Overview of Plagiocephaly
Since 1992, when the American Academy of Pediatricians made the recommendation for infants to be positioned on their sides or back for sleeping, to decrease the incidence of Sudden Infant Death Syndrome (SIDS), the occurance of deformational plagiocephaly has risen to estimates as high as 40% of healthy infants. Positional plagiocephaly is characterized by flattening of one side of the occiput, forward progression of the ear on the same side, and bossing of the ipsilateral forehead.
For those infants who do not make progress with therapy or positioning by three months of age, the prescription of a custom orthosis is recommended. At Boston Brace, we manufacture a cranial remolding helmet known as the Boston Band. We utilize a unique layering technique for our helmets which gives the Orthotist the ability to remove layers whenever necessary thereby allowing the infants head to grow in a normal fashion.
Protocol for Treatment
The following guidelines are provided to ensure that the identification of Plagiocephaly and the referral for treatment, are managed to provide optimal results for each patient.
· It is recommended that at three months of age, as a standard of practice, each child be evaluated and measured for cranial symmetry. Anthropometric calipers may be used for manual measurement taking.
· If it is determined that a cranial asymmetry of 8mm or greater is present, the child needs to be referred to a trained specialist in cranial remolding for treatment, care, and tracking of progress.
Treatment with the Boston Band
The treatment of plagiocephaly with a cranial remolding orthosis should commence at approximately 3 months of age. The Boston Band is a lightweight, plastic and foam orthosis made from a cast impression or a 3-D scan of the infant’s head. It is made of a plastic flexible shell lined with polyethylene foam. The foam can be modified over time to allow for growth and will provide a pathway for the infant’s head to grow into a more symmetrical shape. The Boston Band allows the baby to sleep in any position he or she wants, yet keeps pressure off the flat spots and constrains head growth along the axis of the prominent parts. It offers a simple and direct solution to the problem of positional plagiocephaly and brachycephaly. Correction usually occurs within 2 to 3 months for patients beginning Boston Band treatment at 3 months of age. In older patients, longer treatment time is necessary.
Frances Kiser CPO
Certified Prosthetist and Orthotist
After earning her Bachelors degree at The University of Massachusetts, Frances Kiser CPO started working on Cape Cod as a secretary and fitter at Bay Orthopedics.
She decided she had a unique aptitude and empathy for the practice of Orthotics and Prosthetics.
She applied and was accepted to Northwestern University’s Orthotic and Prosthetic Practitioner program at The Rehab Institute of Chicago.
Frances graduated in 1982 with a certificate in Orthotics and Prosthetics. She moved to California and was a staff Orthotist Prosthetist at Orthomedics Inc. in Riverside CA.
Frances married Michael Kiser CO in 1983 and earned her Prosthetic and Orthotic certification in 1984.
She and Michael founded Kiser’s Orthotic and Prosthetic Services, Inc. in Keene, NH in 1987.
Certifications in: C-Leg microprocessor knee, I-limb microprocessor hand, MAS Socket, Harmony Suction System, etc.
Mike entered Cerritos College in the Orthotic and Prosthetic program as he started working at Johnson’s Orthopedic in Orange, CA in 1976.
He graduated and earned certificates at UCLA in Orthotics and Prosthetics. Mike was accepted to Northwestern University’s Orthotic Practitioner program at The Rehab Institute of Chicago and graduated in 1982 with a certificate in Orthotics.
He resumed his position at Johnson’s Orthopedic in Orange, CA where he was a staff Orthotist in attendance of eight California Children’s Service clinics. Mike had extensive experience in pediatric orthotics, scoliosis treatment, fracture management, and Reciprocation Gait orthotics.
Mike married Frances Kiser CPO in 1983 and earned his Orthotic certification in 1984. He and Frances founded Kiser’s Orthotic and Prosthetic Services, Inc. in Keene, NH in 1987.
Certifications in: Boston Scoliosis system, Charleston Bending nocturnal scoliosis system, Providence Scoliosis System, Reciprocation Gait Orthosis, Sarmiento Fracture Management, Dynamic Movement Orthosis (DMO), Boston Band Cranial Remolding Helmet, and WalkAide Functional Electrical Stimulation System and etc.
Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. The normal spine curves gently backward in the upper back and gently inward in the lower back.
When viewed from the side, the spine should show a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back.
When a person with a normal spine is viewed from the front or back, the spine appears to be straight.
When a person with scoliosis is viewed from the front or back, the spine appears to be curved.
What Causes Scoliosis?
There are many types and causes of scoliosis, including:
Congenital scoliosis. A result of a bone abnormality present at birth.
Neuromuscular scoliosis. A result of abnormal muscles or nerves, frequently seen in people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis.
Degenerative scoliosis. This may result from traumatic (from an injury or illness) bone collapse, previous major back surgery or osteoporosis (thining of the bones).
Idiopathic scoliosis. The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable cause. There are many theories, but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited.
Who Gets Scoliosis?
Approximately 2% to 3% of Americans at age 16 has scoliosis. Less than 0.1% has curves measuring greater than 40 degrees, which is the point at which surgery becomes a consideration. Overall, girls are more likely to be affected than boys. Idiopathic scoliosis is most commonly a condition of adolescence affecting those ages 10 through 16. Idiopathic scoliosis may progress during the "growth spurt" years, but usually will not progress to adulthood.
How Is Scoliosis Diagnosed?
Most curves are initially detected on school screening exams, by a child's pediatrician or family doctor, or by a parent. Some clues that a child may have scoliosis include uneven shoulders, a prominent shoulder blade, uneven waist or leaning to one side. The diagnosis of scoliosis and the determination of the type of scoliosis are then made by a careful bone exam and an X-ray to evaluate the magnitude of the curve.
What Is the Treatment for Scoliosis?
The majority of adolescents with significant scoliosis with no known cause are observed at regular intervals (usually every four to six months), including a physical exam and a low radiation X-ray. Treatments include:
Braces. Bracing is the usual treatment choice for adolescents who have a spinal curve between 25 to 40 degrees -- particularly if their bones are still maturing and if they have at least two years of growth remaining.
The purpose of bracing is to halt progression of the curve. It may provide a temporary correction, but usually the curve will assume its original magnitude when bracing is eliminated.
The Boston Scoliosis Brace is accepted worldwide as the proven system for the non-operative treatment of idiopathic scoliosis.
The Boston Scoliosis Brace is currently used as the primary orthotic solution at some of the worlds foremost pediatric medical centers.
Providence Scoliosis system
- Lumbar curves
- Thoracic curves
- Double major curves
- Thorocolumbar curves
By combining precise grid coordinates of the patented measuring board, (picture inset), and utilization of a CAD CAM system we can effectively establish consistent modification strategies. The Providence Scoliosis system aggressively corrects the curves while the patient sleeps.
Charleston Bending Brace TLSO
The Charleston Bending Brace is a nocturnal TLSO for scoliosis it is effective for the noncompliant Boston brace wearer or as an adjunct to the Boston Brace.
The Charleston Bending brace overcorrects the curve while sleeping, This TLSO may not be worn when up because of the unbalanced position that it puts you in.
Soft Neuromuscular Scoliosis TLSO
Cerebral palsy, Osteoporosis, Myelomeningocele, Wheelchair seating support, Scoliotic deformities
- Muscular dystrophy, Cancer patients, Geriatrics
Designed for patients that cannot tolerate a rigid orthosis. The Flex Foam offers a softer inner layer of foam for the relief of bony prominences combined with a dense outer foam. The rigid external frame provides support where indicated. The frame is detachable and can be strategically adjusted as indicated by patient needs.