{ "abstract": "A minimally monitored clinical protocol demonstrated preliminary short-term feasibility and tolerability: 18/23 (78.3%) fitted patients were confirmed compliant, with 18/20 (90%) respondent compliance and three patients of unknown status, without serious adverse events. Longer follow-up studies are needed to assess sustained compliance throughout the pre-cranioplasty period. Future research should standardise materials and outcome measures to inform clinical practice guidelines. Background/Objectives: 3D-printed externally applied cranial orthosis (PEACO) represents an emerging solution for temporary cranial protection, though evidence remains limited regarding real-world implementation using minimally monitored clinical protocols. Methods: Retrospective cohort study conducted at a 121-bed rehabilitation centre in Singapore (November 2022-November 2025). Adults >21 years, >3 weeks post-DC with healed wounds and available caregivers were included. PEACO devices were individually designed from CT stereotaxis scans using contralateral hemi-cranium mirroring and fabricated using Ultra-durable Resin. Rehabilitation therapists fitted devices using progressive wearing schedules. T0 outcomes (30 min post-fitting) included therapist-observed pain, redness, skin imprints, and pruritus. T1 outcomes (at least 2 weeks post-fitting) included wearing duration, cosmesis ratings (0-10 scale), compliance, and adverse events via digital surveys. Exploratory comparisons using descriptive analysis were performed to compare outcomes from 2021 (n = 10) and 2025 (n = 23) cohorts. Results: Twenty-three patients (14 males, median age 56.0 years) were fitted with PEACO at median 67 days post-DC, (13 traumatic brain injury, 10 stroke). At T0, primary reprinting for poor fit was required in 3/23 (13.0%), 18/23 (78.3%) fitted patients were confirmed compliant, 18/20 (90%) were compliant with responder feedback; 2/20 (10.0%) were non-compliant, with three patients of unknown status. At T0, 9/23 (39.1%) had therapist-observed mild, transient adverse events, with no reported wound dehiscence. At T1, among 18 respondents: 16/18 (88.9%) wore PEACO ≤4 h/day, 7/18 (38.9%) reported self-limiting discomfort or transient skin changes at T1, median cosmesis rating was 6.0/10. At T1 assessment, no falls with head impact occurred. Clinical Trials Registration: ClinicalTrials.gov NCT07122752.", "abstract_shown": true, "affiliations": [ "Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, National Healthcare Group Health, 1 Tan Tock Seng Link, Singapore 307382, Singapore.", "R3 Institute Singapore (R3I), Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore.", "Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore.", "Clinical Research and Innovation Office, Tan Tock Seng Hospital, National Healthcare Group Health, 11 Jln Tan Tock Seng, Singapore 308433, Singapore.", "3D Medical Printing Centre, Tan Tock Seng Hospital, National Healthcare Group Health, 11 Jln Tan Tock Seng, Singapore 308433, Singapore.", "Department of Orthopaedic Surgery, Tan Tock Seng Hospital, National Healthcare Group Health, 11 Jln Tan Tock Seng, Singapore 308433, Singapore.", "Medairum Pte Ltd., 701 Sims Drive, LHK Building, Singapore 387383, Singapore.", "Department of Neurosurgery, National Neuroscience Institute, Singapore Health Services, 11 Jln Tan Tock Seng, Singapore 308433, Singapore.", "Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore." ], "article_type": "research article", "arxiv": null, "author_total": 12, "authors": [ { "affs": [ 0, 1, 2 ], "name": "Karen Sui Geok Chua" }, { "affs": [ 1, 3 ], "name": "Ravi Shankar", "orcid": "0009-0005-5578-3481" }, { "affs": [ 1, 2, 4, 5 ], "name": "Michael Gui Jie Yam" }, { "affs": [ 0, 3 ], "name": "Emily Yee" }, { "affs": [ 0, 1, 2 ], "name": "Rathi Ratha Krishnan", "orcid": "0000-0002-2868-2037" }, { "affs": [ 0 ], "name": "Tegan Kate Plunkett" }, { "affs": [ 0 ], "name": "Wei Binh Chong", "orcid": "0009-0002-1888-8813" }, { "affs": [ 0 ], "name": "Jaclyn Ai Mei Low" }, { "affs": [ 4, 6 ], "name": "Nasrul Hadi B Said" }, { "affs": [ 4, 5 ], "name": "John Chao" }, { "affs": [ 7 ], "name": "Suan Gek Ng" }, { "affs": [ 2, 7, 8 ], "name": "Jai Prashanth Rao", "orcid": "0000-0001-6296-5295" } ], "bibtex": "https://research.draconitic.com/paper/18asdzeybq9p7.bib", "cited_by": 0, "doi": "10.3390/healthcare14203361", "fulltext_url": "https://europepmc.org/articles/PMC13703988", "id": "18asdzeybq9p7", "issns": [ "2227-9032" ], "landing_url": "https://europepmc.org/article/MED/42940406", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2204|Anatomy and Medical Technology" ] ], "openalex": "W7221185530", "pdf_url": "https://europepmc.org/articles/PMC13703988?pdf=render", "pmcid": "PMC13703988", "pmid": "42940406", "published": "2026-10-09", "publisher": null, "ris": "https://research.draconitic.com/paper/18asdzeybq9p7.ris", "sources": [ { "first_seen": "2026-10-30T12:22:24Z", "native_id": "MED:42940406", "source": "europepmc", "url": "https://europepmc.org/article/MED/42940406" } ], "subjects": [], "title": "Preliminary Feasibility Implementation of Post-Decompressive Craniectomy 3D-Printed Externally Applied Cranial Orthosis (PEACO) During Inpatient Rehabilitation: A Retrospective Cohort Study Reporting Short-Term Tolerability and Patient/Caregiver-Reported Feedback.", "title_text": "Preliminary Feasibility Implementation of Post-Decompressive Craniectomy 3D-Printed Externally Applied Cranial Orthosis (PEACO) During Inpatient Rehabilitation: A Retrospective Cohort Study Reporting Short-Term Tolerability and Patient/Caregiver-Reported Feedback.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:22:24Z", "url": "https://research.draconitic.com/paper/18asdzeybq9p7", "venue": "Healthcare (Basel, Switzerland)", "versions": [] }