Choosing a Neck Support for Patients with ALS
ALS patients usually wear neck supports only for specific activities (i.e. walking, reading, riding in a car or airplane, writing, or dressing). At other times, wheelchair head rests or high back chairs provide the needed head support. Neck supports should not be worn while eating. Neck supports that immobilize weakened neck muscles are usually rigid, uncomfortable, and may inhibit speech and swallowing. It may be difficult to find a collar that will meet all the needs of an individual patient and the type of support needed will change if weakness progresses. The therapist or physician will need to test the strength of the neck and upper body muscles to determine the degree and type of support required.
The patient should take an active role, with the help and advice from the medical team, in choosing the neck support that best meets their individual needs. Most patients prefer the least "restrictive" collar as possible, but one that will also provide adequate support. The proper amount of support, combined with appropriate seating, postural training, and exercise, can improve comfort, function, and independence for most ALS patients. Important questions to ask when selecting a collar include:
1. Does the collar provide adequate support?
2. Does the collar cause sweating or friction?
3. Does the collar cause a "choking" sensation?
4. Is it affordable?
5. Is it cosmetically acceptable?
Based on experience and input from patients, the following is a listing of collars that have been successfully used for patients with amyotrophic lateral sclerosis.
Soft Collar
These
collars are inexpensive and can be purchased from most medical supply
companies. They are used when there is very mild neck weakness to prevent
fatigue and strain. When significant neck weakness occurs, these collars
are not adequate to support the weight of the head. Since they tightly
encircle the neck, they may feel restrictive and uncomfortable and
therefore, they usually are worn only for brief periods of time. Soft
collars are available with or without a vinyl stabilizing panel and in
various contours, foam densities (medium, firm) and heights (2", 3", 4",
4.5") to fit wide range of patient neck sizes.
Headmaster Collar (Adjustable Wire Frame Cervical Collar)
This
collar is lightweight, open, and is comfortable in warm climates. It is
easily formed by hand to fit snuggly under the chin. It is made of a
specially tempered wire frame which is liberally padded with foam rubber
covered in a soft, washable fabric and uses a Velcro closure strap
attached to cushioned back piece. It is very helpful for patients with
weak neck extensors to prevent the head from falling forward. However, if
weakness is present in rotation and/or lateral flexion (i.e. when shaking
the head "no" or touching the ear to the shoulder), it will not be
adequate and more support is needed.
Symmetric Designs Ltd.
2059 North End Road,
Salt Spring Island, BC, Canada,
V8K 1C9
Toll Free Phone (Canada & USA): 800-537-1724
Website: http://www.symmetric-designs.com
Executive Collar
Similar
in general design to the Headmaster Collar, this collar is made of a
comfortable, lightweight Kydex frame and has an open neck design. An
occipital pad (back piece) attached to hook 'n pile strap can be
positioned to fit any neck circumference. Available in small (4" height),
medium (4˝ height) and large (5" height) sizes. As with the Headmaster, it
is very helpful for patients with weak neck extensors to prevent the head
from falling forward. However, if weakness is present in rotation and/or
lateral flexion (i.e. when shaking the head "no" or touching the ear to
the shoulder), it will not be adequate and more support is needed.
Aspen Collar
This
collar (formerly called the Newport collar) encircles the neck, is
somewhat open, and provides motion restriction without creating pressure
points that lead to skin breakdown. It is extremely rigid, yet flexible at
its edges to conform to each patient's anatomy. Pads & shells are
removable and washable. This is the best style of collar for ALS patients
who have neck weakness in both flexion and extension (up and down) as well
as in lateral flexion and rotation (side to side).
Aspen Medical Products, Inc.
1901 Obispo Avenue,
Long Beach, CA USA 90804-1223
Toll Free Phone: 800-295-2776
Website: http://www.aspencollar.com/
Miami J Collar
This
collar is similar in style to the Aspen collar. Its polyethylene shell
provides rigid support and immobilization. Contact pressure is evenly
distributed, and all contact points are padded. Sorbatex padding absorbs
and wicks moisture away from skin. Pads & shells are removable and
washable.
Jerome Medical
305 Harper Drive, Moorestown, NJ
08057-3239
Toll Free Phone: (800) 257-8440
Website:
http://www.jeromemedical.com
Philadelphia Collar
Constructed
from high-density polyethylene plastic this collar features removable
Orthowick™ foam padding. The contoured back of this collar provides
support at the back of the head. The front tends to restrict motion and
confine the throat. If needed, an extension can be used for more support,
but results in additional restriction. This collar is recommended when
less restrictive collars are unable to provide enough support.
Philadelphia Cervical Collar Company
I-295 Industrial Ctr, Bldg V Westville, NJ 08093
Toll Free Phone: 800-923-9760
Website: http://www.phillycollar.com
Sternal Occipital Mandibular Immobilizer (SOMI)
The
S.O.M.I. is more expensive than most supports, but is fully adjustable and
provides maximum support. The positive features include the occipital
support and a removable chin plate. A headband may be used to maintain
rigidity when the chin plate assembly is removed. The negative features
are that it is difficult to assemble, as well as to put on and take off.
PRO-DFS Wheelchair Head Support System
The
PRO-DFS system provides wheelchair mounted head support. It is especially
designed to provide light anterior support for the individual who has
difficulty keeping his/her head in an upright position. It uses a patented
pulley system allows the forehead strap to actually move safely with the
user. An assortment of strap styles are available.
Whitmyer Biomechanix, Inc
1833 Junwin Court, Tallahassee, FL 32308
Toll Free Phone: 877-944-8246
Website: http://www.whitbio.com
Reprinted with permission by Pamela A. Cazzolli, R.N.