it is still developing. The flatness is usually first recognised by parents when the infant is 2-3 months old.2 Since the ‘Back to Sleep Program’ in 1992 there has been a significant rise in the prevalence of plagiocephaly. However the actual prevalence of plagiocephaly is uncertain due to the range in estimates. Estimates vary from 16-21% at 6-7 weeks old and 20% at 4 months old3 to 47% of infants aged 7-12 weeks old out of cohorts of healthy full term infants.4 The real issue is not only the rise in incidence but also long-term risk factors. The UK National Health Service (NHS) states plagiocephaly is “cosmetic only.”5 This statement contradicts the research suggesting that plagiocephaly is associated with learning disabilities, dysfunctional auditory processing and developmental delay in the gross motor and cognitive domains.6,7,8,9,10