CMSG-POPS owns one of only ten STARband™ scanners in the United States.
What is positional plagiocephaly?
The newborn infant’s head is quite pliable, allowing it to pass through the birth canal and grow rapidly throughout the first year of life. Brain growth continuously pushes against the bones of the skull to expand the head until the sutures (fibrous connections between the bones) begin to fuse between 18 and 24 months. Many infant heads have some degree of asymmetry. In most cases, the infant’s head resumes a symmetrical shape by 6 weeks of age as the confining conditions that caused the temporary deformation are eliminated. Abnormal head shape beyond this period may indicate a condition requiring further medical observation and/or treatment.
Positional plagiocephaly is characterized by unusual flattening of the head and often a prominent or flattened forehead is visible. Plagiocephaly exhibits a variety of different head shapes. It includes those that have flattening on one side of the back of the head with an asymmetric forehead, and brachycephalic head shapes that are flat across the entire back of the head with very prominent foreheads. Another type of head shape, scaphocephaly, is long and narrow, and more common for infants that spent extended time in neonatal intensive care units.
In any of these deformities, the ear alignment may be affected and the infant may also have facial asymmetry. Several treatment options are recommended including repositioning techniques to move the infant off the flattened area of the head, physical therapy to stretch tight neck muscles, and treatment with a cranial remolding orthosis such as the STARband™.
When parents first notice that their infant has an unusual head shape, they often bring it to their pediatrician’s attention. At that time, the physician encourages repositioning and evaluates head circumference measurements, asymmetry, and tightness of the neck musculature. If repositioning and/or therapy are not effective, the pediatrician may refer the infant to a pediatric neurosurgeon or plastic surgeon for further assessment.
The specialist will conduct a physical examination and may order diagnostic tests (i.e., X-ray, CT scan or MRI) to rule out synostotic (non-positional) plagiocephaly. This condition is characterized by an abnormal head shape caused by premature suture closure, not external forces, and may require surgery to obtain correction. The STARband cannot be used to treat synostotic plagiocephaly, but may be used after surgery for protection or to direct the head into a more symmetrical shape.
Why do some infants develop positional plagiocephaly?
The incidence of positional plagiocephaly has increased since 1992 when the American Academy of Pediatrics recommended that parents place infants on their backs or sides to sleep in order to prevent Sudden Infant Death Syndrome (SIDS). This highly effective program has dropped the SIDS rate in the United States and across the world by 40%. However, the additional time many infants spend in infant seats, car seats, and other supine (back) positions may place them at risk to develop greater flatness and/or asymmetrically shaped heads.
As many as 85% of the infants with positional plagiocephaly also have torticollis. This condition is caused by tightness on one side of the sterno-cleidomastoid muscle in the neck. When one side of this muscle is shortened, the infant’s head bends forward, tilts toward the shoulder on the affected side, and the face rotates toward the opposite shoulder. This muscle tightness causes the head to rest consistently in the same position, creating areas of flatness on the back of the skull and compensatory growth in other areas of the head. This process of deformation happens quickly in young infants because of the softness of the skull and flexibility of the sutures.
Physical therapy treatment is often prescribed to address torticollis. Home programs for stretching and massage of the affected muscle are very successful in addressing this problem. Therapists may also provide additional information regarding repositioning and handling techniques that include placing the infant on the tummy while supervised during the day. Other factors contributing to the development of positional plagiocephaly include premature births, multiple births, restrictive intrauterine positioning, birth trauma, and cervical spine abnormalities.
How does the STARband work?
The orthotic treatment program focuses on redirecting cranial growth towards greater symmetry. This is accomplished by maintaining contact over the areas of bossing or protrusion and allowing room for growth in the areas of depression or flattening. The STARband uses the period of most active skull growth, between 3 and 18 months of age, to create a pathway for more symmetrical growth to occur. Progressive adjustments over the course of the treatment program accommodate growth and ensure optimum outcomes.
The STARband Cranial Remolding Orthosis derives its name from its purpose—Symmetry Through Active Remolding. This custom orthosis is manufactured from a model of the infant’s head to obtain optimal fit and function. The rigid outer shell maintains the structural integrity of the design and is lined with closed cell foam to allow progressive adjustments and promote hygienic conditions. The side opening on the STARband makes it easy to apply and remove, and allows the STARband to adjust in circumference as the infantÕs head grows and changes.
What happens at the first visit?
The initial visit includes a thorough patient evaluation, gathering of patient history, clinical photographs and discussion about the treatment process. It may be necessary to verify insurance coverage prior to initiating the treatment program, so another visit may be scheduled for the casting procedure. It is important that no more than two weeks pass between the time of the casting and the initial fitting of the orthosis. If you are ready to begin the process immediately, the orthotist or prosthetist will make an exact duplicate of your baby’s head from a plaster impression or 3-D scan.
What happens at follow- up appointments?
Within two weeks from the date of casting, you will return for the STARband fitting and delivery. The orthotist will determine final trim lines, answer any questions, and provide you with specific instructions regarding wearing time, cleaning the STARband, and follow-up appointments. Follow-up is an integral part of STARband treatment. In most cases, your infant will be seen within 7-10 days after the STARband fitting and delivery.
Additional follow-up visits take place at two-week intervals for the first month, and at 2-4 week intervals thereafter. At each appointment the orthotist will assess the fit of the orthosis, monitor changes in head shape, and may make adjustments to the STARband to direct more symmetrical skull growth. Depending on your infantÕs age, unique head shape, and response to the orthosis, your follow up appointments may be more or less frequent than those stated above. You are encouraged to contact your orthotist immediately if you have concerns about the fit, notice reddened areas that do not disappear within a reasonable amount of time, or feel that your infant needs an adjustment before the next scheduled appointment.
How long does STARband treatment take?
On average, treatment programs with the STARband take approximately 8-16 weeks for infants between the ages of four and seven months. Older infants may require a longer treatment program because head growth slows after 12 months. Research indicates that the greatest symmetry can be attained through early intervention, although some correction may be possible in infants over 18 months.
How do I get a STARband for my baby?
STARband Cranial Remolding Orthoses are available by prescription only. Your pediatrician or specialist can write a prescription for the STARband Cranial Remolding Orthosis, which you can then take to a certified orthotist or prosthetist within your community.
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