When is postural support needed to control the head and what to use?
For children, young people and adults with complex needs, a wide range of postural equipment is needed for positioning. In some cases, support of the neck and head is also required, to enable and sustain an upright position of the head.
In this article you can read about:
- Development of head control
- Why is head control so important?
- Limited head control in people with disabilities
- Postural support to assist head control
- What is a Headaloft?
- Who is it for?
- What are the benefits?
- What is a Neck Collar?
- Who is it for?
- What are the benefits?
Development of head control
Head control a is one of the earliest motor developmental skills that an infant acquires. Head control is a basic skill and a driver for motor development. A newborn baby is not able to control their head and needs a lot of support when lifted and carried around. A newborn mainly turns his/her head to the sides when lying on their back, due to the size of their head in relation to their body and because the neck muscles have not yet developed strength.
By the age of 2 months a baby will try to lift their head when lying on their tummy and may also try to turn their head to the sides. Around 3 months old, the baby have gained more control and can lift their head and upper part of the chest with support from their arms when lying on the tummy. Closer to 4 months the baby is able to hold their head up while in a supported sitting position. Between 4 to 6 months of age there is a dramatic development of motor control, and he/she will roll and even start to push into a sitting position. Head control is usually developed by now and new motor skills are gained rapidly.
Why is head control so important?
Head control plays an important role in the development of postural control and motor development. Head control enables visual orientation, and they reinforce each other. The baby is turning its head to follow the mother or father who is moving in the room or looking at a toy lying close by. The muscles are challenged and strengthen. Vision and head control is improved.
Communication is also influenced by head control. This is a consequence of respiratory control, empowering the speech and the ability to take in more information from the environment around. Head control also has an effect on feeding with solid food. The neck and trunk are stronger, and the position of the cheeks change.
Limited head control in people with disabilities
Limited head control is often related to overall reduced motor function. People with disabilities such as cerebral palsy and especially with more severe variants, like GMFCS IV and V (Gross Motor Function Classification System) struggle to keep the body in an aligned position especially while in sitting and standing against gravity. This also includes limited control of the head.
Individuals with severely reduced motor function are often in need of postural support from assistive technology and equipment to maintain a position. Type of support equipment needed depends on intended purpose or activity, but typically includes seating systems, manual or electrical wheelchairs, static or dynamic standing equipment, gait trainers or walkers etc.
The purpose of postural support equipment is to assist an appropriate position that enables function, participation and activity. It should allow the person to be more independent, empower mobility, ease communication and enable a good position for basic needs like breathing and eating. Equipment is also used to position the person to prevent secondary outcomes that may occur for people with severe disabilities over time, such as deformities and contractures.
Positioning of the head is complex and closely related to positioning of the entire body. Assistive technology and postural support equipment often has a standard solution to support the head, and, in many cases, a reclined position can be enough to stabilise the head in an appropriate position. In some cases, specially designed head supports are required to achieve a good position of the head.
Postural support to assist head control
Most commonly the support of the head is required in sitting and/or in standing position, where gravity impacts mostly on head control.
Your responsible occupational therapist or physiotherapist will together with you assess individual needs and help you to decide on the type of equipment needed and where and when to use it.
Headaloft and the Neck Collar are two types of support to assist with head control. The great benefit of these devices is that they can easily be used in combination with different pieces of equipment, and you can switch them between products.
What is a Headaloft?
Headaloft is a new head support available in Great Britain. It is specifically designed to provide comfortable and secure head support for individuals using wheelchairs, standing and seating systems. It is very easy to attach to any headrest with two straps, and can be switched between systems – for example between wheelchair and gait trainer. The support is delivered with 3 sizes of forehead straps and covers head circumferences from 42-66 cm, meaning it fits both children, young people and adults. There is no need to buy additional parts for the device when your child or the one you care for is growing.
Who is it for?
Headaloft is suitable for any individuals who have limited head control and are unable to independently hold their head upright in sitting and standing positions.
What are the benefits of the Headaloft?
The most important benefit of the Headaloft is that it supports the head in a natural position to enable easier respiration, swallowing, eye contact, communication and social interaction. A comfortable position of the head allows in general more activity and participation!
The head support is easy to put on and take off. This means it doesn't need to be worn it all the time in a position, for example in seating. It can be used during eating and drinking to enable a better positioning for swallowing, but if more mobility is need during an activity, you can remove the forehead strap. This allows great flexibility depending on activity and tasks.
Comfortable padding gently supports the forehead and occiput, but also allows some movement of the head, so the head will not be fixed in one position.
The head support is attachable to any device with a headrest. Two straps at the back of the Headaloft are strapped around the headrest and tightened. This allows you to switch the head support from one device to another. For example, between the wheelchair and the standing frame.
See how Headaloft works:
Buy Headaloft here.
What is a Neck Collar?
The Neck Collar is like the Headaloft supporting the head in a natural position. The difference is that the Neck Collar is attached around the neck. The soft front prompt rests on the chest and ensures that the Neck Collar stays in position with the chin resting on the upper part of the collar. This avoids the head from falling forward and to the sides.
It is essential that the Neck Collar fits the size of the neck circumference, to ensure the best support of the head. Measure the neck circumference with a soft measuring tape and choose the right size. The small Neck Collar fits a neck circumference of 25-35 cm, size medium 35-45 cm and size large 45-55 cm.
Who is it for?
The Neck Collar is suitable for children, adolescent and adults with moderate to significantly reduced independent head control. It provides necessary support, without the individual being deprived of full head control.
What are the benefits of the Neck Collar?
The Neck Collar provides necessary support of the head in a natural position, avoiding the head from tipping forward or sideways due to limited muscle control and strength. A controlled position of the head in sitting and standing is important to enable activity and participation in everyday situations.
A great benefit with the Neck Collar is the ability to use it within any device in sitting and standing, as it is not attached to the device. In addition, it allows you to use it during transfers, for example when hoisting from a seated position in the wheelchair to standing in a standing frame or in the Innowalk. Transfer situations can be challenging for individuals with limited head control and often demands more hands, but by using the Neck Collar the transfer situation becomes more comfortable and safe for all involved.
Comfort is essential when wearing a collar around your neck. Therefore, the cover on the Neck Collar is made in a soft material and all seams are not in contact with the head and neck. The inner foam is firm to ensure stability, but the top layer of the Neck Collar which is in contact with the chin and jaw is made of a softer material. The combination of the soft cover and top layered soft form ensure good comfort during use. For hygiene reasons the cover can easily be removed, and machine washed.
The Neck Collar has a Velcro strap at the back and is easy to put on and take off and also allow you to adjust tightness within each size.
Buy the Neck Collar here.
Rikke Damkjær Moen brings many years of experience as clinical physiotherapist to the Made for Movement team. Her mission is to ensure that everybody, regardless of mobility problems, should be able to experience the joy and health benefits of physical activity. As our Medical Manager, Rikke is passionate about sharing knowledge so that individuals with special needs, families, and clinicians can discover the possibilities and solutions provided by Made for Movement.
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