title: Range-of-motion restriction and craniofacial tissue-interface pressure from four cervical collars.
abstract: 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.
authors.affiliation: Department of Nursing, Mayo Clinic, Rochester, Minnesota 55905, USA. tescher.ann@mayo.edu
authors.forename: Ann N
authors.initials: AN
authors.lastname: Tescher
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Rindflesch
authors.forename: James W
authors.initials: JW
authors.lastname: Youdas
authors.forename: Therese M
authors.initials: TM
authors.lastname: Jacobson
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Downer
authors.forename: Anne G
authors.initials: AG
authors.lastname: Miers
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Basford
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cullinane
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.forename: V Shane
authors.initials: VS
authors.lastname: Pankratz
authors.forename: Paul A
authors.initials: PA
authors.lastname: Decker
mesh_terms: 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