***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Deformational occipital flattening is the most common cause of abnormal head shape . Current treatment calls for repositioning and cervical stretching in infants younger than 5 months . The authors assessed the effectiveness of a modifiable cranial cup compared to repositioning and cervical stretching to correct early deformational plagiocephaly . Methods : This nonr and omized , prospect i ve clinical trial used historical controls . The treatment and control groups consisted of infants , younger than 4 months , referred for deformational posterior plagiocephaly . The control children were managed by repositioning and cervical stretching exercises . An adjustable concave cranial cup was used in the treated group . Infants were examined at the initial and final visits by a single examiner . Calvarial asymmetry was measured using a large cranial caliper . Active head rotation and degree of rotational asymmetry were estimated to the nearest 10 degrees . Results : There were no statistically significant differences between the control ( n = 23 ) and treatment groups ( n = 24 ) with respect to gestational age at birth , age at initial visit , initial head rotational asymmetry , initial transcranial difference , final head rotational asymmetry , and age at final evaluation . Mean time between initial and final evaluation was 56.3 days for the treatment group and 61.6 days for the control group . The mean transcranial difference decreased from 11.2 to 3.5 mm in the treatment group , and from 9.0 to 8.0 mm in the control group ( p = 0.000 ) . Conclusion : The cranial cup , a modifiable concave resting surface , is significantly more effective than repositioning and physical therapy for correcting early deformational plagiocephaly Objective : To evaluate the long-term effectiveness of helmet therapy in the correction of deformational plagiocephaly and to assess the early occlusal abnormalities seen in these patients . Design : A prospect i ve study with blinded measurements . Patients : Twenty-eight patients with deformational plagiocephaly who were treated with molding helmet therapy with at least 5 years of follow-up . Interventions : The average length of molding helmet treatment was 6.2 months . At the time of this follow-up evaluation , the mean interval since completing the molding helmet therapy was 5.6 years . Main Outcome Measures : Anthropometric measurements of cranial asymmetry included cranial vault asymmetry ( CVA ) , orbitotragial depth asymmetry ( OTDA ) , and cranial base asymmetry ( CBA ) . A dental examination was also performed . Results : At the completion of therapy , the most improvement was seen in the measurement of CBA , followed by CVA and OTDA . However , in evaluating the long-term stability of molding treatment , OTDA tended to continue improving after the initial treatment , while CBA and CVA appeared to regress , although none of the changes reached statistically significant levels . In dental measurements , all the dental midline and chin deviations were toward the unaffected side with respect to occipital deformation . Conclusion : This study demonstrated that helmet remodeling with the dynamic orthotic cranioplasty b and is effective in the correction of cranial asymmetry , with some nonstatistically significant changes in long-term cranial vault symmetry . Dental observations indicated the possibility of occlusal abnormalities that may affect dental , especially orthodontic , diagnosis and teatment planning OBJECTIVE This study was design ed to evaluate the effectiveness of helmet therapy ( DOC b and ) in the correction of patients with moderate to severe posterior deformational plagiocephaly . DESIGN In this prospect i ve study , the infants were evaluated using 18 anthropometric measurements . PATIENTS The charts of 248 patients seen between August 1 , 1995 , and July 31 , 1999 , were review ed , and 125 met the criteria for inclusion in the study . All the patients had posterior deformational plagiocephaly with no other craniofacial deformities or medical conditions . Treatment was instituted prior to 1 year of age , and all patients were compliant with DOC b and usage and had complete anthropometric measurements . RESULTS The study recorded a 41.56 % ( p < .001 ) reduction in cranial vault asymmetry and a 40.23 % ( p < .001 ) reduction in cranial base asymmetry . Orbitotragial asymmetry was improved 18.72 % ( p = .0738 ) . The age at which treatment was begun was not a significant factor in predicting treatment outcomes Background Despite much interest in positional ( deformational ) plagiocephaly , the natural history is unclear . The purpose of this study was to determine cosmetic and developmental outcomes at a minimum of 5 years of age in children diagnosed in infancy with positional plagiocephaly ( PP ) and the impact of cranial orthotic use . Methods A question naire survey was sent to parents of children diagnosed with PP in infancy and now aged more than 5 years . A retrospective review of the child ’s clinic chart was performed of consenting families , and prospect i ve follow-up was done when families agreed to return for assessment . Results Of 278 eligible children with plagiocephaly , question naires were completed by 65 parents , and 27 brought their child for assessment . Participants and non participants were similar . Cranial orthoses were used in 18 of 65 children . Parents perceived the cosmetic appearance of their child as “ very abnormal ” in 2 , “ mildly abnormal ” in 25 , and “ normal ” in 38 . Residual asymmetry was noted by parents in 58 % , but only 21 % were concerned about appearance . In the last year , 7.7 % of children commented about asymmetry of head , and 4.6 % were teased occasionally . Thirty-three percent had received learning assistance , and 14 % were in a special class . Long-term outcomes , as perceived by the parent or child , were no different between children with and without orthosis use . Conclusions The results allow better counselling of parents about outcome of infants with PP , reducing anxiety , and allowing more rational selection of management modality Deformational plagiocephaly , cranial asymmetry secondary to positioning , continues to be a leading cause of head shape abnormalities in infants . Treatment recommendations include nonintervention , positioning therapies , and helmet therapy . Although most agree that surgical intervention is rarely indicated , the ideal therapy is not agreed on . Some even debate the necessity of treatment , especially third-party payers . The purpose of this prospect i ve study is to use an objective outcome analysis tool , computerized tomography , to assess the efficacy of a soft shell helmet therapy .  Sixty-nine children with a diagnosis of deformational plagiocephaly were enrolled in this study to assess the success of a soft shell helmet for the correction of cranial asymmetry .  Computed tomography scanning was done before therapy and 6 months after the initiation of therapy . Three-dimensional reconstructions of these scans were reformatted into a st and ardized orientation by utilizing the nasion ( radix ) , frontozygomatic suture lines , and posterior aspect of the foramen magnum . Intracranial volumes were calculated on a quadrant basis , and asymmetry was evaluated with regard to the hemispheres ( left versus right ) and the posterior quadrants . Thirty-four children ( 27 boys and 7 girls ) completed the study protocol . The side involved was the right in 62 % of cases and the left in 38 % . Mean age at the initial scan was 6.3 months , and mean age at the follow-up scan was 14 months . Mean duration of helmet therapy  was 7 months . Compliance with therapy was average to above average in 88 % of the children and poor in 12 % . There was a 36 % to 54 % improvement in asymmetry in the compliant patients over the 6-month study period . Soft shell helmet therapy is an effective technique to decrease cranial asymmetry based on objective outcome measurements . Additionally , it is cost-effective , with the total cost of therapy for the helmet and office visits ranging from $ 600 to $ 700 . This therapy compares favorably with other more expensive and time-consuming therapies that have been reported in the literature Objective This study evaluates the safety and parent satisfaction of a new cranial orthosis design ed to treat deformational plagiocephaly . Design A retrospective phone survey of parental satisfaction of a new cranial orthosis that has Food and Drug Administration ( FDA ) clearance for treatment of deformational plagiocephaly . Setting A tertiary referral center for children with craniofacial anomalies . Patients The first 232 consecutive infants enrolled in this program were retrospectively review ed . Interventions Infants were entered in the cranial orthosis program if they had been diagnosed with deformational plagiocephaly and were less than 1 year of age , and if the infant 's parents were interested in enrolling in a monitored cranial orthosis program . Main Outcome Measure After completing therapy , a r and om sample of 81 parents ( half completing treatment ) was surveyed . Parents rated the improvement in their infant 's head shape from 1 ( least ) to 5 ( most ) . They were asked if they would repeat the program with a subsequent child . To date , 70 % ( 162/ 232 ) have completed treatment . Results The orthosis was worn an average of 89 days . On average , parents rated head shape improvement 4.06 out of 5 ( range , 3 to 5 ) . Of parents surveyed , 81 ( 100 % ) would repeat the program with a subsequent child . There were three ( 3/232 or 1.3 % ) minor complications : one child with a persistent rash that resolved with termination of orthosis use , one child with a skin irritation that resolved with orthosis recontouring , and one child who could not be successfully fit . Conclusions The CranioCap , a new cranial orthosis with clearance for treatment of deformational plagiocephaly , appears to be safe , well tolerated , and has excellent parent satisfaction Objective To determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5 - 6 months . Design Pragmatic , single blinded , r and omised controlled trial ( HEADS , HElmet therapy Assessment in Deformed Skulls ) nested in a prospect i ve cohort study . Setting 29 paediatric physiotherapy practice s ;  helmet therapy was administered at four specialised centres . Participants 84 infants aged 5 to 6 months with moderate to severe skull deformation , who were born after 36 weeks of gestation and had no muscular torticollis , craniosynostosis , or dysmorphic features . Participants were r and omly assigned to helmet therapy ( n=42 ) or to natural course of the condition ( n=42 ) according to a r and omisation plan with blocks of eight . Interventions Six months of helmet therapy compared with the natural course of skull deformation . In both trial arms parents were asked to avoid any ( additional ) treatment for the skull deformation . Main outcome measures The primary outcome was change in skull shape from baseline to 24 months of age assessed using plagiocephalometry ( anthropometric measurement instrument ) . Change scores for plagiocephaly ( oblique diameter difference index ) and brachycephaly ( cranioproportional index ) were each included in an analysis of covariance , using baseline values as the covariate . Secondary outcomes were ear deviation , facial asymmetry , occipital lift , and motor development in the infant , quality of life ( infant and parent measures ) , and parental satisfaction and anxiety . Baseline measurements were performed in infants aged between 5 and 6 months , with follow-up measurements at 8 , 12 , and 24 months . Primary outcome assessment at 24 months was blinded . Results The change score for both plagiocephaly and brachycephaly was equal between the helmet therapy and natural course groups , with a mean difference of −0.2 ( 95 % confidence interval −1.6 to 1.2 , P=0.80 ) and 0.2 ( −1.7 to 2.2 , P=0.81 ) , respectively . Full recovery was achieved in 10 of 39 ( 26 % ) participants in the helmet therapy group and 9 of 40 ( 23 % ) participants in the natural course group ( odds ratio 1.2 , 95 % confidence interval 0.4 to 3.3 , P=0.74 ) . All parents reported one or more side effects . Conclusions Based on the equal effectiveness of helmet therapy and skull deformation following its natural course , high prevalence of side effects , and high costs associated with helmet therapy , we discourage the use of a helmet as a st and ard treatment for healthy infants with moderate to severe skull deformation . Trial registration Current Controlled Trials IS RCT N18473161 ObjectiveS tereophotogrammetry enables a simple and radiation free longitudinal analysis of skull asymmetries : in a three-dimensional coordinate system various distances ( length , breadth , cephalic index , oblique diameters , ear shift , head circumference ) can be analyzed . We also defined separate volume sections in order to further quantify the degree of asymmetry in the posterior and anterior components of both sides of the head . Patients and methods In 51 infants ( mean age , 6 months ; SD 0.97 ) with positional plagiocephaly , we determined these parameters at the beginning as well as at the end of molding helmet therapy ( mean therapy time 4.9 months ) . Thirty-seven infants without positional deformity ( mean age , 6.4 months ; SD 0.3 ) served as control group and provided data about what appears to be normal and how these parameters change during growth over a comparable period of time . Results Compared with the control group , the plagiocephalic heads were more brachycephalic , but closely approximated the normal shape under molding therapy . The striking volume difference between the left and right posterior 
    Output:
    
There is a fairly substantive body of nonr and omized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy , especially if the deformity is severe , provided that helmet therapy is applied during the appropriate period of infancy .
In general , infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction ( and even normalization ) of head shape .