Toward a new paradigm in describing the therapeutic activity of helmets

[Guest guest]

On Jan 14, 2010, at 5:49 PM, wrote:

> I don't understand the terms active and passive regarding helmets.

> My ortho kind of said there really isn't a 'passive' helmet. Not

> using the typical definition of the word, at least.

>

> Can you explain the terms better? My daughter just got a Starband

> which is suppose to be classified as active.

Yeah: I don't understand it either, , and neither do the

STARband orthotists, evidently. Mine described the STARband as

active when I questioned him, but initially he called it passive. To

clarify, he said it is passive compared to the DOC Band. I found

this inexplicable, given that they are similarly constructed, as a

plastic shell with foam lining. You *can* order a STARband to be

made as a passive helmet, which I believe means that the shape is

initially symmetrical, rather than closely conforming to the existing

shape of your baby's head. But that's not what he meant.

What I've come to realize is that because of the kind of adjustments

he tends to make to the foam lining, he was right. The helmet

resists unfavorable growth toward the end of the adjustment interval,

as the prominent points of the skull come into increased contact with

the helmet. Then he shaves down the most tight places, allowing the

helmet to rotate, and the cranium overall remains in its asymmetrical

orientation.

So I thought long and hard about what was going wrong, and I think

I've finally cracked the code. With greater attention to the

differential in angular relationships between plates of the skull and

planes of the helmet, greater therapeutic effect is *possible* with

" active " helmets. But if the orthotist is just going to allow the

skull to grow into the interior volume in the most time-efficient

manner, this potential is not realized. Better to save some money

and get a passive helmet, which at least aims toward perfect

symmetry, and which a trained monkey could probably adjust.

I conclude that " active " and " passive " are just garbage terms used

for marketing purposes only. Cranial Tech benefits from the

resultant devaluing of passive helmets, which offer therapeutic

potential at low cost, whereas high cost is the weakness of their

business model. Orthomerica benefits by having therapeutic

effectiveness attributed to their material product, their strong

point, rather than orthotist skill, their weakness.

On Jan 14, 2010, at 10:31 AM, DomsMom wrote:

> [...] I do not agree with is how you refer to helmets for treating

> brachy as inherently being passive devices. I will agree with you

> that treating brachy is more complex and that correction requires

> more time. More growth is needed to produce positive results. If

> a baby with moderate to severe brachy is ever going to get their CI

> within normal range, mid to low 80's there are a few things that

> must occur. First, beginning treatment at a very young age 3-4

> months old. Second, the type of band used. In my opinion, a

> series of DOC Bands would need to be used. Here is why: DOC Bands

> do not last as long as STAR and others. They hold closer on the

> prominent areas. There is not as much foam, so babies grow out of

> them faster. After 6-9 weeks of growth, a young baby has outgrown

> their first band. A second is introduced. The holding points are

> different from the first band. Different holding points, produce

> greater change. The term you used " angular conformance " seems like

> it may apply in this situation. Also, since making sure that the

> width is being held, is a critical part of an active band's role in

> treating brachy. Passive bands do not hold the head width in the

> same manner. Also, I did notice results almost immediately after

> my son began wearing his DOC Band at a little over 4 mo old. It

> looked like his forehead was narrower than it had been. Obviously

> he did not have the time to produce much growth circumference wise.

Great points, and thanks for joining the discussion! I don't doubt

the superiority of the precisely-adjusted DOC bands for a second,

even in brachycephaly. I intended the term " passive " in a non-

disparaging way, but I admit folly in reverting to the very

terminology I was criticizing.

The basic problem being, certain manufacturers have implied superior

knowledge of how remolding helmets achieve their effect by calling

their products " active, " but don't really describe what " action "

distinguishes them from other helmets. (Can we really blame the

pediatricians for not believing in them?) So I'm also proposing a

new term for the therapeutic process as commonly understood, where

the helmet's holding points are matched to prominent areas, and the

head " grows into " the shape of the helmet: " circumferential

conformance. "

That doesn't immediately bring to mind any replacement terms for

" active " and " passive " to categorize the helmets themselves,

unfortunately. The head " grows into " passive helmets as well, does

it not? I would say that each model probably uses both means

(angular conformance and circumferential conformance) to produce its

therapeutic effect, but with varying precision and duration. So I'm

afraid we'll need even more new terms to disambiguate the confounding

semantics.

The " passive " helmets seem to flex their plastic shells against

prominent areas with only a thin, relatively non-adjustable lining.

How about, " flexible " ? It seems that their shape is not adjusted

over time to meet the shape of the head in any directed manner. I

imagine they do stretch a bit, though, like an elongated bubble

before it reaches equilibrium, as the head grows into it.

Instead of " active, " how about referring to all of the relatively

thick, foam-lined, adjustable helmets as " conforming " ? As the skull

grows, an orthotist repeatedly adjusts the interior shape to meet the

shape of the head. They " form together. "

Ah, but what about the clear, rigid helmets that are also supposedly

" active, " fitting closely to the head (which is " conforming " in

another sense), but only slightly adjustable through reheating the

plastic? We don't hear a lot of good about those around here. I

suspect the difficulty arises from a failure to make the helmet more

symmetrical over time, which would require heating large areas of the

helmet repeatedly. (Maysa's blog suggested such a problem.) In

Thad's new-speak, failure to approach symmetry would be termed a lack

of progressive angular conformance. We could therefore call these

helmets " non-progressive " to indicate limited adjustability over time.

--

Thad Launderville

Montpelier, VT

Clara age 21 months, in STARband ~5 months

>

>>

>> We as parents sometimes have more faith in the technology than the

>> practitioners. My kid is 21 months old. I've been jerked around by

>> just about every professional I've come into contact with, yet I

>> still hold great hopes for Clara's treatment. Here's why:

>>

>> You'll notice that a lot of us with helmets see surprising

>> improvements immediately, like, in the first week or two. Everyone

>> *says* improvement depends on growth, but I don't think that's

>> entirely true. Big growth spurts are ideal, because they produce new

>> skull plate molded in the shape of the helmet, making the skull more

>> rounded.

>>

>> But it only takes a miniscule amount of growth to bend the sutures

>> between existing, flat plates to a new angle. A skillfully adjusted

>> helmet can almost *immediately* alter the angles between skull

>> plates, because sutures are typically pliable, if they've even formed

>> yet.

>>

>> I believe there is a further, intermediate and variable amount of

>> growth that will make the new angles " stick, " even when there hasn't

>> been enough circumferential growth to make the cranium very well

>> rounded. Being an older baby with thicker skull plates may actually

>> help against regression.

>>

>> Brachycephaly is known to be more resistant to treatment than common

>> plagio. I think it is because brachy does not much benefit from this

>> undescribed therapeutic process, which I call " angular conformance. "

>> The concept has better descriptive validity than the muddled " active "

>> vs. " passive, " because it defines precisely what the " action " of an

>> active helmet is. An active helmet holds the skull plates in a more

>> favorable angular configuration until new growth, in underlying soft

>> tissue as well as bone, reinforces the alterations.

>>

>> In my view, all brachy helmets are " passive, " while so-called

>> " passive " helmets for plagio merely have an imprecisely directed

>> activity. So one implication of this theory is that passive helmets

>> are undervalued, and unskilled orthotists overvalued. I guess that

>> makes it dead in the water.

>>

>> --

>> Thad Launderville

[Guest guest]

On Jan 15, 2010, at 4:11 AM, Thad Launderville wrote:

> Ah, but what about the clear, rigid helmets that are also

> supposedly " active, " fitting closely to the head (which is

> " conforming " in another sense), but only slightly adjustable

> through reheating the plastic? We don't hear a lot of good about

> those around here. I suspect the difficulty arises from a failure

> to make the helmet more symmetrical over time, which would require

> heating large areas of the helmet repeatedly. (Maysa's blog

> suggested such a problem.) In Thad's new-speak, failure to

> approach symmetry would be termed a lack

> of progressive angular conformance. We could therefore call these

> helmets " non-progressive " to indicate limited adjustability over time.

I'll apprehend myself this time. Calling a *helmet* non-progressive

would once again confound what is expected to happen to the head with

what the helmet does. (I'm trying to disambiguate the terms

" passive " vs. " active " so orthotists, parents, maybe even scientists

working for the manufacturers can free themselves from marketing

mumbo-jumbo and figure out what actually works best for our kids.)

I now favor the term " Rigid conforming " to describe hard, clear

plastic helmets like ECA's.

For DOC Band and STARband, " Gradual reconforming. "

For Clarren, " Flexible symmetrical. "

I think those are at least good, bold strokes with which to begin

painting the helmet side of the picture. To some extent, we can

recombine terms for other models, for example, thinly padded,

flexible helmets probably exist that are contoured to a baby's

existing head shape with therapeutic modifications. " Flexible

conforming. "

--

Thad Launderville

Montpelier, VT

Clara age 21 months, in STARband ~5 months

[Guest guest]

Hi Thad,

I have to say I can't see the point of coming up with a new set of terms for

these things. Already education on plagio and banding is pretty bad. I would

rather focus on raising awareness of the problem and the treatment that exists.

If you decide to design a new helmet then the terms might become more critical.

;-)

-christine

sydney, 4 yrs, starband grad

>

> > Ah, but what about the clear, rigid helmets that are also

> > supposedly " active, " fitting closely to the head (which is

> > " conforming " in another sense), but only slightly adjustable

> > through reheating the plastic? We don't hear a lot of good about

> > those around here. I suspect the difficulty arises from a failure

> > to make the helmet more symmetrical over time, which would require

> > heating large areas of the helmet repeatedly. (Maysa's blog

> > suggested such a problem.) In Thad's new-speak, failure to

> > approach symmetry would be termed a lack

> > of progressive angular conformance. We could therefore call these

> > helmets " non-progressive " to indicate limited adjustability over time.

>

> I'll apprehend myself this time. Calling a *helmet* non-progressive

> would once again confound what is expected to happen to the head with

> what the helmet does. (I'm trying to disambiguate the terms

> " passive " vs. " active " so orthotists, parents, maybe even scientists

> working for the manufacturers can free themselves from marketing

> mumbo-jumbo and figure out what actually works best for our kids.)

>

> I now favor the term " Rigid conforming " to describe hard, clear

> plastic helmets like ECA's.

>

> For DOC Band and STARband, " Gradual reconforming. "

>

> For Clarren, " Flexible symmetrical. "

>

> I think those are at least good, bold strokes with which to begin

> painting the helmet side of the picture. To some extent, we can

> recombine terms for other models, for example, thinly padded,

> flexible helmets probably exist that are contoured to a baby's

> existing head shape with therapeutic modifications. " Flexible

> conforming. "

>

> --

> Thad Launderville

> Montpelier, VT

> Clara age 21 months, in STARband ~5 months

>

[Guest guest]

On Jan 18, 2010, at 11:12 AM, christineashok wrote:

> If you decide to design a new helmet then the terms might become

> more critical. ;-)

You say that cynically, but patent claims probably do actually have

as much undue influence on what we believe as marketing, currently.

I'm now softening toward the uneducated (I would have said,

" ignorant " ) pediatricians. I think maybe they've simply heard a

pitch, and were unimpressed. Government, insurance, and

manufacturers are just going to have to sponsor more research besides

" this product is effective. " In the meantime, case observations and

speculative theory remain their authoritative domain.

But I think we s, at our best, can function in parallel, using

facilitated communication rather than conventions and committees to

formulate our opinions.

--

Thad Launderville

[Guest guest]

I just want to add that while Maysa's passive helmets from ECA were as hard as a rock, they never had any holding points (unlike what our orthotist said). The helmet was holding Maysa's head at the sideburns, right next to her ears. That became a concern for me when it got red and when I brought it up, and her orthotist tried to heat one of them to relief the pressure, that night, it broke while I was cleaning it. He would otherwise never have reheated that plastic shell.

I also want to say that he did a fabulous job selling us his helmet and comparing it to the competition. We fell for it not knowing what we were doing and while I am definitely not an expert, both the DOC band and the STARband and even Hanger make a lot more sense to me than that kidcrap he calls the kidcap...

Other passive helmets around might have worked for others, the kidcrap (excuse me the kidcap) didn't.

LeilaMaysa, 2 years old

DOC band Grad 5.26.09www.mymaysa.wordpress.com

From: christineashok <christineashok@...>Subject: Re: Toward a new paradigm in describing the therapeutic activity of helmetsPlagiocephaly Date: Monday, January 18, 2010, 11:12 AM

Hi Thad, I have to say I can't see the point of coming up with a new set of terms for these things. Already education on plagio and banding is pretty bad. I would rather focus on raising awareness of the problem and the treatment that exists. If you decide to design a new helmet then the terms might become more critical. ;-)-christinesydney, 4 yrs, starband grad> > > Ah, but what about the clear, rigid helmets that are also > > supposedly "active," fitting closely to the head (which is > > "conforming" in another sense), but only slightly adjustable > > through

reheating the plastic? We don't hear a lot of good about > > those around here. I suspect the difficulty arises from a failure > > to make the helmet more symmetrical over time, which would require > > heating large areas of the helmet repeatedly. (Maysa's blog > > suggested such a problem.) In Thad's new-speak, failure to > > approach symmetry would be termed a lack> > of progressive angular conformance. We could therefore call these > > helmets "non-progressive" to indicate limited adjustability over time.> > I'll apprehend myself this time. Calling a *helmet* non-progressive > would once again confound what is expected to happen to the head with > what the helmet does. (I'm trying to disambiguate the terms > "passive" vs. "active" so orthotists, parents, maybe even scientists > working for the manufacturers can free themselves from

marketing > mumbo-jumbo and figure out what actually works best for our kids.)> > I now favor the term "Rigid conforming" to describe hard, clear > plastic helmets like ECA's.> > For DOC Band and STARband, "Gradual reconforming. "> > For Clarren, "Flexible symmetrical. "> > I think those are at least good, bold strokes with which to begin > painting the helmet side of the picture. To some extent, we can > recombine terms for other models, for example, thinly padded, > flexible helmets probably exist that are contoured to a baby's > existing head shape with therapeutic modifications. "Flexible > conforming."> > -- > Thad Launderville> Montpelier, VT> Clara age 21 months, in STARband ~5 months>