Friday, March 23, 2012

Hello Facebook Friends,

We are having an easter egg hunt at http://www.alexandrasphate.org/.  We have hidden Easter eggs within our website.  Visit our website at http://www.alexandrasphate.org/, find the eggs and comment on this status update to tell us how many you found.  Correct answers will win a "My Brother Has A Crooked Head" Coloring book by Orthomerica.

Visit our Facebook Page by Clicking here.

Good Luck and Happy Hunting

**The first ten comments to give the correct answer will win a coloring book. 

Thursday, March 22, 2012

The Definition of Plagiocephaly! Enter for your chance to win a coloring book!

You can get several definitions of the term "plagiocephaly" by clicking HERE. It is weird that there are so many different ones, but they all have to do with the same condition. If you would like more information about plagiocephaly, please visit our website at http://www.alexandrasphate.org/.

Please "like" our page on Facebook for your chance to win a "My Brother Has A Crooked Head" coloring book by Orthomerica.

Like Us Here!

Also visit us on twitter @AlexandrasPHATE.

Thursday, March 15, 2012

Like us on Facebook to win a Helmet Therapy Coloring Book!

Facebook Friends.  Hello, we have a couple of things going on right now for all of you.  We are giving away (2) coloring books this month.  The first one will be to a lucky entrant of a picture to our facebook page.  The second will be to someone that likes our facebook page between now and 3/31.

You can like us or post your picture here or by clicking the facebook logo to the left.






Tuesday, March 13, 2012

Extra! Extra! Read all about it!

Fantastic News today from Alexandras PHATE.  We donated our first STARband helmet of 2012 to a family in Texas.  Special thanks to Blake Norquist at Orthomerica and Shevy Schmaus at Dynamic Orthotics & Prosthetics in Houston, TX.  Shevy is donating her time to help a family in need.  What an amazing act of kindness.  Glad we could help and we look forward to continuing our mission into the future.

For more information on our foundation, please visit www.alexandrasphate.org


Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
gary@alexandrasphate.org

Monday, March 12, 2012

Are flat heads in Babies a sign of genius or a sign of the times?

Are flat heads in babies a sign of genius or a sign of the times? Centuries ago, the shape of a baby's head would indicate certain traits and talents, but today's parents often think their baby has something wrong with it if its head is not perfectly formed. And the fact is, flat-headed babies are on the rise. According to experts, the "back-to-sleep" movement that's been prominent worldwide in the past decade, a successful movement designed to protect babies from Sudden Infant Death Syndrome or SIDS, has resulted in an increased number of babies with flat heads.

That increase, coupled with our society's unfortunate focus on body image, has troubled some parents enough to send them to clinics that fit their flat-headed babies with helmets that have to be worn 23.5 hours a day; months of helmet-use encourages baby's head to grow into a socially desirable round shape.

Flat-headedness even has a medical term -- plagiocephaly -- and until recently the condition was assumed to be of cosmetic concern only. But last month, results of a study of babies with the condition indicated that plagiocephaly might be a red flag for early neuro-devlopmental disadvantage, says researcher Dr. Matthew Speltz.

The clinical psychologist from the Seattle Children's Research Institute says that the so-called "disadvantage" he refers to is in the area of motor skills: In other words, up to one-quarter of the babies with flat-heads in his study were a little behind in their motor or movement skills compared to babies whose heads were not flat.

Speltz prefers the term positional plagiocephaly because the babies' flat heads are caused in part by their spending so much time on their backs ' sleeping in cribs, lying back in car seats and carriages.

"There's been a dramatic rise in positional plagiocephaly since the 1990s," he says. That coincides with the campaigns that urged parents to put their babies on their backs to sleep in order to protect them from SIDS.

In the 1970s, one in 300 infants had plagiocephaly, but by 2006 as many as one or two out of 10 babies had the condition.

"That increase, to all of us, is a small price to pay for the reduction in SIDS," says the pediatric researcher. "Many parents and doctors in the past dismissed it as a cosmetic issue, but our study suggests that we should look deeper."

Speltz and his team studied six-month old infants with and without flat heads, measured their skulls and assessed each using a respected scale of infant development. The flat-headed babies performed worse on their motor skills than the control subjects by an average of 10%.

"It's not that deformational or positional plagiocephaly causes neuro-developmental delay," explains Speltz. 'It's more that it's a marker of an elevated risk for delays."

Because babies who have flattened areas in the back of the head during the first year may be at risk for developmental delay, Speltz feels that pediatricians "should monitor closely the development of infants with this condition."

He says that it may be that flat-headed infants who show motor developmental delays will simply catch up with normal-headed babies by the time they're a year old and sitting up and moving more. (His team is in the process of examining that.)

"We need to look at their development down the road," he says.

"We don't want parents to think that flatness causes delay -- it's more an associated feature that may be a red flag. We want parents to continue to put babies to sleep on their backs. We hope that doctors will simply be more vigilant as to potential motor issues because early intervention is key and quite effective."

Baby helmet heads

The Clarren Helmet, used to treat uneven head shapes in babies, was invented at the Seattle Children's Hospital in 1979. The helmet, worn 23.5 hours daily from three to eight months in total, is designed so that the child's pliable head grows into the molded shape of the helmet. Pediatric researcher Dr. Mathew Speltz says that about 30% of parents whose babies have been diagnosed with plagiocephaly choose a helmet treatment for their babies. There are also other techniques used, including certain head bands.


Is your baby's head flat?

Remember that flat spots in a young baby's head can be common and by itself is no cause for alarm. Infants' skulls are soft and malleable until approximately one year. Other tips for parents and caregivers from the Seattle Children's Research Institute:

* If your baby is diagnosed with plagiocephaly, ask the doctor to screen for developmental delays in both motor and cognitive skills.

Talk about the results.

* Remember that babies develop at different times, and at different rates. What is 'normal' for your baby may be ahead of or behind what is normal for another baby. Babies who start out slower often catch up later.

* Always place babies to sleep on their backs: this remains the safest way to sleep. Place your baby's head at one end of the crib and switch to the other end the next night.

* Encourage active 'tummy time' when babies are awake: find ways to for baby to engage, play and move while on their tummy, several times each day. Watch your baby during tummy time.

* Choose different positions and ways for babies to play and be held: variety of stimulation is important. Switch the arm you use to cradle your baby each feeding session; right one time, left the next.

* Use strollers, car seats, infant seats, bassinets, cribs and play pens when necessary, but remember that babies need frequent lap time, cuddling, active play times and chances to move that aren't limited to being in stationary positions.

* Develop motor skills: play with babies to get them moving. Encourage crawling, rolling, reaching, pushing, pulling, holding, grasping.

* Develop cognitive skills: play with babies to get them thinking and talking. Encourage interactions with their environment, looking, listening, imitating, babbling, singing, talking, reading.

Source:  chealth.canoe.ca | Marilyn Linton

Friday, March 9, 2012

Seems like so long ago! September 16, 2010


Friends of Alexandra's P.H.A.T.E.,

Today, September 16,2010, marks a milestone in our organization's brief history. Our application for 501(c)3 status has been approved by the IRS. We received word today that our tax-exempt status is retroactive to our date of application, January 19,2010. Wow, it took almost none months, but was worth every bit of the paperwork and time involved. If you have made a donation in the past or would like to in the future, your donation will be deductible on your taxes.


Thanks to everyone for their continued support and if you would like to make a donation please visit http://www.alexandrasphate.org/donate_phate.html


Gary, Valerie and Alexandra Tate

Monday, March 5, 2012

Youtube video about Positional and Deformational Plagiocephaly.

Here is an informative video about Positional and Deformational Plagiocephaly.  Chad A. Perlyn, MD, PHD is a Pediatric Plastic Surgeon for Miami Children's Hospital. He explains what Positional Plagiocephaly, Deformational Plagiocephaly and Lambdoid craniosynostosis are. Using model skulls, Dr. Perlyn explains this common pediatric craniofacial challenge.

Check out the video by clicking the link below.

http://www.youtube.com/watch?v=UXFlErBDlv4
 
Thanks Miami Childrens!


TheARspecialists Signature

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
gary@alexandrasphate.org

Everything Plagiocephaly, Long Read but Informative.

In 1992, the American Academy of Pediatrics initiated the “Back to Sleep” campaign recommending that infants be placed to sleep in the supine position to reduce the incidence of sudden infant death syndrome (SIDS). Although there was a significant decrease of approximately 40% in the occurrence of SIDS, the practice creates a condition of flattening of the occipital area referred to as positional plagiocephaly, which has increased sixfold. Plagiocephaly is derived from the Greek word meaning “oblique head”. In addition to the asymmetrical head shape, infants present with a head tilt, reduced range of cervical motion, and a form of torticollis apparently associated with positional plagiocephaly. The significant increase of plagiocephaly, is as high as 48%. The associated increase in muscular torticollis is 84%. Positional plagiocephaly and secondary muscular torticollis increased in incidence is a concern because it has a strong influence on the effects of child development. Evidence-based practice identifies that an infant needs to receive early assessment and treatment to correct these conditions that are acquired in the first several weeks of life. A plethora of research is available on the internet, as well as accessible in medical journals regarding the prevention, care, assessment and rehabilitation of these musculoskeletal injuries. Parental support sites are available for additional information on these subjects.

A variety of developmental problems exist that could be interesting to research to gain more knowledge that would be beneficial in treating children. It is a con to isolate the resources to such a concentration on one subject. The negative aspect of focusing just on positional plagiocephaly and secondary muscular torticollis is that the two conditions have multiple causes and different versions of injury that may be attributed to more than just supine positional compression.

Positional head deformities are caused by external pressures placed on a quickly developing skull. The infant’s head becomes deformed as the result of external modeling forces applied prenatally, postnatally or both. The increased use of car seats and carriers has been an attributing factor to positional plagiocephaly. Sleeping in the supine position and feedings always offered from the same side correlate with a positional head deformity. Plagiocephaly occurs first and predisposes other forms of neck imbalance. Torticollis may occur in association with plagiocephaly; each condition exacerbates the other or, successful treatment of one demands recognition and then treatment of the other condition. Plagiocephaly associated torticollis; the onset is immediate and appears to be related to the infant adopting a favored sleeping position usually lying supine with the head turned to one side. Ipsilateral sternocleidomastoid (SCM) muscle shortens resting in a torticollis position because the head rotates and tilts initiating the side preference and the occiput flattens correspondingly. Risk Factors for plagiocephaly and torticollis include but are not limited to intrauterine development, prematurity, multiple births, congenital anomalies, neurological injury, tumors, cervical defects, muscular, bony, and restrictive condition development. The key to the successful management of infants with deformational plagiocephaly is to prevent the occurrence of injury, however early diagnosis and treatment is extremely important.

The infant’s head shape and neck range of motion must be assessed first as a newborn and again evaluated at two months. Approximately one out of 300 healthy birth infants have a noticeable flattening of the head, asymmetry of the skull base and face, or both. Plagiocephalic deformity may be perpetuated or worsened by gravitational forces, so the supine position creates a higher likelihood for deformation. Early recognition of positional head deformity is crucial with the rapid growth of an infant’s skull. Deformational plagiocephaly has been described as a parallelogram shaped head when looking from a vertex view or when observed from a top down analysis of the skull. There is asymmetry that may cause deformation of the facial features when severe and an ipsilateral ear shift and a contralateral forehead flattening. Some degree of facial distortion is usually apparent, but it also may be minimal, however it becomes more noticeable when the infant is held up to a mirror. The mirror reflection can be checked for asymmetry without distraction of the babies’ response.

Dysfunction of the neck musculature is almost a universal finding in patients with deformational plagiocephaly.6 Torticollis has some limitations of active rotation of their heads away from the flattened side of the occiput Neck dysfunction can be diagnosed by the rotating stool test, which can be used in children 3 months or older. Torticollis can effect vertical eye movements or strabismus secondary to the head tilt created by the SCM muscle shortening. The number of affected patients can be reduced by early screening, identifying patients at risk, educating parents about the importance of rotating infants, and supervised “tummy time”.

The most important treatments for plagiocephaly and torticollis are prevention and awareness. Educating the infant’s caregiver related to supervised tummy time and how it promotes development of the trunk musculature and improves both gross and fine motor skills is the first line of defense. Prone positioning while the infant is awake and being observed is crucial to prevent the development of flat spots on the occiput and to facilitate development of shoulder girdle strength, necessary for motor milestones. Encouraging and implementing a nightly alternating head position, changing the supine head position during sleep and periodically changing the orientation of the infant to outside activity can make all the difference. The preventative interventions are also part of the solution to reducing the plagiocephaly and torticollis in existing conditions.

Parents must be involved to make a difference in the infant’s condition. All patients under the age of 18 months should be given active and passive neck stretching exercises as the first line of treatment. Most forms of intervention rely on redirecting symmetrical growth of the skull during the first year of life when 80% of growth occurs. Additionally, in the first 6 to 18 months of life there is an attempt to use remaining brain growth to redirect head shape. It is critical that parents be taught a home exercise program since physical therapy at one hour visits three times a week will be insufficient to make a difference in plagiocephaly and torticollis alone. A regiment that includes repetitive passive stretches of the affected SCM muscle and strengthening exercises for the contralateral side needs to be done regularly. In addition, positioning and handling skills will aid in resolution, allowing the infant to alter head orientation more freely. Neck exercises should be done with each diaper change, three repetitions of 10 second stretches of the SCM, upper trapezius, and the ipsilateral trunk muscles need to be performed. Caregivers must reposition their child frequently by alternating the arm in which the child is carried and fed. Parents can subsequently relieve pressure sites on the skull by rotating the position of toys in the crib, stroller, swing and car seat, which will in turn improve the range of motion of the neck. Parents need to approach feeding to the side opposite of the flattened area to encourage head turning and lengthening of the SCM muscle. A cranial orthoses, in addition to a stretching program, are a viable option to aid in the recovery from plagiocephaly and decrease the secondary torticollis. Significant improvements in overall symmetry are found with use of a cranial remolding orthosis.

Helmet therapy or an external orthotic device is an effective treatment option that has similar results to using repositioning and stretching. The theory is based on the mechanism that pressure from a rapidly growing brain against a concave surface should round flattened areas caused by earlier pressure against a flat surface. The best response for helmets occurs in the age range of 4-12 months because at the greater malleability of the young infant skull bone and the normalizing effect of the rapid growth of the brain.10 Using slight alterations in design, all cranial orthoses, bands and caps attempt to achieve a more normalized skull through strategically placed forces and directing new growth. The orthosis may need to be kept on for approximately 20 hours out of the day. Therapeutic physical adjustments of the orthosis is necessary to correct for positional changes. Also, a cervical collar can be used to block lateral flexion to the involved side to decrease range of motion deficits. When conservative treatment has been exhausted, surgery is a viable option.

The earlier the treatment begins for plagiocephaly and torticollis, the greater the likelihood of a successful outcome. Immediately after diagnosis, the majority of the literature suggests that conservative treatment should be started. This initial intervention suggests proper positioning, followed by a rigorous stretching program, both implemented by the parents. It has been identified that 95 percent of congenital muscular torticollis resolves within 1 year with manual stretching. A cranial orthoses or helmet therapy has also been used with positive results with patients under 3 months of age. However, 25 percent of the 3 to 6 months old infants, 70 percent of 6-18 month old infants and 100 percent of the older children required surgery. Surgical management of torticollis is rare. Therefore, a craniofacial surgeon should only be considered if there is a progression of the condition or a lack of improvement following a trial of mechanical adjustments. There were long-term problems noted related to subtle cerebral dysfunction during the school-age years involving language disorders, learning disability, and attention deficits in this population. This may be due to compression in certain areas of the brain that are manifested as the child grows into their deficits. Disruption of the head in the midline position through trauma or deformation such as torticollis can also affect the processing of sensory stimulation and lead to visual disturbances.5 The visual deficits if not resolved are the major reason torticollis is surgically corrected. Other factors should not be over-looked, psychosocial issues such as depression and self image problems may occur if the deformities are not corrected. Social interactions may be avoided by a child that looks different. For example, there may be fear avoidance of being singled out by their peers.

In conclusion, I agree with the rationale for prevention, care, assessment, and rehabilitation of plagiocephaly and torticollis as seen in the current literature. The inherent symmetrical brain growth and the skull’s natural flexibility and plasticity in the early months create dynamic correction and improve cranial shape.5 The skull undergoes approximately 80 percent of its postnatal growth with the first year of life. Awareness of the condition and its causes may decrease the occurrence of positional plagiocephaly and torticollis. Currently, approximately 25 percent of parents never place their infants prone, even for play. It is essential to encourage prone playing and teach parents how to alter eating positions to diminish the side preference of their child. Stretching is the most effective intervention for a parent to perform regularly, however other options like the cranial orthosis exist. The majority of infants referred to neurosurgeons with occipital plagiocephaly can be successfully managed nonsurgically. My conclusions are supported by a sizeable amount of research that is available in reputable journals and online.

Several of my articles are from the Journal of Pediatrics and the American Academy of Pediatrics (AAP). These studies varied in the size of the subjects tested. There was a 15 year retrospective study of 82 infants with non-surgical interventions and 18 with surgery. A clinical report regarding guidance for rendering care by the AAP with recent citations was also available. There was a case study and a clinical report that were small sample subject sizes, however the information quoted in these articles was recent and noteworthy. There was not a preponderance of evidence with in the case study research given their prospective size. The clinical report and several other articles were funded by the company that made the cranial orthoses as were two other articles, which made me question if the papers were indeed unbiased. Luther had a population of 821 with muscular torticollis and stretching exercises, 90 percent had positive outcomes for non-surgical intervention. Another well written article by de Chalain had 159 infants from three out-patient facilities giving some diversity to the population. There were also a couple of articles such as BNI quarterly in 2001; that released a well researched management guide. However, an actual study was not performed. It seemed that there was more guideline and background information available than actual studies with large population sizes with good research formats that are unbiased. In quite a few articles the follow-up decreased the number of subjects analyzed by almost half of the total subjects available. Further research is needed to help identify prevention, assessment, and management of these conditions.

Future research is essential to evidence-based practice. It would be interesting to have a study of caregivers who are given information and prevention methods on positional plagiocephaly and torticollis. Research conducted prenatally will be followed-up at three months, six months and a year to identify how many of these children develop this condition in comparison to controls that do not receive training. There seemed to be a lot of studies that were created by the cranial orthosis companies. I believe to legitimize the use of these devices it is essential to have independent unbiased research comparing both stretching/ positioning and helmet use in the first year of life after diagnosis of positional plagiocephaly and associated torticollis. There should be one group that only uses cranial orthoses, a second group that only uses stretching/positioning and a third group that is a combination of the two groups. Finally, I would like to see a population of positional plagiocephaly and secondary torticollis in the second year of life comparing the non-surgical interventions effectiveness. It seemed as though surgical intervention was the primary option during this time because of the decrease in brain and cranial growth. I would like a study to perform non-surgical interventions in the second year toddler. Similar studies with the use of all intervention strategies should be analyzed with larger subject samples and different patient demographics. A power analysis should be done to identify appropriate sample sizes for this population in future studies.


Works Cited


1) Academy of Pediatrics. (2002). While in Utero, One Twin More Likely to Develop Misshapen
Head. Pediatrics.140.1.

2) Biggs, Wendy S. MD. (2003). Diagnosis and Management of Positional Head Deformity.
American Family Physician.67.1953-60.

3) de Chalain TM and Parak S. (2004). Torticollis Associated with Positional Plagiocephaly: A Growing Epidemic. Journal of Orthotics and Prosthetics.16(4S).28-30.

4) Emery, C. (1994). The Determinants of Treatment Duration for Congenital Muscular Toticollis.
Pediatrics.74 (10).921-9.

5) Lima D. and Fish D. (2003) Acquiring Craniofacial Symmetry and Proportion Through
Repositioning, Therapy, and Cranial Remolding Orthoses. Journal of Orthotics & Prosthetics.15 (1S) 1-8.

6) Littlefield TR, Reiff JL, and Rekate HL. (2001) Diagnosis and Management of Deformational
Plagiocephaly. BNI Quarterly.17 (4).1-9.

7) Luther, Brenda L. (2002) Congenital Muscular Torticollis and Placiocephaly. National
Association of Orthopaedic Nurses.21 (3).21-29.

8) Miller RI and Sterling CK. (2000) Long-Term Developmental Outcomes in Patients with Deformational Plagiocephaly. Pediatrics.105 (2).E26-30.

9) National Institute of Neurological Disorders and Stroke, National Institute of Health. (Oct. 13, 2005). Dystonias. Retrieved November 22, 2005, from
http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm.

10) Persing, John MD.etal. (2003) Prevention and Management of Positional Skull Deformities In Infants. Pediatrics.112.199-202. 



Source:  Dr. Julie C. | Epinions.com


If you would like more information on Torticollis, Plagiocephaly or Cranial Remolding Orthosis, please visit our website at www.alexandrasphate.org or fill out the "contact me" form below.

TheARspecialists Signature

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
GARY@ALEXANDRASPHATE.ORG

Thursday, March 1, 2012

A Cranial Remolding Orthosis? Plagiocephaly Helmet? Whats That?

A cranial remolding orthosis or helmet, is a device used to treat head shape deformities such as plagiocephaly, brachycephaly and scaphocephaly. The helmet treatment is effective in infants from 3-18 months of age. The earlier treatment is initiated, the better the outcome due to the decrease in growth rate as the child ages. The first cranial remolding orthosis was developed by Dr. Clarren in 1979. Thousands of infants have been treated with the STARband, which is the first cranial remolding device with FDA clearance and availability to pracitioners across the world. The STARfamily of cranial remolding orthoses are manufactured by Orthomerica.

The improvements in head shape are achieved by providing contact in the bossed areas and reliefs in the flattened areas. As the skull continue to grow, the reliefs are filled out and the skull rounds out. The amount of improvement is directly related to the amount of growth during their time in the helmet. The younger the infant, the faster the rate of skull growth. The ideal age for initiation of helmet treatment is 4-7 months.

What causes head shape deformities?
The most common cause of head shape deformation is supine sleep positioning. An infant's head triples in size in the first 12 months of life. During this time, their head is susceptible to external pressure that may influence it's shape such as supine sleep position, inutero constraint, car seats, baby carriers etc. Increased risk factors include, multiple births, premturity and torticollis. Torticollis is a condition in which a tight neck muscle on one side causes the head to tilt and turn. Physical therapy is recommended to stretch, strengthen and improve range of motion at the neck.

Repostitioning should be attempted in all cases as early as possible. If two months of repositioning does not improve head shape, a helmet may be necessary. Repositioning and tummy time is important for ALL infants. Since infants spend the majority of time on their backs, spending waking hours on their tummy is critical in strengthening for normal physical development. Click here for handouts on repositioning.
When is a cranial remolding orthosis needed?
Once any skull flatness or asymmetries are noticed, it is advised to ask your pediatrician to refer you to a craniofacial specialist. The specialist will evaluate the infant to rule out potentially more serious causes such as craniosynostosis(premature fusing of a cranial suture), assess head shape and determine if a helmet and/or any other treatment are needed. Pediatricians can prescribe a cranial remolding orthosis, but it is advised to see a specialist in order to rule out other potential, more serious issues. The earlier the infant is evaluated the better the overall outcome. Repositioning efforts must be attempted for at least two months. If these efforts fail to improve the head shape, a helmet may be required.
Will insurance cover a cranial remolding orthosis?
We see coverage from 0% to 100%. It is best to call your insurance and see if there are any exclusions in your specific plan. Cranial remolding orthoses fall under a sub category of orthotics and prosthetics which are under the category durable medical equipment. The device code is S1040. Contact us for more information
To read more about the STARscanner data acquisition system information click here.
If you would like more information regarding cranial remolding orthosis, or need assistance with an insurance appeal, please click here to fill out our contact form.

TheARspecialists Signature

Gary Tate Jr.
President and Founder
Alexandra's P.H.A.T.E.
Pittsburgh, PA
412-860-4557
http://draft.blogger.com/gary@alexandrasphate.org