Infantile postural asymmetry and osteopathic treatment, a randomized therapeutic trial

Participants

• Numbers: 32 infants (14 female and 18 male)
• Criteria of inclusion: postterm age of 6 to 12 weeks, with a diagnosis of postural asymmetry.
• Criteria of exclusion: asymmetry score < 12, significant underlying disease, gestational age < 36 weeks, any current or past asymmetry treatment (with the exception of handling), predominance of an oblique body position masking the trunk curvature, parents not familiar with the German language.
• Groups of study: 2 groups obtained by randomization
  • Group 1: OMT, 16 infants (7 female and 9 male, mean age 9 weeks)
  • Group 2: sham treatment, 16 children (7 female and 9 male, mean age 9 weeks)
    • 1 child did not receive his last treatment

Interventions and evaluations

• In order to determine the inclusion or exclusion of the participants:
  • complete medical history, neurological (with a pediatric neurologist) and physical (with a physiotherapist) examinations to define the degree of asymmetry.
• At the beginning and at the end of the study, assessment of the degree of asymmetry (on a 0 to 24 scale) through visual evaluation recorded by 3 different observers, the relative mean value was then calculated; assessment of the convexity of the trunk and the cervical rotation as reactive movements to an orienting head turn in a supine or prone position.
• Evaluation of possible mediators of the effect of the intervention on the primary outcome (including infantile position either awake or asleep, time during which the infant was held, time during which the infant was seated in a car, possible diseases developed during the study) and influence of the treatment on autonomic parameters (vomiting, sleep, drinking, mood, excitability, bowel movement frequency).
• 4 weekly sessions of OMT or sham treatment of 45-60 minutes.
• OMT: overall structural evaluation and assessment of tissue quality and mobility and consequent personalized treatment based on the above
• Sham treatment: hand placed in the same position as for the OMT but without applying any technique.
• Waiting list: physiotherapy at the end of the study
• OMT performed by osteopaths with an expertise in treating infants and small children
  After the intervention all parents were instructed on how to help their babies using a handling technique based on the Borath concept

Results

• Primary outcome: OMT promoted a decrease in the degree of asymmetry by 4.7 points more than sham treatment, in a statistically significant way. In addition, while in the OMT group 13 children improved (degree of asymmetry reduced by at least 3 points) and 3 remained stable, in the control group 5 children improved, 8 remained stable and 3 worsened (degree of asymmetry increased by at least 3 points).

• Secondary outcomes: none of the identified mediators of the effect of OMT and sham treatment on the degree of asymmetry showed any sort of correlation to it. Likewise, both treatments seem to have equally influenced (and therefore without any statistically significant difference) the autonomic outcomes. An inconsolable crying was reported in 4 infants in the OMT group and in 6 infants in the control group, as well as 4 infants in the OMT group and 6 in the control group showed a worsening of the autonomic parameters two days after the interventions. No other adverse effects were detected.

Discussion

The OMT showed to be able to help improve a state of postural asymmetry, which could probably resolve spontaneously over time but also crystallize in a postural alteration (eg, scoliosis) or indicate worse problems (eg, hemiplegia).

Unfortunately, no factor had been highlighted to predict how a child would have responded (positively or not) to treatment: therefore, to date, it is unclear what children with asymmetry need to be treated, which would resolve spontaneously and which would not respond to treatment. However, it is clear that to assess asymmetry it is necessary to consider the entire range of behaviors of the child instead of focusing on purely anatomical simple aspects. A particularly interesting result was the lack of serious and/or specific side effects of OMT. However, studies on a much larger sample are needed to assess the actual consistency of OMT.