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Plagiocephaly Severity Scale
 

Age: birth to 4 months

A documented two month period of repositioning is highly recommended prior to reffering for cranial remolding ortheses evaluation. This conservative step is typically required by third-party payers before authorizing a cranial remolding orthosis.

If torticollis is suspected, early referral to physical therapy is recommended.

Age: 4+ months

Assess for further treatment when any of these secondary skull characteristics are observed.
 
PLAGIOCEPHALY BRACHYCEPHALY

Clinical Presentation:

  • Ipsilateralear shift
  • Ipsilateral front bossing
  • Contralateral frontal flattening

Clinical Documentation:

  • Measure the longest and shortest diagonal from the forehead to the posterior skull using calipers
  • Calculate the cranial vault asymmetry index (CVAI)

Clinical Presentation:

  • Bilateral forehead bossing
  • Increased posterior vault
  • Bilateral protrusion of parietal bone above the ears

Clinical Documentation:

  • Measure the M/L and A/P lengths of the skull using calipers
  • Calculate Cephalic Ratio (CR)
  • If CR ˃ 90, orthotic evaluation is recommended
Cranial Vault Asymmetry Index (CVAI):







Cephalic Ratio (CR):
 
 
 
 
 
 
 
 
 
Level of severity
Clinical Presentaion
Recommended Treatment
CVAI
1
  • All symmetry within normal limits
No treatment required
  ˂ 3.5
 2
  • Minimal asymmetry in one posterior quadrant
  • No secondary changes
Repositioning Program
3.5 to 6.25
 3
  • Two quadrant involvement
  • Moderate to severe posterior quadrant flattening
  • Minimal ear shift and/or anterior involvement

Conservative treatment:

  • Repositioning
  • Cranial remolding orthesis (based on age and history)
6.25 to 8.75
  4
  • Two or three quadrant involvement
  • Severe posterior quadrant flattening
  • Moderate ear shift
  • Anterior involvement including noticeable orbit assymetry

Conservative treatment:

  • Cranial remolding orthesis
 8.75 to 11
 5
  • Three or four quadrant involvement
  • Severe posterior quadrant flattening
  • Severe ear shift
  • Anterior involvement including orbit and cheek assymetry

Conservative treatment:

  • Cranial remolding orthesis
˃11
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