Dynamic Cervical Orthosis: A Case Study
Introduction
The patient was born full term. She was 6 pounds 12 ounces and 19 ½ inches long. She left the hospital with mom 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 at age 1 year.
She started physical therapy at 14 months. She received aquatic therapy, physical therapy and vision therapy at home. During that time, 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 this 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 her size and for the fact that it did not require an external chair for use.
Method
She 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. This should be taken into consideration when looking at her fatigue levels.
Results
| Prior To Use | After 2 Weeks of Use | After 4 weeks of Use | |
|---|---|---|---|
| Range of Motion | Pectoral muscle protracted bilaterally. | Range increased to neutral, easier passive range of motion into protraction. | |
| Sitting | Would sit with bilateral upper extremity pedi wraps donned and placed in sitting position with tactile cures at upper lip for motivation to lift into midline. She could hold position with constant tactile cues for ten seconds prior to loss of balance or head falling into flexion. | She would sit with bilateral upper extremity pedi wraps donned and placed in sitting positon with maximum assistance at mid-trunk. With DCO and pedi wraps, she would bring her head up independently and hold for 10 seconds. | She would prop sit independently when placed for 5 seconds. |
| Eyes/Head Control | Would open eyes majority of the time when in side-lying or with head supported. She would hold her head in midline for 2 seconds. | Would keep eyes open in supported sitting with improved tracking. She would hold her head in midline for 5 seconds. | |
| Gross Motor | Would roll side to side but not completely into side-lying. | Would roll from supine to side-lying and almost into prone but is unable to clear arm to complete skill. | |
| Endurance | Would tolerate up to 20 minutes with DCO on in focused play. | Would tolerate 30-45 minutes with DCO on in focused play. |