Cephalic Index Question Answered by CT's Tim Littlefield

April 7, 2010

Hi Ladies-

The question about what's " normal " in cephalic index is one we hear often on the

board, and it was brought up recently about how the numbers that Molly (another

moderator) posts must be outdated because they seem so low (I believe 79% is

considered normal). Well, I asked Cranial Tech about it (since my son is a

DOCBand grad) and got this very informative answer from Tim Littlefield, the

Vice President of the company (if you've done any research online, you might

have seen his name as the author of some plagio reports and studies).

To clarify one thing, Molly got those numbers from Aetna, and it appears that a

number of insurance companies use those same numbers as standards for brachy.)

Below is Tim's response. I hope it is helpful!

Thanks!

Jake-3.5 (DOCBand Grad 9/08)

Moderator

Hi ,

Carol forwarded your email to my attention to see if I could answer your

question about cephalic index. It is an excellent question and one that I know

a lot of people struggle with.

The values we use for cephalic index come from some very well controlled

anthropometric studies that were performed a few decades ago. They are the most

accurate we have ever found. They were performed by expert anthropologists who

had been formally trained in the measurement of human form, and they are still

the gold standard used in most clinical research studies worldwide.

As you indicated, sometimes these numbers seem `outdated' because we see so many

children with cephalic indices that are so much greater than the mean of 79%.

However, there are a couple of things to consider. First, is that many of the

children you deal with on the boards, as well as what we see here, do in fact

have deformational brachycephaly and their heads are in fact many standard

deviations above the norm (often having CI's in the 90's or higher). This does

not mean the norms should be adjusted so these don't appear so bad. From a

purely functional and anatomical perspective, any infant who has a cranial width

that is approaching their cranial length will likely have many other issues as

well (increased posterior head height, shortened skull base distance behind the

foramen magnum, possible malocclusion etc) not to mention will have difficulty

wearing protective head gear which is designed around the normal values.

The second point is really the same as the first – we have to remember that the

infants we see on a daily basis do not represent the normal population (we see

what 1 in 60, 1 in 30 infants?). To really understand whether the normal values

need to be adjusted because of back sleeping, a new anthropometric study looking

only at infants without any kind of deformational plagiocephaly or brachycephaly

would need to be completed. Unfortunately, I do not see that happening any time

in the near future, although I do think it would be very interesting to see what

impact supine sleeping has had on our heads.

If you would like to share this information, or if you would rather have me

answer questions directly on the board, it is fine with me.

Thanks

Tim

P.S. To answer your other question – the numbers we use are probably what Molly

has, and this is also what the insurance companies use as well.

Tim Littlefield, MS

Vice President

Cranial Technologies, Inc.

480-403-6332

www.CranialTech.com

April 7, 2010

Does anyone have the link to the original study? I've read the article before, but no longer have it. I seem to remember that there were significant faults in their research methods, but I might be mistaken and be thinking of somethine else since it has been awhile. I'd like to take another look at it. Cephalic Index Question Answered by CT's Tim Littlefield

Hi Ladies-The question about what's "normal" in cephalic index is one we hear often on the board, and it was brought up recently about how the numbers that Molly (another moderator) posts must be outdated because they seem so low (I believe 79% is considered normal). Well, I asked Cranial Tech about it (since my son is a DOCBand grad) and got this very informative answer from Tim Littlefield, the Vice President of the company (if you've done any research online, you might have seen his name as the author of some plagio reports and studies). To clarify one thing, Molly got those numbers from Aetna, and it appears that a number of insurance companies use those same numbers as standards for brachy.) Below is Tim's response. I hope it is helpful!Thanks!Jake-3.5 (DOCBand Grad 9/08)ModeratorHi ,Carol forwarded your email to my attention to see if I could answer your question about cephalic index. It is an excellent question and one that I know a lot of people struggle with.The values we use for cephalic index come from some very well controlled anthropometric studies that were performed a few decades ago. They are the most accurate we have ever found. They were performed by expert anthropologists who had been formally trained in the measurement of human form, and they are still the gold standard used in most clinical research studies worldwide.As you indicated, sometimes these numbers seem `outdated' because we see so many children with cephalic indices that are so much greater than the mean of 79%. However, there are a couple of things to consider. First, is that many of the children you deal with on the boards, as well as what we see here, do in fact have deformational brachycephaly and their heads are in fact many standard deviations above the norm (often having CI's in the 90's or higher). This does not mean the norms should be adjusted so these don't appear so bad. From a purely functional and anatomical perspective, any infant who has a cranial width that is approaching their cranial length will likely have many other issues as well (increased posterior head height, shortened skull base distance behind the foramen magnum, possible malocclusion etc) not to mention will have difficulty wearing protective head gear which is designed around the normal values.The second point is really the same as the first â€“ we have to remember that the infants we see on a daily basis do not represent the normal population (we see what 1 in 60, 1 in 30 infants?). To really understand whether the normal values need to be adjusted because of back sleeping, a new anthropometric study looking only at infants without any kind of deformational plagiocephaly or brachycephaly would need to be completed. Unfortunately, I do not see that happening any time in the near future, although I do think it would be very interesting to see what impact supine sleeping has had on our heads. If you would like to share this information, or if you would rather have me answer questions directly on the board, it is fine with me.ThanksTimP.S. To answer your other question â€“ the numbers we use are probably what Molly has, and this is also what the insurance companies use as well.Tim Littlefield, MSVice PresidentCranial Technologies, Inc.480-403-6332www.CranialTech.com

April 7, 2010

,

I really appreciate you posting this interesting response from Mr. Littlefield.

My first reaction was that he is saying some of what I did in a post last week:

namely, that what is common or even average is not necessarily healthy. (I gave

obesity as an example.)

On the other hand, let us keep in mind that Mr. Littlefield can hardly be

considered objective since he works for a company that profits from orthotic

molding devices.

One more comment: 1 in 30 or 1 in 60 is a plenty high fraction of the

population, in my opinion!

>

> Hi ,

>

> Carol forwarded your email to my attention to see if I could answer your

question about cephalic index. It is an excellent question and one that I know

a lot of people struggle with.

>

> The values we use for cephalic index come from some very well controlled

anthropometric studies that were performed a few decades ago. They are the most

accurate we have ever found. They were performed by expert anthropologists who

had been formally trained in the measurement of human form, and they are still

the gold standard used in most clinical research studies worldwide.

>

> As you indicated, sometimes these numbers seem `outdated' because we see so

many children with cephalic indices that are so much greater than the mean of

79%. However, there are a couple of things to consider. First, is that many of

the children you deal with on the boards, as well as what we see here, do in

fact have deformational brachycephaly and their heads are in fact many standard

deviations above the norm (often having CI's in the 90's or higher). This does

not mean the norms should be adjusted so these don't appear so bad. From a

purely functional and anatomical perspective, any infant who has a cranial width

that is approaching their cranial length will likely have many other issues as

well (increased posterior head height, shortened skull base distance behind the

foramen magnum, possible malocclusion etc) not to mention will have difficulty

wearing protective head gear which is designed around the normal values.

>

> The second point is really the same as the first – we have to remember that

the infants we see on a daily basis do not represent the normal population (we

see what 1 in 60, 1 in 30 infants?). To really understand whether the normal

values need to be adjusted because of back sleeping, a new anthropometric study

looking only at infants without any kind of deformational plagiocephaly or

brachycephaly would need to be completed. Unfortunately, I do not see that

happening any time in the near future, although I do think it would be very

interesting to see what impact supine sleeping has had on our heads.

>

> If you would like to share this information, or if you would rather have me

answer questions directly on the board, it is fine with me.

>

> Thanks

>

> Tim

>

> P.S. To answer your other question – the numbers we use are probably what

Molly has, and this is also what the insurance companies use as well.

>

> Tim Littlefield, MS

> Vice President

> Cranial Technologies, Inc.

> 480-403-6332

> www.CranialTech.com

>

April 8, 2010

I guess I'm not really sure this is an issue of non-objectivity. I sort of feel

that he's simply stating fact. That there was a study done this certain way,

that's where the numbers came from, no new study has been done since, so that's

all they have to go by. Plus he does make a good point, the babies they see

every day do present with flattening in some way. I'm sure it's not often (if at

all) that someone with a perfectly round head walks into their clinic looking

for a band.

But you're absolutely right, just because obesity (for example) or flat heads is

becoming more " popular, " doesn't mean we should consider it " normal. "

I'll see if I can find the original study for .

>

> ,

> I really appreciate you posting this interesting response from Mr.

Littlefield. My first reaction was that he is saying some of what I did in a

post last week: namely, that what is common or even average is not necessarily

healthy. (I gave obesity as an example.)

>

> On the other hand, let us keep in mind that Mr. Littlefield can hardly be

considered objective since he works for a company that profits from orthotic

molding devices.

>

> One more comment: 1 in 30 or 1 in 60 is a plenty high fraction of the

population, in my opinion!

>

> >

> > Hi ,

> >

> > Carol forwarded your email to my attention to see if I could answer your

question about cephalic index. It is an excellent question and one that I know

a lot of people struggle with.

> >

> > The values we use for cephalic index come from some very well controlled

anthropometric studies that were performed a few decades ago. They are the most

accurate we have ever found. They were performed by expert anthropologists who

had been formally trained in the measurement of human form, and they are still

the gold standard used in most clinical research studies worldwide.

> >

> > As you indicated, sometimes these numbers seem `outdated' because we see so