Range-of-motion restriction and craniofacial tissue-interface pressure from four cervical collars.
BACKGROUND
Occipital pressure ulcers are well-known complications for trauma patients wearing cervical collars. We assessed the effects of four commercial cervical collars (Aspen, Philadelphia, Miami J, and Miami J with Occian back [Miami J/Occian]) on cervical range of motion (CROM) and mandibular and occipital tissue-interface pressure (TIP).


METHODS
Forty-eight healthy volunteers (24 men, 24 women; mean age, 38.9 years +/- 10.5 years) were stratified by body mass index. CROM was measured in the seated position without and with collars. Sagittal, coronal, and rotatory CROM was measured with a goniometer. Occipital and mandibular pressures were mapped with subjects in upright and supine positions.


RESULTS
All collars significantly restricted CROM in all planes (p < 0.001). The Philadelphia and standard Miami J collars were the most restrictive. The Aspen collar was the least restrictive for flexion and rotation. The Miami J/Occian back was the least restrictive for extension and lateral flexion. For supine measurements, Miami J and Miami J/Occian back had the lowest mean TIP, whereas Aspen and Philadelphia collars had the greatest (p < 0.001). For upright measurements, the Miami J/Occian back produced the smallest mean TIPs; the other collars, ranked by ascending TIP, were Philadelphia, Miami J, and Aspen (p < 0.001). Philadelphia and Miami J collars had significant collar-body mass index interaction effects on supine occiput mean pressure (p = 0.04).


CONCLUSIONS
Miami J and Philadelphia collars restricted CROM to the greatest extent. Miami J and Miami J/Occian back had the lowest levels of mandibular and occipital pressure; these collars may markedly reduce the risk of occipital pressure ulcers without compromising immobilization.
Tescher
Ann N
AN
Department of Nursing, Mayo Clinic, Rochester, Minnesota 55905, USA. tescher.ann@mayo.edu
Rindflesch
Aaron B
AB
Youdas
James W
JW
Jacobson
Therese M
TM
Downer
Lisa L
LL
Miers
Anne G
AG
Basford
Jeffrey R
JR
Cullinane
Daniel C
DC
Stevens
Susanna R
SR
Pankratz
V Shane
VS
Decker
Paul A
PA
D000328:Adult; D049628:Body Size / Q000502:physiology; D001915:Braces; D004867:Equipment Design; D005145:Face / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000502:physiology*; D011187:Posture; D011312:Pressure; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012886:Skull / Q000502:physiology