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Head supports come in a range of shapes, sizes, and configurations. A well-designed head support provides comfort, stability, and alignment of the head and neck, enabling socialization and communication whilst keeping the airway safe for breathing and swallowing.
We are often asked by parents, therapists, teachers, and carers what supports can be used to position the head upright. Anterior head supports may seem like they could work, but I usually try to start with other options to correct posture before considering an anterior head support.
Before prescribing an anterior support, there are a number of considerations:
- Is the seating providing a stable base for alignment? The head is at the end of a chain of body segments. When seated, the pelvis is the keystone and base of optimal positioning. Ensure the pelvis and trunk are aligned well first.
- Could the use of tilt-in-space change the impact that gravity has on posture assist?
- What is the seat-to-back angle and backrest angle? Could alterations improve head position?
- Consider freedom for movement and changes in posture throughout the day. Does the headrest accommodate tone and the different positions the head might be in?
- Check for any areas of high pressure, particularly with extensor tone and repetitive movements/dystonia to minimize friction and shear at areas of contact.
- What is most important most of the time? Just because you could add lateral and anterior head supports doesn't necessarily mean that you should!
- Can the anterior head support be used only during specific times, e.g. meals, speech therapy, learning?
Keep in mind other factors including hearing, vision, and sensory processing disorders which may contribute to poor head position. The first point of stability for head and neck control is the sub-occipital region. Consider a support that cradles the base of the skull whilst still allowing for lateral flexion and rotation. It should limit upper cervical hyperextension and, along with the rest of the supports, encourage chin tuck to protect the airway.
When additional support is needed, move upward providing stability and correction as needed to head itself. Avoid supports that might restrict vision or hearing. Be sure to respect the available tone & ROM and avoid positioning at the end of range.
Supporting the head anteriorly is typically the last support area considered. Some key aspects to note:
- Do not obstruct vision.
- Mounting for anterior supports needs to be easily adjusted to enable transfers and repositioning throughout the day.
- When in a vehicle, there is the risk of movement of the anterior supports that might impact safety of the client. Usage may require supervision throughout the journey.
- Supports along the forehead can create a trigger for tone or upper cervical extension.
Remember the importance of a thorough seating assessment when considering anterior head supports. This will determine how to provide a stable base and trunk to achieve the best functional outcomes for head position.