responses to holding head in extension (part 1)
Paul E Prusakowski
Description
Collection
Title:
responses to holding head in extension (part 1)
Creator:
Paul E Prusakowski
Date:
4/18/2014
Text:
Thank you very much for all the responses.
Here is the original question:
I was wondering what options you have found to work best in helping to maintain neck extension to help someone keep their head up if they have a severe hypotonic condition where the patient's chin is basically touching their chest. They have full passive range of motion. Soft collar has not worked. I recall seeing some TSLO's with suprastructures that have posterior cranial contact and a headband that holds everything in place, but have not used any in the past.
Summary of responses:
1. SOMI
2. Minerva with headband
3. Baseball cap with extension strap (presented by Andrew Hansen, PhD at AAOP) <URL Redacted>
4. Custom fabricated TLSO
Full list of responses: (exact duplications were excluded)
-I have used a Minerva vest with the head strap and that has worked well.
-There was a presentation at the Chicago Academy meeting this spring that used a baseball cap as the head attachment and this was fixed to a semi rigid piece that ran up the neck to the patients waist belt? I walked in late on the presentation. It worked well.
- I've made a few of these for two people who had ALS and also had chin on chest. Do you remember the ill fated Orthomedics noninvasive halo? Orthomerica may have also had it maybe 20 years ago. It basically was a kydex front and back where the front extended under the chin like a phili collar and down to the belly and the back covered the back of the head down the neck and down to the small of the back. They were heavy and bulky. What I made was first a kydex one but it was too heavy. I then made 2 or 3 out of carbon fiber and they were pretty easy to make.
What I did first was to cast him standing with someone holding his head in the position he was most comfortable in. That position allowed him to look down at his feet and forward as well. His ALS took away neck muscle and arms. They just hung at his sides or his wife put his hands in his jeans pockets. The braces allowed him to walk safely. Once I had a good cast, I trimmed it to try on as a check socket and wrapped around the forehead and made a strap system that looked like a back pack. From the neck, the straps went over the shoulders, under the arms, crossed in back through loops and closed in the front. No front section at all except straps.
Once I had a cast shaped what I wanted, we heated and pulled a layer of 1/4 inch aliplast, then wrapped the model in saran wrap and laid two layers of 6 inch carbon stockinette (used for large BK or AK lamo) separated by 2 layers of nylon over the back of the model from the top of the head down over the neck and down the back to the low back. We may have done nylon, carbon, nylon, carbon and nylon. Can't remember. We then painted modified epoxy into the carbon and nylon to saturate, then wrapped again with saran wrap. I believe we may have also then wrapped with black tape.
Once set up, we trimmed and smoothed edges and lightly sanded the surfaces to get rid of any rough spots and then glued in the 1/4 inch aliplast. I made the straps with 1 1/2 inch c-fold attached only at the neck and made back pack shoulder straps. He slipped it on like a back pack and buckled the front. I made some forehead straps out of 1 1/2 inch elastic velcro with kemblo sewn on to be sticky and that held his head in a good position. The carbon one was strong and light weight.
- Anyway I've tried rigging many options for patients with isolated neck drop (typically for Parkinson's). The only thing not rejected for being too cumbersome was something found in the skymall catalogue called the upright sleeper. The wire-collar is hand-adjustable and softer than the wire collar from truform. I added a Velcro strap to cross in back and close anteriorly for suspension.This wasn't a billable solution but the pt can buy online for < $50.
-Head drop brace---can work great. Add aluminum afo upright to thoracic area of tlso. Affix posterior curved band (plastic or metal) to proximal section parallel to forehead. Experiment with silicone, neoprene, Trs axila loop, ko padding with silicone, dj anti migration strap, etc. to grip forehead and align pt in extension
- Greetings Paul........the TLSO with attached suprastructure has worked great for my patients. The trick to keep the patient in this is to have a comfortable forehead strap.
- Paul, we did a small study on this elastic head support with ALS patients. Some love it and some don't, but it is simple and inexpensive to try. I'm attaching the slide deck for this system that I used at the AAOP meeting this year. We'll also have a JRRD paper coming out soon on this study.
- in 35 years of practice, i have made 7 glorious designs that have all failed.
- Have tried various off the shelf collars on patient with little success due to breakdown or lack of total control. I have had success with a few patients using custom danmar COs. A trick in doing them is to have them beef up the anterior rigid structure so that the soft foam does not crush down so fast. You can order them undipped and grind the foam for a more custom fit then send it back for finishing. Nice product.
- I just read the CC'd email from Brian. As he mentioned, I have tried Dr. Hansen's method of treatment and it was accepted very well by the patient, his family, and PT.
That particular patient had tried an Aspen collar and even the Minerva but found that the mandibular piece on the Minerva was very uncomfortable and caused extreme soreness; the patient eventually discontinued use. I was not involved in his initial treatment and/or intervention (i.e. Minerva) so I am unsure if any adjustments were done to the orthosis but can share his reaction and PT's issues with usage.
I considered doing a custom system, similar to the RMI VertebrEase(tm) LSO brace with cervical extension unit. This particular brand was trialed with the patient as well but the cervical control piece was made of a kydex material and caused
head bobbing when walking and did not hold the weight of the head nearly as well as Dr. Hansen's method. The patient I worked with was diagnosed with Parkinson's, so he had head drop but was still able to rotate from side to side.
Here is the original question:
I was wondering what options you have found to work best in helping to maintain neck extension to help someone keep their head up if they have a severe hypotonic condition where the patient's chin is basically touching their chest. They have full passive range of motion. Soft collar has not worked. I recall seeing some TSLO's with suprastructures that have posterior cranial contact and a headband that holds everything in place, but have not used any in the past.
Summary of responses:
1. SOMI
2. Minerva with headband
3. Baseball cap with extension strap (presented by Andrew Hansen, PhD at AAOP) <URL Redacted>
4. Custom fabricated TLSO
Full list of responses: (exact duplications were excluded)
-I have used a Minerva vest with the head strap and that has worked well.
-There was a presentation at the Chicago Academy meeting this spring that used a baseball cap as the head attachment and this was fixed to a semi rigid piece that ran up the neck to the patients waist belt? I walked in late on the presentation. It worked well.
- I've made a few of these for two people who had ALS and also had chin on chest. Do you remember the ill fated Orthomedics noninvasive halo? Orthomerica may have also had it maybe 20 years ago. It basically was a kydex front and back where the front extended under the chin like a phili collar and down to the belly and the back covered the back of the head down the neck and down to the small of the back. They were heavy and bulky. What I made was first a kydex one but it was too heavy. I then made 2 or 3 out of carbon fiber and they were pretty easy to make.
What I did first was to cast him standing with someone holding his head in the position he was most comfortable in. That position allowed him to look down at his feet and forward as well. His ALS took away neck muscle and arms. They just hung at his sides or his wife put his hands in his jeans pockets. The braces allowed him to walk safely. Once I had a good cast, I trimmed it to try on as a check socket and wrapped around the forehead and made a strap system that looked like a back pack. From the neck, the straps went over the shoulders, under the arms, crossed in back through loops and closed in the front. No front section at all except straps.
Once I had a cast shaped what I wanted, we heated and pulled a layer of 1/4 inch aliplast, then wrapped the model in saran wrap and laid two layers of 6 inch carbon stockinette (used for large BK or AK lamo) separated by 2 layers of nylon over the back of the model from the top of the head down over the neck and down the back to the low back. We may have done nylon, carbon, nylon, carbon and nylon. Can't remember. We then painted modified epoxy into the carbon and nylon to saturate, then wrapped again with saran wrap. I believe we may have also then wrapped with black tape.
Once set up, we trimmed and smoothed edges and lightly sanded the surfaces to get rid of any rough spots and then glued in the 1/4 inch aliplast. I made the straps with 1 1/2 inch c-fold attached only at the neck and made back pack shoulder straps. He slipped it on like a back pack and buckled the front. I made some forehead straps out of 1 1/2 inch elastic velcro with kemblo sewn on to be sticky and that held his head in a good position. The carbon one was strong and light weight.
- Anyway I've tried rigging many options for patients with isolated neck drop (typically for Parkinson's). The only thing not rejected for being too cumbersome was something found in the skymall catalogue called the upright sleeper. The wire-collar is hand-adjustable and softer than the wire collar from truform. I added a Velcro strap to cross in back and close anteriorly for suspension.This wasn't a billable solution but the pt can buy online for < $50.
-Head drop brace---can work great. Add aluminum afo upright to thoracic area of tlso. Affix posterior curved band (plastic or metal) to proximal section parallel to forehead. Experiment with silicone, neoprene, Trs axila loop, ko padding with silicone, dj anti migration strap, etc. to grip forehead and align pt in extension
- Greetings Paul........the TLSO with attached suprastructure has worked great for my patients. The trick to keep the patient in this is to have a comfortable forehead strap.
- Paul, we did a small study on this elastic head support with ALS patients. Some love it and some don't, but it is simple and inexpensive to try. I'm attaching the slide deck for this system that I used at the AAOP meeting this year. We'll also have a JRRD paper coming out soon on this study.
- in 35 years of practice, i have made 7 glorious designs that have all failed.
- Have tried various off the shelf collars on patient with little success due to breakdown or lack of total control. I have had success with a few patients using custom danmar COs. A trick in doing them is to have them beef up the anterior rigid structure so that the soft foam does not crush down so fast. You can order them undipped and grind the foam for a more custom fit then send it back for finishing. Nice product.
- I just read the CC'd email from Brian. As he mentioned, I have tried Dr. Hansen's method of treatment and it was accepted very well by the patient, his family, and PT.
That particular patient had tried an Aspen collar and even the Minerva but found that the mandibular piece on the Minerva was very uncomfortable and caused extreme soreness; the patient eventually discontinued use. I was not involved in his initial treatment and/or intervention (i.e. Minerva) so I am unsure if any adjustments were done to the orthosis but can share his reaction and PT's issues with usage.
I considered doing a custom system, similar to the RMI VertebrEase(tm) LSO brace with cervical extension unit. This particular brand was trialed with the patient as well but the cervical control piece was made of a kydex material and caused
head bobbing when walking and did not hold the weight of the head nearly as well as Dr. Hansen's method. The patient I worked with was diagnosed with Parkinson's, so he had head drop but was still able to rotate from side to side.
Citation
Paul E Prusakowski, “responses to holding head in extension (part 1),” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/236312.
