There are many different neurological conditions which can affect the neck muscles leading inability to control, position and lift the head. Motor Neurone Disease (MND) is an example of a condition which leads to weakness of the neck muscles. Other neurological conditions can lead to overactivity and weakness in some of the neck muscles and cause ‘pulling’ of the neck into an abnormal position. An example of this is traumatic brain injury or cerebral palsy. Management of these problems can be hugely different amongst individuals.
Why control head position?
Poor postural control in MND can lead to ‘head drop’. This has a huge impact on quality of life and affects social interaction, eating and drinking and can lead to pain and stiffness.
Methods for improving the head posture and promoting head / neck mobility, comfort and safety include:
1. Achieve and maintain a good body alignment when sitting to promote an upright head position. Use of cushions, pillows, or rolled towels behind the lumbar region of the low back not only helps to align a slumped posture, but will help keep the head and shoulders from slouching forward. If sitting in a high back chair, placing a rolled towel behind the neck also improves the head posture and helps prevent or alleviate discomfort in the neck.
Placing a pillow under each arm or on top of each armrest of the chair helps promote an upright head position, and provides maximum comfort through increasing support when sitting for a long time.
2. Wearing a soft collar or a neck brace can be an effective method of holding up the head if this is difficult. A collar supports the head when the person is walking or being transferred from one position to another. To protect against injury, people with neck weakness should wear a collar when they are moving or being transferred from one seat to another, when walking, or riding in the car. Use of a collar to hold up the head when walking permits a better vision and improves social interaction and may reduce the risk of falling.
3. Identify and use the appropriate collar that will best meet the individual’s needs. Most people with neck weakness are unable to tolerate wearing a collar all the time, due to pressure areas and discomfort. There are many collars available from soft collars through to rigid collars. A simple soft collar provides little stability when the neck muscles are very weak.
One popular lightweight collar is the Headmaster Collar™. This collar requires measurement, prescribing and fitting by a therapist to make sure it is the right on for the individual.
Another collar to consider is the Philadelphia Collar which again requires measurement, prescribing and fitting by a therapist.
To promote comfortable use of head support, alternating the use among several collars may be a solution to reducing pressure areas on the skin.
5. Leaning back in a reclining chair is another method to support the head and to help keep the head from falling forward. This may include a tilt in space wheelchair with a high back or one in which a headrest can be attached. Occupational Therapists are experts in prescribing tilt in space wheelchairs. With many on the market is it vital that the correct one is prescribed for you.
6. Using a head support system can position the head in an upright position by a band across the forehead that attaches to an adjustable headrest that mounts to a chair. Some head support systems include the use of an elastic band, such as the Dynamic Forehead Strap System that moves with the user for a greater degree of movement and comfort than is provided by conventional bands.
7. When in bed making the head is in a good position. A rolled towel placed underneath the back of the neck with the head resting on a low pillow can provide support and comfort of the neck and head when sleeping. In addition, people who have trouble keeping their head upright might try lying in bed a few times during the day to relieve the neck muscles.
8. Stretching exercises of the neck muscles can help promote mobility of the head, alleviate stiffness of the neck, and help prevent and treat neck pain. The individuals family members or carers may need to assist with these exercises. These exercises must be prescribed by a physiotherapist so that they are performed correctly and safely.
9. If poor head position is due to overactivity of muscles in the neck then optimum management can be complex with a wide range of headrests available and some individuals requiring a custom made device.
Optimising head position and control is a vital part of therapy intervention in neurological patients. The best solution may take time and trial and error of many devised available!
The therapy team at ARC are dedicated to investigating all options and are often found surfing the net and talking to overseas suppliers in order to find the right solution for their patients.