Orthotist from Scotland Observes Clinical Practice at SPOT

Orthotist, prosthetist and educator, Tony McGarry of the National Center for Training and Education in Prosthetics and Orthotics at the University of Strathclyde in Glasgow, Scotland, has a problem. There is some unrest in the United Kingdom in general and Scotland in particular as more and more infants are diagnosed with deformational plagiocephaly. The condition, characterized by asymmetrical head shapes, is thought to be closely linked to the recent practice of laying infants on their back to prevent SIDS. The "back to sleep program" arrived in the UK fairly recently, several years after its acceptance in the United States. The increase in deformational plagiocephaly followed closely behind.

Conventional treatment by pediatricians throughout the UK is to let babies "outgrow" the condition. However, as more and more parents became dissatisfied with the outcomes of this treatment option, Tony and some of his colleagues at The Royal Hospital for Sick Children in Glasgow began to carefully scrutinize the available scientific literature regarding incidence, treatment and outcomes. However, as Tony progressed through this process, he realized that before he could really understand the issues at hand, he would need more clinical exposure to the condition and its management.

Several months, and countless emails later, Tony arrived in Salt Lake City as a guest of Phil Stevens, M.Ed, CPO and Specialized Prosthetics and Orthotic Technologies (SPOT). His objective was to become familiar with all the various aspects of the treatment of these children and to take that information back with him to Scotland. As an orthotist, Tony's primary interest is in cranial remolding orthoses, or corrective "helmets" that are used to apply gentle pressure to targeted areas of the infant's head while allowing corrective growth in other areas, ultimately restoring symmetry to the head shape.

While at SPOT, Tony observed Phil throughout every phase of cranial remolding therapy. This begins with the evaluation of new patients, in which Phil reviews the child's medical history and doctor's recommendations. This is followed by the measurement and casting process, in which a plaster impression of the head is obtained and then sent to a specialized fabrication facility. Once the helmet is fabricated, the patient returns for the fitting, at which time Phil adjusts and trims the foam inside the helmet to ensure it fits correctly and that the baby is comfortable. In the weeks and months that follow, adjustments to the helmet are made frequently to keep up with the infant's rapid cranial growth.

However, Phil also reviewed with Tony some of the other, less apparent nuances of managing these patients. "When treating a child, fitting the helmet is only a portion of the process," Phil said. "Parents come in here with a lot of different preconceptions and expectations and they typically have a lot of questions. It's important to address these and make sure that parents understand certain things from the outset. For example, what they can realistically expect from the helmet, what kind of timelines they should anticipate, and how the helmets work. The more information I can give them, the more they become involved with the treatment. It also empowers them to make important decisions."

And so, in addition to showing Tony how to successfully fit the plastic helmets, Phil also shared with him many of the common conversations he has with parents. "Helping the parents appreciate the changes that occur throughout the process, teaching them what to be on the lookout for and when to call and check in with me, helping them decide when it is reasonable to initiate or conclude the treatment given the age of their child and the extent of the asymmetry, these are all just as important as an accurately fitting helmet," Phil said.

In speaking with Tony, Phil noted that one of the upsides of working with helmet patients is the frequency of their visits. "With many orthotic patients, we may only see them a few times a year, depending on the case. With the helmet babies, we can see them every two to four weeks, and we can really see them grow and develop," he said. "It's gratifying to get to know the families and be able to help correct the condition."

During his visit, Tony also attended a helmet clinic at the office of Dr. Steven Warnock, a plastic surgeon with whom Phil works regularly. Additionally, he spent time at a Primary Children's Medical Center physical therapy clinic in Taylorsville where he discussed the management of torticollis with Mary Emerson, MPT. Torticollis is a neck condition that causes a baby's head and neck to tilt to one side and is often linked with plagiocephaly.

Following two days with SPOT, Tony continued on to South Dakota where Phil arranged for him to spend an additional two days with a colleague who specializes in helmets there. "There are certainly a number of ways to approach plagiocephaly and I wanted to expose Tony to as many new ideas as possible," Phil said.

"I am glad to have had the experience visiting clinicians in the States and observing their practice of treating plagiocephaly," Tony said. "I would like to thank all the staff for providing me with a very excellent experience. The information I gained fulfilled my expectations entirely."

Tony will be returning to North America in July when he will be presenting a paper, "Gait Training of the Transfemoral Amputee," at the 12th World Congress of the International Society for Prosthetists and Orthotists in Vancouver. The two colleagues have already made plans to meet again at the venue, as Phil will also be there, co-presenting on "Clinical Foot Assessment Techniques" with Professor David Pratt of Birmingham, England.

BACK