Figure 48: Posterior Head Support
Figure 49: Occipital, Suboccipital, and Lateral Support
Note . From Stealth Products, n.d., retrieved from http://www. StealthProducts.com. © Stealth Products. Reprinted with permission. No head control Clients with minimal or no head control cannot achieve or maintain an upright head position without significant support, often anterior to the head. Severely decreased neck strength, sometimes seen in clients with conditions such as ALS, SMA type I, and congenital myopathies, can cause an inability to control the head, as can extremely high-level spinal cord injuries. Support anterior to the head may be achieved with a forehead
Note . From Stealth Products, n.d., retrieved from http://www. StealthProducts.com. © Stealth Products. Reprinted with permission. strap (Figure 50); rigid swing-away anterior forehead supports (Figure 51); or a collar (Figure 52). Goals of addressing decreased and absent head control are to align the neck for improved swallowing, breathing, and vision; to improve functioning; and to prevent overstretching of the neck extensors, which could further worsen head control (Lange, 2019).
Figure 50: Forehead Strap for Limited Head Control
Figure 51: Rigid Swing-Away Anterior Forehead Supports
Note . (a) From “Whitmyer Dynamic Forehead Strap,” by Medicaleshop, n.d., retrieved from http://www.medicaleshop.com. © Sunrise Medical (US) LLC. Reprinted with permission. (b) Symmetric Designs, n.d., retrieved from http://www.symmetric-designs.com. © Symmetric Designs. Reprinted with permission.
Note . From Stealth Products, n.d., retrieved from http://www. StealthProducts.com. © Stealth Products. Reprinted with permission.
Case study Ryan was initially seen to determine the optimal switch placement for access to a speech-generating device. His positioning was quite poor and led to extreme neck hyperextension and choking (Figure 53). Modifications were made to his wheelchair seating system that placed his pelvis in a neutral position. However, his trunk was still flexed forward, which caused his hyperextended neck position to persist (Figure 54). After the anterior trunk support was adjusted, and his neck was aligned, Ryan was better able to breathe, swallow, visually regard his environment, and access a switch (Figures 55 and 56).
Figure 52: Cervical Collar
Note . From Danmar Products, n.d., retrieved from http://www. danmarproducts.com. © Danmar Products. Reprinted with permission
EliteLearning.com/Physical-Therapy
Book Code: PTNC1023
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