What’s the difference between a CKD physical or occupational therapist and an orthotist on staff? Plenty.

Orthotists are specially trained health care professionals that are skilled at fitting external devices such as back braces and foot splints and sometimes cranial bands to the human body. Some orthotists work in labs and create the devices.

PTs and OTs have wide and deep training in the systems of the body (think bones, muscles, vision, auditory, kinesthetic, proprioceptive, etc.) and the interconnections and how to create or restore movement needed to live, work and play.  They have a wide array of tools to utilize such as strengthening, reflex integration, movement techniques, manual therapy techniques, use of sensory systems; positioning; as well as orthotics.

PTs and OTs are key team members in determining the ideal timing and use of braces and splints and cranial bands as part of a total plan for a child and family.  Of paramount importance is the holistic nature of thoroughly addressing the entire head shape issue.  By simultaneously addressing underlying neck tightness/imbalances and developmental progressions and asymmetries (think rolling in one direction only), the cranial band can achieve the most correction possible.  

If a cranial band is used without thoroughly addressing underlying issues, some improvement to the head shape will occur but it is much less likely there will be optimal change.  That is, if the muscles that attach to the skull such as those in the neck remain unbalanced (one side overly flexible; one side overly tight), the cranial band and the neck muscles are working against each other.  

Fully addressing underlying muscle imbalances, developmental asymmetries and progressions is one essential part to reducing the need for multiple cranial bands.  PTs and OTs are able to provide this level of care given their training in strengthening, reflex integration, movement techniques and manual therapy.

At Carolina Kinder Development, our patients need a second band less than 10% of the time. This excellent correction rate has to do with the biomechanical properties of our band;  the knowledge applied about when to begin using the cranial band based on the particulars of each baby; and addressing all the underlying issues thoroughly and holistically.  

Note, there are some infants who may have had imbalances early on that have resolved fully.  Those infants often need a cranial band only without additional therapy.  A CKD occupational or physical therapist will be able to do a thorough evaluation to help you decide the best course of action for your infant and family.

How does the practices detailed and thorough approach affect cost?

While our level of care is extremely thorough in addressing neck and head shape issues as well as related developmental issues, it also can be a tremendous time and cost savings.  There are two parts to this.  First, we are the experts at helping head shape to change without using a cranial band.  This can represent a huge cost savings.  

Secondly, when a cranial band is needed, the band we use, in the hands of our therapists produces excellent and fast change.  Thus, within one cranial band the level of change is significant and 90% of those infants do not need a second band (age at the start of treatment and severity are two major reasons for the 10% of infants that do need a second band). 

Lastly, but perhaps most importantly is that by addressing development and musculoskeletol issues early and thoroughly, the amount of intervention/therapy/surgeries/bracing in the coming years is lessened (often none at all).       

There is a lot of judgement involved in terms of if a cranial band is needed and what the ideal age is to begin one.  Our therapists utilize cranial bands every day and are intimately familiar with how various head shapes at various ages respond to treatment.  Our skill, training and years of experience plays into the ideal timing of beginning treatment or, whether a cranial band is needed at all.

What if my baby is already seeing an OT or PT outside of Carolina Kinder Development?  

In these scenarios, we recommend continuing to work with the OT or PT on the torticollis portion and also schedule a visit with us as soon as a head shape issue is noted.  As a courtesy to local therapists and families, often there is no charge from us for this visit (check first with front desk for more details).  

Seeing your baby as early as possible allows us to measure, analyze and monitor your infant’s head shape and if needed, continue to do that in the coming weeks and months.  This is very helpful in determining if, or when, a cranial band may be needed.  

There are common patterns that happen as the head changes.  One is that while one part of the head appears to be improving, what has actually happened is another part has worsened, giving the skewed impression of improvement.  We will be in touch with your existing OT or PT with all of our results which may influence their treatment/home program for you.

It’s common for non-CKD therapists and orthotists in the community to measure head shape.  When done inaccurately or most especially when using a system that does not take into account the particulars of an infant’s head shape; or when there is little context to the measurements; the measurements can be misleading.  

The most common scenario for this is that the head shape is measured by a system that was designed to measure a “normal” head shape.  This can grossly under or over-exaggerate the severity and/or complexity of a head shape.  Therefore, the decision of if or when to proceed with a cranial band, can be alarmingly skewed either towards needing a band or not needing a band.  A helpful feature for some head shapes is to understand the change in volume which requires the head to be scanned and also the ability to interpret the data. Our PTs and OTs have this training in contrast to non-CKD therapists and orthotists.

In addition to accurate measurements, it is beneficial to your baby to have the benefit of a visit with the cranial band provider who uses the tool every day.  That is, the intricacies of how a cranial band works for the specific characteristics of a particular infant’s head shape, age and medical history.  There are certain head shapes that change very, very quickly in a cranial band.  Those head shapes are ones that we feel comfortable allowing extra time to see if the infant will change without the need for a cranial band.  Other head shapes may not be severe, but involve bone structures that are more difficult to move.  In those cases, we recommend not waiting too long, as that infant may need more time in a cranial band for correction to complete.  It would be similar to asking your dog trainer what are the best cat toys.  

Also, context and other factors is of paramount importance.  An infant that entered the world with flattening and asymmetry has different implications than an infant whose flattening did not occur until 8 weeks of age.  An infant who was 4 weeks premature has different factors than a full-term infant.  Also, parents come with different desires and goals and these have a central role.  Some families want to avoid a cranial band if at all possible.  Some want to begin as early as possible.  Our role is to equip parents to make the decisions that are right for their infant and their family.  These are just a few of many factors that go into the decision of when or if to utilize a cranial band.

The story of a head shape goes far beyond a standard and limited set of measurements.  

Susan Klemm MS, OTR/L founded Carolina Kinder Development in 2006 to prevent and treat head, neck and developmental issues in infants.  The ongoing developmental and orthopedic issues during the early years are also part of their services.