Craniometer user manual and Mimos pillow analysis. Reference guide

Craniometer user manual and Mimos® pillow analysis Reference guide 2 Cranial measurements To achieve more accurate, reliable and repeatable assessm...
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Craniometer user manual and Mimos® pillow analysis Reference guide

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Cranial measurements To achieve more accurate, reliable and repeatable assessments of cranial deformities and to minimize variations due to the positioning of the craniometer, the department of neurosurgery at the Hospital of St Joan de Deu in Barcelona, Spain and Infocefalia.com have designed an elastic band that achieves dependability in a simple and practical way. To properly place the band, do as shown in Figure 1, i.e. creating a circle of diameter greater than the child’s head, using two fingers of each hand, and allow it to close on the child’s head on the same location as if you were going to measure the head circumference ensuring that the red arrow is aligned with the nose. This will prevent pulling the baby’s hair and therefore minimize discomfort.

Fig. 1: Best way to place the band.

Fig. 2: The red arrow is aligned to the nose.

Fig. 3: The band has to go around the maximum head circumference, exactly where the head circumference is measured.

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Measurements, guideline management and referral protocols for plagiocephaly To assess plagiocephaly, we need to measure 2 diagonals, determined by the black crosses on the elastic band as shown in figures 4 and 5:

Fig. 4: Measuring the right diagonal.

Fig. 5: Measuring the left diagonal.

The difference between the two measurements is called the plagiocephaly index. It is a value in milimeters (mm) determining the degree of assymetry of the head. Apply the plagiocephaly index to the graph on figure 6 to appropriate obtain therapeutic protocols as used by the neurosurgery department at San Juan de Dios Hosptial in Barcelona.

Craniometer user manual and Mimos® pillow analysis

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Fig. 6: Plagiocephaly management protocol. The dotted line represents the máximum correction that can be achieved by passive means. This line is a theoretical curve derived from typical head circumference growth. It shows the average head growth for a baby of a given age until the fontanelles close. The established protocol by specialists is as follows: A: Patients that fall within the shadow area can be treated by repositioning and Mimos Pillow by the pediatrician/health practitioner. B: Patients with measurements in the non-shadow/white area should be sent to a neurosurgeon or specialist for further investigation.

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Measurements, guideline management and referral protocols brachycephaly and doliocephaly (scaphocephaly). To measure the symmetrical deformities such as brachycephaly and dolichocephaly, you must determine the anterior-posterior distance (Fig. 7) and the distance across the coronal plane between the two parietal bones (Fig. 8). Biparietal distance is a measure that may vary depending on the shape of the head and especially if the skull also suffers from plagiocephaly, which is why the band has no measurement marks. You should always seek the maximum distance perpendicular to the anterio-posterior line.

Fig. 7: Determining anterio-posteriordistance between the arrow and the circle on the band.

Fig. 8: Determining maximum biparietal distance.

Once obtained the measurements, we apply the following formula:

Applying the result obtained on the graph in Figure 9, the therapeutic approach used by the neurosurgery department of San Juan de Dios Hospital in Barcelona can be observed. Craniometer user manual and Mimos® pillow analysis

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Fig. 9: Protocol for brachycephaly and dolicocephaly (scaphocephaly). The dotted line represents the maximum correction that can be achieved by passive means. This line is a theoretical curve derived from typical head circumference growth. It shows the average head growth for a baby of a given ages until the fontanelles close. The established protocol by specialists is as follows: A: Patients that have measurements that fall within the shadowed area can be treated by repositioning and Mimos Pillow by the pediatrician/health practitioner. B: Patients with measurements in the white/non shadowed area should be sent to a neurosurgeonor specialist for further investigation.

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Why is Mimos Pillow effective? The design of the Mimos pillow evolved from the fact that preventing or correcting positional deformities of the skull requires the absolute need to relieve the constant pressure focused on the small area of a baby’s skull by increasing the contact area of the surface on which the baby is resting. Until recently the only possible recommendations to avoid these distortions were positional passive measures. These measures which are effective when applied properly, are sometimes difficult and impractical to implement. When a baby has torticollis, innate tendencies tend to always turn the head same direction even without neck muscle damage. Parents and grandparents are understandably too tired or busy to be holding the baby, babies and children spend a lot of time in day care, and prolonged time lying on the back in strollers are some of the reasons that makes it extremely difficult or even make it impossible to get improvement or prevention of flat head syndromes through repositioning. When a baby has the tendency to lie with the head always on the same side it can be very difficult for the baby to get rest with the head turned to the opposite side and this, more often than not, leads to the frustration of parents and caregivers making them lose confidence and stop using repositioning measures. The Mimos® pillow makes this task easy because all you have to do is place the infant on the pillow without worrying about the location of the deformity. As long as the head rests within the pillow cavity, this will reduce the pressure and distribute it over a larger area of contact as shown in Figure 10.

Fig. 10: The pressure under an infant’s head resting on a latex mattress is 40 grams per cm2 (right). Cranial pressure with a Mimos pillow is 10 grams per cm2 (left). As an example a body submerged 10cm deep in sea water receives a pressure of 10.25 grams per cm2.

Craniometer user manual and Mimos® pillow analysis

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How to choose the right size of the Mimos® pillow Use the following table:

Mimos L

Mimos XL

Mimos XXL

Mimos P

Maximum rec. 0 to 3 age usage months

1 to 10 months

5 to 18 months

0 to 6 months

from 33 to 42 Approx. cm head circumference

from 36 to 48 cm

from 45 to 50 cm

from 33 to 45 cm

Special feature

Excellent for use in the cot, pram, or even on the play mat.

Side walls are designed to be slightly higher to help the head stay inside the pillow.

Specifically for the trolley or pram. For use only when the baby is lying down and not sitting. This size is not recomended for cot or bed.

The narrow part of the pillow where the neck part of the spine rests is adapted for newborns who have a very short neck for the first 3-4 weeks of life.

· Sizes L, XL & XXL can be used for bed and cot and also in most models of trolley or pram. · Size P is only necessary for some models of trolley or pram which are very narrow and the L, XL or XXL pillows won’t fit. Size P can be used until 6 months after which the baby is sitting down (not lying down) on the trolley chair/pram most of the time. This pillow is not recommended for sleeping on a bed or cot because the head will easily come out of the pillow. · None of our models have been designed to be used in an incubator in special care nurseries but size L can be used for premature babies once they are mature enough to go back home and parents should be given specific directions by the doctor. In case of premature babies with delayed growth, chose the size based on the head circumference, not the age. · When the head rests on the pillow, the pillow shape will conform to the head shape. Therefore, it is not an important factor the position of the flattening on the head as the pillow will always adapt to it. · It is not necessary to turn the head to the opposite direction (reposition) for plagiocephaly or sleep with the head turned to the side in cases of brachycephaly. The Mimos pillow will redistribute the pressure regardless of the position and allow for rounding and head shape improvement.

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Using the Mimos pillow · Always place the child on the back to sleep unless recommended by a qualified doctor, neurosurgeon or physical therapist (for example post-surgery, prolonged immobilization, etc.). · The head should be placed centered on the pillow cavity with the narrow part of the pillow under the neck. · We recommend turning the pillow over every day to prolong the life and keep it in the best shape.

Craniometer user manual and Mimos® pillow analysis

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Safe materials specifically designed for the Mimos pillow Revolutionary, highly advanced and specialized polyester fabric guarantees that the Mimos pillow has a completely breathable three-dimensional structure that is not only soft to the touch but also ensures security against accidental suffocation and lower cranial pressure. Only 6% of the total volume is made by polyester, the rest – 94% is air.

Fig. 11: Detail of the three-dimensional fabric that offers enough resilience to support the head without losing its shape, making it highly durable. Highly breathable, comprised of 94% air. Detail of the fabric used to cover the pillow. It has a certain level of elasticity that allows the cushion to fit each individual babys’ head shape, adjusting to each deformity to reduce pressure in the right areas. Detail of the pillow cover that is specially designed to allow air to flow through in between polyester microfibers. The cover keeps baby clean, cool and dry, wicking away any sweat or vomit.

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Safety certification Airflow Safety – Anti-Suffocation TUV Certification The certification authority “TUV Rheinland” has devised a rule and the appropriate test to assess the risk of suffocation of mattresses and pillows for infants. This standard specifies the minimum amount of air to flow through a textile material to ensure breathing if a child is trapped against it. Mimos pillow has been tested and conforms to this safety standard. “TUV Rheinland” is the largest certification body in the world on safety issues. They certify in the fields of energy, food, transport and health (www.tuv.com)

European Safety Certification EN 71-1 “Safe for children 0-3 years” The Mimos Pillow complies with european standard EN 71-1: 2005. This safety standard is the same that applies to toys intended for children between 0 and 3 years. The tests include tensile tests, torsion, fall, impact, compression and absence of small parts that can cause choking. This certification guarantees the safety of Mimos pillow for use with children between 0 and 3 years old. Textile Safety Certification- Okotex Class 100 Safe for Babies Ökotex seal is a german certification that guarantees the absence of harmful chemicals in textiles. All materials that make up the pillow including the label and thread to sew the different parts are certified Ökotex 100 Class 1 for babies, the strictest of all. The testing of materials has been made by the Textile Institute Aitex of Alicante in Spain, the authorized service center for this type of test.

Craniometer user manual and Mimos® pillow analysis

Mimos® pillow recommendation While is true that there are no published comparative study with positional measures showing greater or lesser effectiveness of pillows designed to prevent positional plagiocephaly, when the infant has acquired a degree of mobility that is impossible to keep appropriate counter-positioning persisting cranial deformity or circumstances exist which are major obstacles such as torticollis, parents and grandparents too busy or tired or infants who spend most time in day care or extended time spent in strollers. We recommend the use of Mimos pillow based on its observed, anecdotal and theoretical effectiveness. The safety and efficacy characteristics of these pillows, unfortunately, are not regulated by law because they are classified as low risk devices. We have analyzed a total of 15 pillows on the market and only the MIMOS® brand of pillow seems to us both effective and safe. Some pillows which are potentially well designed have a cavity in the center that allows further adjustment of the head to increase the contact area and pressure distribution exerted by the gravitational force. The viscoelastic (memory-foam) material may seem best suited to be a material that adapts to the body as a function of pressure and heat but being a material that does not allow air circulation when the child is turned could make him suffocate and we consider them dangerous. Some manufacturers claim to have solved this problem by making holes on the foam, but we consider it not enough and there is no scientific evidence or safety test that guarantees that. Other pillows, filled with polyester fibers, cannot even withstand the weight of the head, and are deformed easily being totally useless. MIMOS® pillow is designed to distribute pressure appropriately and being filled with a polyester three-dimensional structure that allows air flow is totally safe in case the child turns around and face the pillow.

Dr. Josep Maria i Costa, Head of Neurosurgery of Sant Joan de Déu Hospital in Barcelona, Spain. Dr. Joan Bosch i Hugas Pediatric doctor at CAP Rambla de Sant Feliu de Llobregat, Spain.