Re: Confusing interpretation of STARscan measurements

[Guest guest]

We saw a cranio facial plastic surgeon who prescribed my daughter's starband.

His guideline was to band at 10mm or asymmetry or 90% cephalic ratio. His goal

was to get all his patients below 90% if possible. My daughter graduated at 85

or 86%. You can still see some problem areas, but she started off quite high (96

or 97). I would say banding your baby might be considered borderline, but there

is definitely some concern about brachy, and the decision should be made on how

happy you are with his head. I don't see how she can say there is no brachy.

-christine

sydney, 4.5 yrs, starband grad

>

> Hi everyone! I'm writing because I'm hoping some of you might be able to shed

some light on confusing interpretation I got on STARscan measurements.

>

> I recently took my 5-month-old baby for measurements at a STARscan center

because I was concerned about his brachy. I knew he also had mild plagio (which

had been much improved with repo since he was 2 months old), but I was worried

his brachy was more severe. It turns out I was right about the plagio, and the

clinician agreed: though his CVAI was only 1.0, his Overall Symmetry Ratio was

0.888 (or a 3).

>

> However, the interesting part came next. His Cephalic Ratio was 0.904, which

to my mind equals at least mild, if not moderate, brachy. Based on the shape of

his head, however (which is not flat, but flatter than I've seen in other

babies), the clinician insisted repeatedly that my son has no brachy. Not even

mild brachy. No brachy at all. I am torn between believing that and taking it

with caution. Perhaps she was working with another definition of brachy than I?

She did agree that his CR was 2 standard deviations above the mean, which is

concerning.

>

> Another explanation could be that my baby simply has a very round head

naturally. But that is contradicted by the fact that the clinician said I should

be aiming to go below 2 standard deviations by 7 months when the plagio improves

more. She said that the plagio caused a flat spot on the right side of the back

of his head, which makes the head look flatter. (Also, if his head were

naturally round, would his measurements not fall within the range of normality,

rather than go 2 standard deviations above the mean?)

>

> What do you think?

>

> P.S. She flatly said my baby does not need a band.

>

[Guest guest]

Is there somewhere else you can get measurements taken for a second opinion? If

you got measurements taken, I'm assuming you are concerned about his head and

are not satisfied with the recommendation you were given. I also thought 90%

would be considered brachy. Maybe you could call and ask them what they do

consider the cut-off for a brachy classification. My son's neurosurgeon told me

flattening in the back of the head doesn't typically improve on it's own, so I

wouldn't expect it to get better without treatment. I guess the question in

borderline cases is, if his head shape stayed how it is, would that be okay with

you? Good luck!

> >

> > Hi everyone! I'm writing because I'm hoping some of you might be able to

shed some light on confusing interpretation I got on STARscan measurements.

> >

> > I recently took my 5-month-old baby for measurements at a STARscan center

because I was concerned about his brachy. I knew he also had mild plagio (which

had been much improved with repo since he was 2 months old), but I was worried

his brachy was more severe. It turns out I was right about the plagio, and the

clinician agreed: though his CVAI was only 1.0, his Overall Symmetry Ratio was

0.888 (or a 3).

> >

> > However, the interesting part came next. His Cephalic Ratio was 0.904, which

to my mind equals at least mild, if not moderate, brachy. Based on the shape of

his head, however (which is not flat, but flatter than I've seen in other

babies), the clinician insisted repeatedly that my son has no brachy. Not even

mild brachy. No brachy at all. I am torn between believing that and taking it

with caution. Perhaps she was working with another definition of brachy than I?

She did agree that his CR was 2 standard deviations above the mean, which is

concerning.

> >

> > Another explanation could be that my baby simply has a very round head

naturally. But that is contradicted by the fact that the clinician said I should

be aiming to go below 2 standard deviations by 7 months when the plagio improves

more. She said that the plagio caused a flat spot on the right side of the back

of his head, which makes the head look flatter. (Also, if his head were

naturally round, would his measurements not fall within the range of normality,

rather than go 2 standard deviations above the mean?)

> >

> > What do you think?

> >

> > P.S. She flatly said my baby does not need a band.

> >

>

[Guest guest]

Thanks, . You're right, and that's what I thought also. I'm surprised

there is not more uniformity in response across the different STARscan centers.

It's one thing for your pedi to deny the brachy and another for the very people

working the scan. Anyway, I just thought it strange, and I'm still trying to

understand if I should or should not be concerned about my LO's head shape.

[Guest guest]

Thanks, . Secretly, the reason I went in for measurements was to be

reassured. My ped insisted that the head shape was not a real problem and that

it would correct itself anyway. I wanted numbers to confirm that. Well, the

numbers didn't really confirm that my son doesn't have brachy, but strangely

enough, the clinician insisted he doesn't. It may be that she was posing the

problem from the point of view of his wearing a band, which she said he doesn't

need.

Anyway, I've decided to continue with repo for another month or so. His head is

indeed flat, just not as flat as severe brachy cases. Plus, in Central Florida,

this is the only STARscan I know of. (It's in ville.)

For those of you who do numbers, what do you think of the overall picture?

5-mo-old baby boy:

Circumference (mm): 445.2

Cranial Breadth (M-L): 133.2

Cranial Length (A-P): 147.3

Cephalic Ratio: 0.904

RSI: 44.8

Obligue D1 (-30.0 deg): 144.9

Obligue D2 (30.0 deg): 146.4

Oblique Cranial Minimum (-75.4): 129.4

Oblique Cranial Maximum (15.9): 148.0

Anterior Symmetry Ratio: 0.856

Posterior Symmetry Ratio: 0.921

Overall Symmetry Ratio: 0.888

CVAI: 1.0

Thanks!

[Guest guest]

I found an interesting study claiming that,

" as

kids are growing, their heads are getting longer more than they are getting

wider.

This is important clinically for children with brachycephaly, which is a

flatness

straight across the back of the head. Brachycephaly can occur on its own, or

secondary to plagiocephaly. Our results suggest a natural decrease in cephalic

ratio which could have an impact on current treatment protocols for these

populations if examined further. "

http://smartech.gatech.edu/bitstream/1853/22061/4/presentation_wnotes.pdf

I find that to be an interesting and reassuring claim, since I've mostly heard

that as a rule brachy does not improve naturally.

Any thoughts?

[Guest guest]

CT actually told me this themselves. Our daughter has a borderline case of brachy and plagio but still getting treatment. Her numbers are 7, 4, and 3. They told me it was really up to me as to whether or not to band and if insurance denied it, it wouldn't be the end of the world if she didn't get it. They said her major issue was her head width but that in the next month that number wouldn't be as bad because her head would get longer more so than wider as she got older. It doesn't mean that brachy would correct itself all together but her ratio may improve slightly. This was only a concern to me because if we waited and her ratio improved, the insurance may then deny it because she wouldn't be "bad enough"

I don't believe they are insinuating in any way that brachy would correct itself over time, rather the ratio may not be as bad.

Jen

Re: Confusing interpretation of STARscan measurements

I found an interesting study claiming that,

"as

kids are growing, their heads are getting longer more than they are getting wider.

This is important clinically for children with brachycephaly, which is a flatness

straight across the back of the head. Brachycephaly can occur on its own, or

secondary to plagiocephaly. Our results suggest a natural decrease in cephalic

ratio which could have an impact on current treatment protocols for these

populations if examined further."

http://smartech.gatech.edu/bitstream/1853/22061/4/presentation_wnotes.pdf

I find that to be an interesting and reassuring claim, since I've mostly heard that as a rule brachy does not improve naturally.

Any thoughts?

[Guest guest]

There is a Cranial Tech in Miami. They do free consults. I'm not sure how far

that is for you, but why not get their input as well? I really don't think what

your ped. said about it correcting itself is true. Unfortunately, many ped's

don't know much about plagio and brachy. I've heard from a few sources that

brachy/ flatness in the back of the head does not self-correct. Plagio usually

partially corrects if any torticollis is resolved, but the flatness in the back

of the head also doesn't self-correct in this case usually, and the overall

result without treatment is typically not what most people would consider an

acceptable outcome. Since your son's head is more of a brachy shape, that's why

I say you should make your decision based on whether you'd be okay if your son's

head stays just as it is. Don't make your decision based on the assumption that

it will probably get better on it's own, because that's unlikely. Best of luck

and keep us posted.

>

> Thanks, . Secretly, the reason I went in for measurements was to be

reassured. My ped insisted that the head shape was not a real problem and that

it would correct itself anyway. I wanted numbers to confirm that. Well, the

numbers didn't really confirm that my son doesn't have brachy, but strangely

enough, the clinician insisted he doesn't. It may be that she was posing the

problem from the point of view of his wearing a band, which she said he doesn't

need.

>

> Anyway, I've decided to continue with repo for another month or so. His head

is indeed flat, just not as flat as severe brachy cases. Plus, in Central

Florida, this is the only STARscan I know of. (It's in ville.)

>

> For those of you who do numbers, what do you think of the overall picture?

>

> 5-mo-old baby boy:

>

> Circumference (mm): 445.2

> Cranial Breadth (M-L): 133.2

> Cranial Length (A-P): 147.3

> Cephalic Ratio: 0.904

> RSI: 44.8

>

> Obligue D1 (-30.0 deg): 144.9

> Obligue D2 (30.0 deg): 146.4

> Oblique Cranial Minimum (-75.4): 129.4

> Oblique Cranial Maximum (15.9): 148.0

>

> Anterior Symmetry Ratio: 0.856

> Posterior Symmetry Ratio: 0.921

> Overall Symmetry Ratio: 0.888

>

> CVAI: 1.0

>

> Thanks!

>

[Guest guest]

I believe that there are different views regarding the severity of brachy. For

example, my ortho, who is quite good and has done a lot of work in the field,

claims that anything below 91 percent is in the normal range because that is

within two standard deviations. And, I do know that most fields consider within

two standard deviations to be " normal. " Two standard deviations was 91 point

something for boys. I believe that she would probably agree that a baby with

those numbers does not need a band.

Personally, I think that a 90 percent is more like a mild brachy, given the

current trends in head shape. I take my guidelines from statistics in general

and how normal is typically defined. Usually, when dealing with numbers between

one and two standard deviations, scientists do think of a characteristics that

is not significantly different from the normal population, or something that is

" at risk " or " mild. " It seems that the plagio and brachy field is not united in

their definitions of brachy so I have come to my own conclusions. Most articles

that you read say that banding is not indicated for mild plagio and brachy, but

some places will do so if the parent desires it. It just depends upon where you

go.

>

> Hi everyone! I'm writing because I'm hoping some of you might be able to shed

some light on confusing interpretation I got on STARscan measurements.

>

> I recently took my 5-month-old baby for measurements at a STARscan center

because I was concerned about his brachy. I knew he also had mild plagio (which

had been much improved with repo since he was 2 months old), but I was worried

his brachy was more severe. It turns out I was right about the plagio, and the

clinician agreed: though his CVAI was only 1.0, his Overall Symmetry Ratio was

0.888 (or a 3).

>

> However, the interesting part came next. His Cephalic Ratio was 0.904, which

to my mind equals at least mild, if not moderate, brachy. Based on the shape of

his head, however (which is not flat, but flatter than I've seen in other

babies), the clinician insisted repeatedly that my son has no brachy. Not even

mild brachy. No brachy at all. I am torn between believing that and taking it

with caution. Perhaps she was working with another definition of brachy than I?

She did agree that his CR was 2 standard deviations above the mean, which is

concerning.

>

> Another explanation could be that my baby simply has a very round head

naturally. But that is contradicted by the fact that the clinician said I should

be aiming to go below 2 standard deviations by 7 months when the plagio improves

more. She said that the plagio caused a flat spot on the right side of the back

of his head, which makes the head look flatter. (Also, if his head were

naturally round, would his measurements not fall within the range of normality,

rather than go 2 standard deviations above the mean?)

>

> What do you think?

>

> P.S. She flatly said my baby does not need a band.

>

[Guest guest]

,

You make an excellent point regarding the definition of brachy. I think plagio

is more easily defined because of the asymmetry. Brachy, on the other hand,

especially the symmetrical and milder form, can fall well within the variety of

wider yet " normal " head shapes. I see people with wide and round heads whose

measurements would probably qualify them for brachy yet whose backs of the head

are not flat (or not extremely flat). Also, I think that the current stats were

developed by insurance companies as guidelines for coverage, but numbers alone

are not able to fully determine if a head shape is " abnormal " or not, simply

because normality itself is very hard to define. There are too many variables to

consider--gender, age, being the easier ones; variety of head shapes the harder

one.

I've also read articles that claim that the Cranial Index is usually paired with

the CVAI in deciding the severity of the problem. The level of the CI alone is

not a good determining factor in assessing the issue.

> >

> > Hi everyone! I'm writing because I'm hoping some of you might be able to

shed some light on confusing interpretation I got on STARscan measurements.

> >

> > I recently took my 5-month-old baby for measurements at a STARscan center

because I was concerned about his brachy. I knew he also had mild plagio (which

had been much improved with repo since he was 2 months old), but I was worried

his brachy was more severe. It turns out I was right about the plagio, and the

clinician agreed: though his CVAI was only 1.0, his Overall Symmetry Ratio was

0.888 (or a 3).

> >

> > However, the interesting part came next. His Cephalic Ratio was 0.904, which

to my mind equals at least mild, if not moderate, brachy. Based on the shape of

his head, however (which is not flat, but flatter than I've seen in other

babies), the clinician insisted repeatedly that my son has no brachy. Not even

mild brachy. No brachy at all. I am torn between believing that and taking it

with caution. Perhaps she was working with another definition of brachy than I?

She did agree that his CR was 2 standard deviations above the mean, which is

concerning.

> >

> > Another explanation could be that my baby simply has a very round head

naturally. But that is contradicted by the fact that the clinician said I should

be aiming to go below 2 standard deviations by 7 months when the plagio improves

more. She said that the plagio caused a flat spot on the right side of the back

of his head, which makes the head look flatter. (Also, if his head were

naturally round, would his measurements not fall within the range of normality,

rather than go 2 standard deviations above the mean?)

> >

> > What do you think?

> >

> > P.S. She flatly said my baby does not need a band.

> >

>