What is a cervical orthosis?

Orthoses for stabilizing the neck muscles are called cervical orthoses (“cervix” is the Latin word for “throat” or “neck”).

ALS can lead to severe weakness of the neck muscles, which is accompanied by instability of the head posture. The neck muscles are responsible for stabilizing the cervical spine, but also for the positioning and upright position of the head (positioning and holding muscles of the head). In the event of muscle weakness (or spasticity) of the neck muscles, the head can no longer be held in an upright position independently and assumes a flexed position. Patients perceive the muscle weakness as an increasing “heaviness” of the head, which has a tendency to fall forward (“droppedheadsyndrome“). In this situation, an orthosis (“splint”) of the neck muscles can be beneficial for the upright position of the head.

A wide variety of cervical orthoses are available for treatment, which can be made of different materials (foam, plastic, carbon or metal applications). Cervical orthoses made of soft material have the advantage that head movements are possible and the radius of action is less restricted. A disadvantage of orthoses with foam materials (“neck brace”) is the relatively low degree of stabilization. The heat generated under the orthosis (depending on weather conditions and room temperature) can also be a strain. Orthoses made of carbon and other stable materials (plastic, metal) have the advantage of stabilizing the head in an upright position. A disadvantage can be the “fixation” of the head in this position, so that turning the head is only possible to a limited extent. The restricted view forwards and downwards can be problematic, so that the immediate space in front of the patient can only be seen to a limited extent. This can lead to uncertainty and risks when walking, as any obstacles are not recognized.

Cervical orthoses must therefore be adjusted in such a way that sufficient stability and an optimal field of vision are achieved at the same time. This is a major challenge in the fitting of cervical orthoses. Due to the different fields of application, fitting several orthoses for different situations may also be justified. A foam orthosis (with the continued option of tilting the head forwards and maintaining the field of vision) may be appropriate for walking, while wearing a carbon orthosis promises greater stability and is more suitable than a foam orthosis for watching television or other activities that do not require a downward gaze. Orthoses made of carbon and other stable plastics are also recommended when riding in a car in order to ensure greater stability for the head (e.g. during braking maneuvers and acceleration). In the case of cervical orthoses, special experience on the part of the supplying medical supply retailer (and the prescribing doctor) is an advantage.