Clinical References and Resources
Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure From Four Cervical Collars
Ann N. Tescher, RN, PhD, CNS; Aaron B. Rindflesch, PT, PhD; James W. Youdas, PT; Therese M. Jacobson, RN, CNS; Lisa L. Downer, RN, CNS; Anne G. Miers, RN, CNS; Jeffrey R. Basford, MD, PhD; Daniel C. Cullinane, MD; Susanna R. Stevens, MS; V Shane Pankratz, PhD; Paul A. Decker, MS
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.
(C) 2007 Lippincott Williams & Wilkins, Inc.
- Full article can be found on The Journal of Trauma website