ISPO UK MS ASM 2023 - Invited Paper

Evaluating cervical collar design and fit in the context of skin health

Name:  Laurence J Russell, PhD Student, CDT in Prosthetics & Orthotics, University of Southampton, UK



Cervical collars provide external support to restrict cervical spine movement, minimising the risk of spinal cord injury. Collars apply mechanical loading to the skin, putting it at risk of damage. Indeed, cervical collar-related pressure ulcers are unacceptably prevalent, especially at the occiput, mandibles, and chin. Collar design and fit are often key considerations for prevention.

This study compared four commercial prehospital and acute care cervical collars on a cohort of healthy volunteers. Pressure, microclimate, transepidermal water loss and skin hydration were measured at the interface between the device and the skin with participants lying supine. Range of motion restriction was measured to evaluate effective immobilisation. Head, neck, and shoulder morphology was evaluated using three-dimensional scans.

Results showed that interface pressures exceeded established damage thresholds for prolonged loading for individuals in all four collar designs. The occiput experienced significantly higher interface pressures than the chin and mandibles for three of the four collar designs. This was especially the case for the Stiffneck extrication collar, where occipital pressure was significantly higher than other collar designs. The Stiffneck collar also provided the most movement restriction, though not significantly more than other designs. Relative humidity and temperature at the device skin interface were significantly higher for the Stiffneck and Philadelphia collars, corresponding to closed cell foam padding, in contrast to the open cell foams lined with permeable fabric used in the Aspen Vista and Miami J collars. Collar discomfort correlated with both occipital pressure and skin humidity.

The occiput is at increased risk of cervical collar-related pressure ulcers during supine immobilisation, especially for Stiffneck extrication collars. Further design improvements are needed to reduce pressure ulcer risk. Lined open-cell foams could be used to minimise skin temperature and humidity, reducing the risk of pressure ulcers, and increasing comfort.

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