the pediatric dco

by Megan

The Surestep DCO (dynamic cervical orthosis) is a great option for patients with head drop. It is a dynamic system that facilitates a more neutral head position while allowing small motions in flexion and rotation. Check out this case study written by Physical Therapist Nicole McWilliams about one of her patient’s results with the pediatric DCO.


CC was born full term on 9/26/2012. She was 6 pounds 12 ounces and 19 ½ inches long. She left the hospital with her mother two days after delivery. Prenatal history included nicotine use. An MRI had findings of periventricular leukomalacia. She had a negative genetic workup. Additional diagnoses included dystonia, esotropia, strabismus, dysphasia and reflux. She was placed on baclofen in the fall of 2013.

CC started physical therapy in November 2013. She received aquatic and physical therapy as well as home-based vision therapy. During the first year, no major gross motor skill gains were made and other interventions were considered. She was unable to roll or sit and had significant head lag with pull to sit and poor head control in any position. Her eyes were closed in any upright position. In side-lying, with her head supported, she would open her eyes and track objects.

At that time, it was determined that she needed head support in sitting to work on endurance and visual, spatial, cognitive and social skills in a seated position. A Surestep Dynamic Cervical Orthosis (DCO) was used to facilitate external head support and control. The DCO was a good fit for CC due to her size and for the fact that it did not require an external chair for use.

The Surestep DCO was developed for patients with mild to moderate head ptosis (head drop). It is a low profile device that encourages neck extension to promote a more upright posture that utilizes elastic tension bands to provide dynamic support of the head and neck.


CC utilized the DCO in her home daily for four weeks. Wear time ranged between 20 and 45 minutes per session. Her caregiver reported that during these sessions, she also worked on focused attention and play which should be taken into consideration when looking at her fatigue levels.


Range of Motion

Prior to use, her pectoral muscles were protracted bilaterally. After four weeks of use, her range increased to neutral with easier passive range of motion completed into protraction.


Prior to use, she would sit with bilateral upper extremity pedi-wraps donned and placed in sitting position with tactile cures on her upper lip for motivation to lift into midline. She could hold this position with constant tactile cues for ten seconds prior to loss of balance or her head falling into flexion.

After two weeks of use, she would sit with bilateral upper extremity pedi-wraps donned and placed in sitting positon with maximum assistance at her mid-trunk. With DCO and pedi-wraps, she would bring her head up independently and hold for 10 seconds.

After four weeks of use, she would prop sit independently for five seconds when placed in that position.

Eyes/Head Control

Prior to use, she would open her eyes the majority of the time when in side-lying or with head supported. She would hold her head in midline for two seconds.

After four weeks of use, she would keep her eyes open in supported sitting with improved tracking. She would hold her head in midline for five seconds.

Gross Motor

Prior to use, she would roll side to side but not completely into side-lying.

After four weeks of use, she would roll from supine to side-lying and almost into prone but was unable to clear arm to complete skill.


After two weeks of use, she would tolerate up to 20 minutes with DCO on in focused play.

After four weeks of use, she would tolerate 30-45 minutes with DCO on in focused play.


CC greatly benefited from the four week DCO trial. Her pectoral range of motion increased bilaterally. She was able to prop sit independently with better head control and showed decreased asymmetrical tonic neck reflex (ATNR). She was able to keep her eyes open in a seated position and had improved tracking. She was starting to gain gross motor skills that were previously not developing. By the end of the four weeks, her endurance utilizing the device and working in focused play improved drastically. All of these results point to a positive response to the DCO. CC will continue utilizing the Surestep DCO.