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.

@article{chua2026preliminary,
  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.}},
  author = {Karen Sui Geok Chua and Ravi Shankar and Michael Gui Jie Yam and Emily Yee and Rathi Ratha Krishnan and Tegan Kate Plunkett and Wei Binh Chong and Jaclyn Ai Mei Low and Nasrul Hadi B Said and John Chao and Suan Gek Ng and Jai Prashanth Rao},
  journal = {Healthcare (Basel, Switzerland)},
  year = {2026},
  month = oct,
  doi = {10.3390/healthcare14203361},
  url = {https://europepmc.org/article/MED/42940406},
  note = {CC BY},
}

TY  - JOUR
TI  - 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.
AU  - Karen Sui Geok Chua
AU  - Ravi Shankar
AU  - Michael Gui Jie Yam
AU  - Emily Yee
AU  - Rathi Ratha Krishnan
AU  - Tegan Kate Plunkett
AU  - Wei Binh Chong
AU  - Jaclyn Ai Mei Low
AU  - Nasrul Hadi B Said
AU  - John Chao
AU  - Suan Gek Ng
AU  - Jai Prashanth Rao
PY  - 2026
DA  - 2026/10/09
JO  - Healthcare (Basel, Switzerland)
DO  - 10.3390/healthcare14203361
UR  - https://europepmc.org/article/MED/42940406
AB  - 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.
SN  - 2227-9032
ER  -