Pat Ricalde, MD, DDS, FACS
About Helmet Therapy Treatment
- Dr. Ricalde works as a team with the referring pediatrician, physical therapist and an orthotist to manage the child’s care.
- The referring physician is kept informed on the progress the child is making during treatment.
- Cranial Remolding Orthoses (helmets) are worn 23 hours/day after an initial 5-day break-in schedule.
- It is important when fitting that the ears should sit comfortably in the helmet spaces to avoid twisting.
- The helmet needs to be removed once per day for cleaning of the helmet and bathing of the child. The child’s skin should be checked for irritation. Some redness or irritation is normal. If redness is severe or lasts longer than an hour, the helmet may need to be adjusted.
- If for any reason the helmet is removed for more than 24 hours, it will need to be professionally readjusted before it can be placed back on the head.
- Parents are instructed to dress the child in light clothing on hot summer days to keep the child cool while the helmet is donned.
- Parents are advised to remove the helmet for physical therapy and torticollis stretching.
Patient History
- Mother went in to pre-term labor at 28 weeks.
- Infant patient diagnosed with congenital muscular torticollis at birth.
- Unusual head, face and cheek shape and ear asymmetry.
- Child showed no signs of craniosynostosis.
- Eye exam was normal, no diagnosis of strabismus.
- MRI revealed some lymphadenopathy.
- No abnormalities in the brain or soft tissues of the neck, no abnormalities of the craniovertebral junction of the spine.
- Mother sought treatment before 6 months of age due to concern about misshapen head.
- Dr. Ricalde diagnosed the child with positional plagiocephaly.
“The results were undeniable. Our child has developed beautifully thanks to the helmet. We were thrilled with the results.”
Cranio Measurements
Initial Measurements at Evaluation (Child age 3 months):
Circumference: 416.1mm
Cranial Width: 124.4mm
Cranial Length: 138.9mm
Cephalic Ratio: 89.6%
Cranial Vault Asymmetry: 12.1mm (Normal <6mm)
Final Measurements After Helmet Therapy (Child age 8 months):
Circumference: 436.9mm
Cranial Width: 127.8mm
Cranial Length: 147.7mm
Cephalic Ratio: 86.5%
Cranial Vault Asymmetry: 4.7mm (Normal <6mm)
Timeline of Helmet Therapy Treatment of Child
12/16/11:
After a complete examination, Dr. Ricalde diagnosed the child with plagiocephaly and determined the child was a candidate for helmet therapy.
01/04/12:
Child was seen by the orthotist for fitting and delivery of custom Cranial Remolding Orthosis.
01/13/12:
Orthotist determined helmet fit was not ideal. Impression obtained for fabrication of new helmet.
01/23/12:
New helmet fit and delivered.
03/05/12:
Child had follow-up appointment with Dr. Ricalde to monitor progress.
2/12 – 5/12:
Child was seen consistently by orthotist every two weeks for adjustments and follow-up measurements.
05/15/12:
Child had final appointment with Dr. Ricalde to discontinue helmet wear.
Outcome
- After 2-months of helmet treatment, the child’s Cranial Vault Asymmetry (CVA) had improved to 6.7mm.
- By the end of treatment, the child showed a total of 7.4mm improvement in CVA with a final CVA of 4.7mm. (Normal CVA is <6mm).
- Overall, the child’s head shape showed dramatic, positive improvement with helmet therapy.
- Child is still being treated for torticollis.
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