{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T21:24:32Z","timestamp":1789075472733,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,4,19]],"date-time":"2020-04-19T00:00:00Z","timestamp":1587254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Brachycephaly has several potential deleterious effects, including malocclusion, sleep apnea, and abnormal posture. Nevertheless, the research regarding helmet therapy as a treatment strategy for brachycephaly is limited. Herein, we aimed to analyze the factors influencing the effects of helmet therapy in infants with brachycephaly. We retrospectively reviewed the records of 207 infants aged 3\u201314 months with a cranial index (CI) &gt;90% who received helmet therapy between May 2016 and October 2019 and complied with the treatment protocol well. We used a multiple regression analysis to determine which factors affected the duration of therapy and a Jonckheere\u2013Terpstra test to establish differences in the duration of helmet therapy according to age and severity. We identified brachycephaly severity (p &lt; 0.001), asymmetry (p &lt; 0.001), and age (p &lt; 0.001) as factors affecting the duration of therapy. Helmet therapy might be effective for infants with moderate to severe brachycephaly, assuming good protocol compliance. In addition, younger treatment initiation age and less severe and less asymmetric brachycephaly significantly shorten the treatment duration.<\/jats:p>","DOI":"10.3390\/jcm9041171","type":"journal-article","created":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T05:48:52Z","timestamp":1587448132000},"page":"1171","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Outcome Analysis of the Effects of Helmet Therapy in Infants with Brachycephaly"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1470-2914","authenticated-orcid":false,"given":"Hyehoon","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5475-4153","authenticated-orcid":false,"given":"Seong Hoon","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon Sung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9290-6173","authenticated-orcid":false,"given":"Bo Young","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1002\/ajmg.a.32612","article-title":"Elements of morphology: Standard terminology for the head and face","volume":"149","author":"Allanson","year":"2009","journal-title":"Am. J. Med. Genet. A"},{"key":"ref_2","first-page":"35","article-title":"Class I and Class III malocclusion sub-groupings related to headform type","volume":"62","author":"Martone","year":"1992","journal-title":"Angle Orthod."},{"key":"ref_3","first-page":"2333794X18805618","article-title":"Helmet Treatment of Infants with Deformational Brachycephaly","volume":"5","author":"Kelly","year":"2018","journal-title":"Glob. Pediatr. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1164\/ajrccm.163.4.2005136","article-title":"The relationship between craniofacial morphology and obstructive sleep apnea in whites and in African-Americans","volume":"163","author":"Cakirer","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"755.e11","DOI":"10.1016\/j.wneu.2016.10.027","article-title":"Nonsynostotic Posterior Brachycephaly with Hindbrain Herniation","volume":"97","author":"Pathmanaban","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1097\/00006534-200111000-00007","article-title":"Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis","volume":"108","author":"Panchal","year":"2001","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jpeds.2019.04.042","article-title":"Positional plagiocephaly\/brachycephaly is associated with later cognitive and academic outcomes","volume":"210","author":"Knight","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.neuchi.2019.09.003","article-title":"Deformational plagiocephaly: State of the art and review of the literature","volume":"65","author":"Beuriat","year":"2019","journal-title":"Neurochirurgie"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-Santos, J., Gonz\u00e1lez-Bernal, J., De-la-Fuente-Anuncibay, R., Aguilar-Parra, J., Trigueros, R., Soto-C\u00e1mara, R., and L\u00f3pez-Liria, R. (2020). A Prospective Study of Cranial Deformity and Delayed Development in Children. Sustainability, 12.","DOI":"10.3390\/su12051949"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/00004703-200510000-00008","article-title":"Neurodevelopmental implications of \u201cdeformational\u201d plagiocephaly","volume":"26","author":"Collett","year":"2005","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1024\/1661-8157\/a001506","article-title":"Positional plagiocephaly in infancy: Diagnosis and management","volume":"102","author":"Gautschi","year":"2013","journal-title":"Praxis (Bern. 1994)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1046\/j.1469-7580.2002.00074.x","article-title":"Central nervous system phenotypes in craniosynostosis","volume":"201","author":"Aldridge","year":"2002","journal-title":"J. Anat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"577","DOI":"10.5014\/ajot.56.5.577","article-title":"The relationship of infant sleep and play positioning to motor milestone achievement","volume":"56","author":"Salls","year":"2002","journal-title":"Am. J. Occup. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0301-0503(84)80201-5","article-title":"Oculo-motor disorders in craniofacial malformations","volume":"12","author":"Morax","year":"1984","journal-title":"J. Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1097\/SCS.0b013e3181aee369","article-title":"Incidence of otitis media in children with deformational plagiocephaly","volume":"20","author":"Purzycki","year":"2009","journal-title":"J. Craniofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1007\/s00701-019-03924-2","article-title":"Prevalence and severity of positional plagiocephaly in children and adolescents","volume":"161","author":"Ble","year":"2019","journal-title":"Acta Neurochir. (Wien.)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E632","DOI":"10.1227\/NEU.0000000000001430","article-title":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients With Positional Plagiocephaly","volume":"79","author":"Tamber","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s00381-019-04354-2","article-title":"The role of age on helmet therapy in deformational plagiocephaly and asymmetric brachycephaly","volume":"36","author":"Cevik","year":"2020","journal-title":"Childs Nerv. Syst."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1159\/000479326","article-title":"The Role of Age and Initial Deformation on Final Cranial Asymmetry in Infants with Plagiocephaly Treated with Helmet Therapy","volume":"52","author":"Mackel","year":"2017","journal-title":"Pediatr. Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.jcms.2019.01.011","article-title":"Outcome analysis of molding helmet therapy using a classification for differentiation between plagiocephaly, brachycephaly and combination of both","volume":"47","author":"Hinken","year":"2019","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/00001665-200401000-00031","article-title":"Molding helmet therapy in the treatment of brachycephaly and plagiocephaly","volume":"15","author":"Teichgraeber","year":"2004","journal-title":"J. Craniofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jcms.2015.11.016","article-title":"Impact of severity and therapy onset on helmet therapy in positional plagiocephaly","volume":"44","author":"Freudlsperger","year":"2016","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1097\/00001665-200107000-00003","article-title":"Active counterpositioning or orthotic device to treat positional plagiocephaly?","volume":"12","author":"Loveday","year":"2001","journal-title":"J. Craniofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Graham, T., Adams-Huet, B., Gilbert, N., Witthoff, K., Gregory, T., and Walsh, M. (2019). Effects of Initial Age and Severity on Cranial Remolding Orthotic Treatment for Infants with Deformational Plagiocephaly. J. Clin. Med., 8.","DOI":"10.3390\/jcm8081097"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"338","DOI":"10.5999\/aps.2012.39.4.338","article-title":"Outcome analysis of cranial molding therapy in nonsynostotic plagiocephaly","volume":"39","author":"Yoo","year":"2012","journal-title":"Arch. Plast. Surg."},{"key":"ref_26","unstructured":"Kliegman, R.M. (2019). Nelson Textbook of Pediatrics, Elsevier. [21st ed.]. Chapter 23."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.jpeds.2004.10.017","article-title":"Deformational brachycephaly in supine-sleeping infants","volume":"146","author":"Graham","year":"2005","journal-title":"J. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1097\/01.prs.0000259190.56177.ca","article-title":"Nonsynostotic occipital plagiocephaly: Factors impacting onset, treatment, and outcomes","volume":"119","author":"Losee","year":"2007","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/00006534-199902000-00003","article-title":"Analysis of posterior plagiocephaly: Deformational versus synostotic","volume":"103","author":"Mulliken","year":"1999","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/pch\/19.8.423","article-title":"Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging","volume":"19","author":"Mawji","year":"2014","journal-title":"Paediatr. Child Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-Santos, J., Gonz\u00e1lez-Bernal, J.J., Anuncibay, R.D.-l.-F., Soto-C\u00e1mara, R., Cubo, E., Aguilar-Parra, J.M., Trigueros, R., and L\u00f3pez-Liria, R. (2020). Infant Cranial Deformity: Cranial Helmet Therapy or Physiotherapy?. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17072612"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1001\/archpediatrics.2011.92","article-title":"Development in toddlers with and without deformational plagiocephaly","volume":"165","author":"Collett","year":"2011","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e537","DOI":"10.1542\/peds.2009-0052","article-title":"Case-control study of neurodevelopment in deformational plagiocephaly","volume":"125","author":"Speltz","year":"2010","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1007\/s00381-012-1731-y","article-title":"Brain volume and shape in infants with deformational plagiocephaly","volume":"28","author":"Collett","year":"2012","journal-title":"Childs Nerv. 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