STARband™

 

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. 

Contact us today to find out how we        can help!

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