Dear Listserv,
I have a patient that underwent radiation treatment over 30 years ago. 25
years after her radiation she began to suffer from “dropped head syndrome”.
She literally does not have the extensor muscles in the spine to extend her
neck. She has tried several different devices and the one that she is
using now is one that I modified for her. It is a trimmed down portion of a
custom TLSO, a recently added custom posterior PE section that distributes
the pressure over the prominent cervical spinous processes and acts as a
support as to not just have the head hyperextend, an aspen quick draw
riveted on to the TLSO for anchoring and a third point of pressure, an
aluminum posterior upright that fastens to the posterior of the TLSO
traveling to a custom molded occipital piece, with a head band and lamb’s
wool to hold her head back.
She has tried other devices such as a customized SOMI, an aspen vista(which
she uses for when she is cooking), and other collars over the years. The
device that she wears every day is the one previously described.
Her goals are to resist the head band from slipping proximally off the
equator of the head, gain independence with donning (currently if she
doesn’t have her husband to help don the device, she has to lie supine on
the floor so her head stay back in position and then fasten the head band),
avoid proximal migration of the quick draw, and avoid using any type of
mandibular piece.
My thoughts were to fabricate a device using some form of a step lock in the
posterior section along the cervical spine, so she can strap her head
independently, and then once secured, she could push her head utilized the
step lock to hold in desired position.
My question is : Does anyone have any better solutions? Does the step lock
idea seem feasible? What other head band materials would be comfortable,
hygienic, and reduce slippage (currently using lamb’s wool for interface but
currently trying pieces of an Ossur sleeve or a custom pq piece in the head
band), solution for resisting proximal migration of aspen quickdraw besides
a full tlso or anchoring suspenders.
Pictures of current device and patient with and without device can be found
at the following link: http://www.oandp-l.org/shared/pjqno.jpg
Marc Kaufman ,CPO, LPO
Atlanta Prosthetics and Orthotics Inc.
www.atlantapo.com
