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Boston Band Cranial Remolding Guide for Medical Professionals

Development


As with many other devices developed by Boston Brace, the Boston Band was developed in conjunction with the top physician specialists in their field.  In this case, it was with specialists in cranio-facial (plastic surgery) and pediatric neurology.  The Boston Band technique was developed because, simply, we felt there was a better way and better results were possible.  Many other types of cranial remolding helmets exist however our experience was that they required a tremendous amount of follow-up appointments and the results were slow to achieve.  We have proven our results through our quality assurance program & research (appendix of literature also available here).  Average length of time that an infant is in the Boston Band is only 10-14 weeks compared to 4-6 months as advertised by other devices.

Causes


Positional cranial deformity means the head shape has been caused by the child’s position.  Often, infants establish a preference of position and do not yet have the ability or wherewithal to move their head.  In some cases, the infant may have a conditional called Torticollis.  This is the tightness the sterno-cleido-mastoid muscle on one side of the head & causes the child to look towards the contralateral shoulder.  It is therefore this contralateral side, posteriorolaterally that can become deformed.  Early on in life, over time, this same positional preference can cause flatness in a given area, typically in the occipital and/or parietal bones, because the skull is soft & growing but growing at a slower rate where there is pressure with the sleep surface for instance.

 

Concerns for Pediatricians

Many of our patient referrals do come from specialists such as Cranio-facial surgeons however this is not necessarily a requirement. In fact, thankfully, there are a growing number of our patient referrals coming directly from pediatricians. This is a widely accepted practice because in the vast majority of cases, the deformation is truly positional and there are no other underlying concerns.

Why then have some Pediatricians been reluctant to get involved in this treatment? Well, some forms of synostosis (premature closure of the cranial sutures) can sort of take the appearance of plagiocephaly. Here are some pictures:


Please understand we are in no way discouraging use of specialists however we are saying that in many cases, a Pediatrician with proper training can make the diagnosis of positional cranial deformity versus synostosis and refer the patient directly to an orthotist if a cranial remolding orthosis is warranted.  This process obviously saves time & money.  If there is any doubt whatsoever or co-morbidities present, please contact a specialist immediately.

 

Other treatment options


In cases that are identified very early on or when the child is predisposed to have positional cranial flattening (premature birth, multiple birth, in NICU for period of time at/after birth) we are certainly advocates of re-positioning techniques.  Often these are found to be unsuccessful.  As a result, we have collaborated in development of a new sleep surface.  The PlagioCradle™ is available for infants as a means to prevent cranial deformity.

 


Once the child is capable of rolling over a cranial remolding orthosis is the best and fastest way to gain the desired correction.  The Boston Band can only be used on children 3 months of age & older.  It can successfully treat positional deformation up to about 18 months in age when the brain has reached near full size.  These helmets cause no pain and do not exert any force on the skull.  They are considered passive devices meaning the helmet is not forcing change but in this case it is actually the growth of the brain that is directing the shape of the head.  Due to this, the best results occur when the brain is growing the fastest.  These growth charts show you the best time is between 3-9 months of age for both boys and girls.

 


Positional deformity is certainly no cause for alarm and can be easily treated.  Our NOPCO staffPartner groups successfully treat about 1,000 new patients per year with Boston Bands.   We will be honored for you to entrust us with this care of your child and will happily go into greater detail in any of these areas.
 

 

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