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Objective: Deformational Plagiocephaly (DP) is commonly treated with cranial orthosis, or helmet therapy. A large, national study on the impact of insurance status on helmet outcomes is lacking. We assessed treatment outcomes for helmet therapy based on insurance status. Design: This was a retrospective data analysis of patients referred to Cranial Technologies, Inc for helmet therapy between 2014–2020 across 21 states. Patients, Participants: There were a total of 211,417 patients referred for helmeting, of whom 141,513 received helmet therapy. Main Outcomes Measures: Multivariate regression was used to assess the relationship of insurance status with post-treatment residual flattening, measured by cephalic index (CI) and cranial vault asymmetry index (CVAI), and treating provider rating of success. Results: Patients with Medicaid were more likely to complete treatment with residual flattening measured by CI and CVAI when compared to patients with private insurance (OR: 1.58, CI: 1.51–1.65, p < 0.001 and OR: 1.21, CI: 1.15–1.28, p < 0.001, respectively). Providers of patients with Medicaid were more likely to give a low rating of success following treatment (OR: 3.25, CI: 2.70–3.92, p < 0.001). Conclusions: Our study investigating the impact of insurance status on helmet therapy across 21 states found that patients with Medicaid were more likely to experience residual flattening and have lower provider-rated outcomes compared to those with commercial insurance. Given significant caregiver burden posed by helmet therapy, which requires frequent visits and consistent helmet use, caregivers of patients with Medicaid may require greater support to reduce outcome disparities observed here. [ABSTRACT FROM AUTHOR]

Objective. In part 1 of this investigation, we demonstrated that children of multiple birth pregnancies are at higher risk for development of deformational plagiocephaly. In the current investigation, we explore whether certain prenatal and postnatal risk factors predispose one twin over the other by examining the occurrence and severity of plagiocephaly in both discordant (only 1 affected) and concordant (both affected) twin pairs. Methods. Throughout 1999, we obtained detailed medical histories on 140 sets of twins who had presented for treatment at 1 of 9 treatment centers across the United States. The study cohort consisted of 46 concordant and 94 discordant twin pairs (a total of 280 study participants). Information about prenatal and postnatal history of each infant was obtained through detailed review of the children&apos;s medical records as well as analysis of a patient database maintained on all infants who receive treatment. Follow-up interviews were performed to verify the information recorded and to obtain additional information about the child who had not received treatment (if appropriate) or use of reproductive assistance (fertility drugs, intracytoplasmic sperm injection, etc) that had not been previously recorded. Statistical analyses were performed to assess the effects of prenatal and postnatal risk factors (in utero position, in utero orientation, birth weight, neck involvement, sleeping position) with respect to which infant was affected in the discordant twin pairs and to which infant was more severely affected in the concordant twin pairs. Results. Statistical analyses of both discordant and concordant twin pairs demonstrated that the lower in utero infant was significantly more likely to be affected ([chi square] = 17.391). In addition, the more severely affected infant was significantly more likely to have some form of neck involvement (torticollis, neck tightness; [chi square] = 46.380), as well as have been carried in a vertex position ([chi square] = 7.408). Conversely, neither sleeping position nor gender was found to be associated with development of plagiocephaly. Conclusions. The results of this investigation strongly support an in utero cause of plagiocephaly and demonstrate that intrauterine positioning may play a prominent role in determining both the occurrence and severity of deformational plagiocephaly in twins. These findings confirm that the lower in utero infant is at increased risk for the development of plagiocephaly, likely resulting from the more restrictive intrauterine environment encountered during the later part of the pregnancy. Pediatrics 2002;109:19-25; deformational plagiocephaly, multiple birth, plurality., Deformational plagiocephaly refers to a condition in which an infant's head becomes deformed as the result of external molding forces being applied to the malleable cranium. This distortion often leads [...]

Objective: Deformational Plagiocephaly (DP) is commonly treated with cranial orthosis, or helmet therapy. A large, national study on the impact of insurance status on helmet outcomes is lacking. We assessed treatment outcomes for helmet therapy based on insurance status., Design: This was a retrospective data analysis of patients referred to Cranial Technologies, Inc for helmet therapy between 2014-2020 across 21 states., Patients, Participants: There were a total of 211,417 patients referred for helmeting, of whom 141,513 received helmet therapy., Main Outcomes Measures: Multivariate regression was used to assess the relationship of insurance status with post-treatment residual flattening, measured by cephalic index (CI) and cranial vault asymmetry index (CVAI), and treating provider rating of success., Results: Patients with Medicaid were more likely to complete treatment with residual flattening measured by CI and CVAI when compared to patients with private insurance (OR: 1.58, CI: 1.51-1.65, p < 0.001 and OR: 1.21, CI: 1.15-1.28, p < 0.001, respectively). Providers of patients with Medicaid were more likely to give a low rating of success following treatment (OR: 3.25, CI: 2.70-3.92, p < 0.001)., Conclusions: Our study investigating the impact of insurance status on helmet therapy across 21 states found that patients with Medicaid were more likely to experience residual flattening and have lower provider-rated outcomes compared to those with commercial insurance. Given significant caregiver burden posed by helmet therapy, which requires frequent visits and consistent helmet use, caregivers of patients with Medicaid may require greater support to reduce outcome disparities observed here., Competing Interests: Declaration of Conflicting InterestsMr. Littlefield is the Chief Science and Technology Officer at Cranial Technologies, Inc., and he has a financial interest in Cranial Technologies, Inc. All other authors have no conflicts of interest relevant to this article to disclose.