Range-of-motion restriction and craniofacial tissue-interface pressure from four cervical collars

Ann N. Tescher, Aaron B. Rindflesch, James W. Youdas, Therese M. Jacobson, Lisa L. Downer, Anne G. Miers, Jeffrey R. Basford, Daniel C. Cullinane, Susanna R. Stevens, Vernon Shane Pankratz, Paul A. Decker

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


BACKGROUND: Occipital pressure ulcers are well-known complications for trauma patients wearing cervical collars. We assessed the effects of four commercial cervical collars (Aspen, Philadelphia, Miami J, and Miami J with Occian back [Miami J/Occian]) on cervical range of motion (CROM) and mandibular and occipital tissue-interface pressure (TIP). METHODS: Forty-eight healthy volunteers (24 men, 24 women; mean age, 38.9 years ± 10.5 years) were stratified by body mass index. CROM was measured in the seated position without and with collars. Sagittal, coronal, and rotatory CROM was measured with a goniometer. Occipital and mandibular pressures were mapped with subjects in upright and supine positions. RESULTS: All collars significantly restricted CROM in all planes (p < 0.001). The Philadelphia and standard Miami J collars were the most restrictive. The Aspen collar was the least restrictive for flexion and rotation. The Miami J/Occian back was the least restrictive for extension and lateral flexion. For supine measurements, Miami J and Miami J/Occian back had the lowest mean TIP, whereas Aspen and Philadelphia collars had the greatest (p < 0.001). For upright measurements, the Miami J/Occian back produced the smallest mean TIPs; the other collars, ranked by ascending TIP, were Philadelphia, Miami J, and Aspen (p < 0.001). Philadelphia and Miami J collars had significant collar-body mass index interaction effects on supine occiput mean pressure (p = 0.04). CONCLUSIONS: Miami J and Philadelphia collars restricted CROM to the greatest extent. Miami J and Miami J/Occian back had the lowest levels of mandibular and occipital pressure; these collars may markedly reduce the risk of occipital pressure ulcers without compromising immobilization.

Original languageEnglish (US)
Pages (from-to)1120-1126
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number5
StatePublished - Nov 1 2007


  • Cervical collar
  • Pressure ulcer
  • Range of motion
  • Tissue-interface pressure

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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