A bioengineering investigation of cervical collar design and fit: implications on skin health
A bioengineering investigation of cervical collar design and fit: implications on skin health
Background: cervical collars restrict cervical spine movement to minimise the risk of spinal cord injury. Collars apply mechanical loading to the skin putting it at risk of skin 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.
Methods: this comprehensive study evaluated four commercial prehospital and acute care cervical collars. Pressure, microclimate, transepidermal water loss and skin hydration were measured at the interface between the device and the skin. Range of motion restriction was measured to evaluate effective immobilisation. Head, neck, and shoulder morphology was evaluated using three-dimensional scans.
Findings: the occiput experienced significantly higher interface pressures than the chin and mandibles for most collar designs. Interface pressure at the occiput was significantly higher for the Stiffneck extrication collar compared to the other collar designs. The Stiffneck collar also provided the most movement restriction, though not significantly more than other designs. Relative humidity at the device skin interface was 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 other collars. Collar discomfort correlated with both occipital pressure and skin humidity.
Interpretation: the occiput is at increased risk of cervical collar-related pressure ulcers during supine immobilisation, especially for Stiffneck extrication collars. Lined open-cell foams could be used to minimise skin humidity and increase comfort.
Cervical collar, Interface pressure, Pressure ulcer, Range of motion
Russell, Laurence J.
060b13e9-9203-4f98-b7ad-f77ef2e08f35
Dodd, Tamara
aaeeb303-a2e1-41c1-ba75-d51b65915611
Kendall, Daniel
b94a0bbe-2c44-47e6-bcaa-c7c6e4efb73c
Lazenbury, Amber
e3d7cbfd-108f-4dd3-8e9d-640a3f7ec49c
Leggett, Abigail
d76c4acc-46f8-4579-b2ed-2fa27ec82187
Payton-Haines, Sophie
ff0f04d4-105a-460b-acc2-ba20e17912f8
Jiang, Liudi
374f2414-51f0-418f-a316-e7db0d6dc4d1
Filingeri, Davide
42502a34-e7e6-4b49-b304-ce2ae0bf7b24
Worsley, Peter R.
6d33aee3-ef43-468d-aef6-86d190de6756
February 2024
Russell, Laurence J.
060b13e9-9203-4f98-b7ad-f77ef2e08f35
Dodd, Tamara
aaeeb303-a2e1-41c1-ba75-d51b65915611
Kendall, Daniel
b94a0bbe-2c44-47e6-bcaa-c7c6e4efb73c
Lazenbury, Amber
e3d7cbfd-108f-4dd3-8e9d-640a3f7ec49c
Leggett, Abigail
d76c4acc-46f8-4579-b2ed-2fa27ec82187
Payton-Haines, Sophie
ff0f04d4-105a-460b-acc2-ba20e17912f8
Jiang, Liudi
374f2414-51f0-418f-a316-e7db0d6dc4d1
Filingeri, Davide
42502a34-e7e6-4b49-b304-ce2ae0bf7b24
Worsley, Peter R.
6d33aee3-ef43-468d-aef6-86d190de6756
Russell, Laurence J., Dodd, Tamara, Kendall, Daniel, Lazenbury, Amber, Leggett, Abigail, Payton-Haines, Sophie, Jiang, Liudi, Filingeri, Davide and Worsley, Peter R.
(2024)
A bioengineering investigation of cervical collar design and fit: implications on skin health.
Clinical Biomechanics, 112, [106178].
(doi:10.1016/j.clinbiomech.2024.106178).
Abstract
Background: cervical collars restrict cervical spine movement to minimise the risk of spinal cord injury. Collars apply mechanical loading to the skin putting it at risk of skin 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.
Methods: this comprehensive study evaluated four commercial prehospital and acute care cervical collars. Pressure, microclimate, transepidermal water loss and skin hydration were measured at the interface between the device and the skin. Range of motion restriction was measured to evaluate effective immobilisation. Head, neck, and shoulder morphology was evaluated using three-dimensional scans.
Findings: the occiput experienced significantly higher interface pressures than the chin and mandibles for most collar designs. Interface pressure at the occiput was significantly higher for the Stiffneck extrication collar compared to the other collar designs. The Stiffneck collar also provided the most movement restriction, though not significantly more than other designs. Relative humidity at the device skin interface was 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 other collars. Collar discomfort correlated with both occipital pressure and skin humidity.
Interpretation: the occiput is at increased risk of cervical collar-related pressure ulcers during supine immobilisation, especially for Stiffneck extrication collars. Lined open-cell foams could be used to minimise skin humidity and increase comfort.
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Participant_Study_Paper_v29_revisions_no_highlights
- Accepted Manuscript
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- Accepted Manuscript
More information
Accepted/In Press date: 8 January 2024
e-pub ahead of print date: 9 January 2024
Published date: February 2024
Additional Information:
his work was supported by the UK Engineering and Physical Sciences Research Council (EPSRC) grant EP/S02249X/1 for the Centre for Doctoral Training in Prosthetics and Orthotics. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising.
Keywords:
Cervical collar, Interface pressure, Pressure ulcer, Range of motion
Identifiers
Local EPrints ID: 486434
URI: http://eprints.soton.ac.uk/id/eprint/486434
ISSN: 0268-0033
PURE UUID: 1d616662-aa5f-439d-aada-ab78f2591a35
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Date deposited: 22 Jan 2024 17:37
Last modified: 18 Mar 2024 04:03
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Contributors
Author:
Laurence J. Russell
Author:
Tamara Dodd
Author:
Daniel Kendall
Author:
Amber Lazenbury
Author:
Abigail Leggett
Author:
Sophie Payton-Haines
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