LAUSR

BACKGROUND The neurodevelopmental impact of skull asymmetry and orthotic helmet therapy for deformational plagiocephaly (DP) have had limited investigation. This study assessed the long-term neurocognitive outcomes in DP patients and their association with orthotic helmet therapy and head shape abnormality. METHODS 138 School-age children with a history of DP of whom 108 received helmet therapy were tested with a neurocognitive battery assessing academic achievement, intelligence quotient, and visual-motor function. Severity of presenting plagiocephaly was calculated using anthropometric and photometric measurements. Analysis of covariance was used to compare outcomes between helmeted and non-helmeted cohorts, unilateral plagiocephaly and concomitant brachycephaly, and left and right-sided plagiocephaly. The association between severity of plagiocephaly and neurocognitive outcome was assessed through a residualized change approach. RESULTS There were no significant differences in neurocognitive outcomes between the helmeted and non-helmeted DP cohorts or the unilateral plagiocephaly and brachycephaly cohorts. Left-sided DP patients performed significantly worse in motor coordination than right-sided patients (84.8 vs 92.7, ES=-0.50, p=0.03). There was a significant laterality by cephalic index (CI) interaction, with a negative association between CI and reading comprehension and spelling for left-sided patients. No significant associations were found between severity of presenting or post-treatment deformity and neurocognitive outcome. CONCLUSION Pre- and post-treatment severity of plagiocephaly were not correlated with neurocognitive function at school age. Helmet therapy was not associated with better or worse long-term neurocognitive function. However, patients with left-sided DP demonstrated worse neurocognitive outcomes than right-sided patients in the domains of motor coordination and some types of academic achievement.