The Role of the Headmaster Collar (Cervical) for Dropped Head Syndrome in Hodgkin Lymphoma Survivors

Abstract

Background Dropped head syndrome is a potential late neurologic complication of radiation therapy in survivors of Hodgkin lymphoma. There is limited evidence for conservative management of this condition. Objective To discover patient utilization patterns of the commonly prescribed Headmaster Collar (cervical) in Hodgkin lymphoma survivors with radiation‐induced dropped head syndrome. Design Questionnaire‐based retrospective observational study. Setting Single‐site academic cancer center. Patients Twenty‐six Hodgkin lymphoma survivors treated with radiation therapy involving the mantle who were prescribed a Headmaster Collar for dropped head syndrome. Methods or Interventions Patients were interviewed by phone with a structured set of questions. Main Outcome Measurements Compliance, patterns of use, individual modifications, and side effects of collar use. Results Although 58% of patients who were prescribed a Headmaster Collar eventually discontinued its use, 62% of all patients used the collar for more than 6 months. The majority of users wore the collar for up to 3 hours per day, usually for static seated activities. Thirty‐eight percent of patients made personal modifications to their collar, most commonly the addition of extra padding. All but one patient had complaints about the collar, most commonly discomfort, rigidity, and confinement. Conclusions The Headmaster Collar (cervical) is often utilized for a few hours a day, for longer than 6 months, to help with static seated activities. Insights from this study might help to improve future orthotic designs with better long‐term compliance rates for the treatment of radiation‐induced dropped head syndrome. Level of Evidence IV

Late side effects of radiation treatment for head and neck cancer

“…The dropped head syndrome (DHS) is a disabling condition caused by severe weakness of the neck extensor muscles causing progressive reducible kyphosis of the cervical spine and the inability to hold the head up [24]. DHS can occur from 3 months to 30 years after RT.…”

“…Treatment with physiotherapy and surgery have not been very successful, and the management of DHS is supportive, including employing a cervical collar to maintain the head in an upright position [4,24]. The condition generally does not spread to other muscles or worsens.…”

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

“…Pain associated with neck extensor weakness is assumed to be multifactorial due to fatigue and painful spasm of the muscles as well as functional overload and muscle imbalance (Stubblefield 2011 ). Consequently, the mainstay of neck extensor weakness treatment is physical therapy to emphasize postural retraining although, as the fibrotic process cannot be directly affected, weakness and dysfunction often progress over time so that ultimately, some patients need a cervical orthotic to maintain the head in an upright position (Stubblefield 2011 ; Kim and Stubblefield 2019 ). In our cohort, no patient showed severe weakness requiring a prescription for a headmaster cervical collar although several survivors reported worsening of pain and muscle weakness as the day progressed which has been described as a typical feature of radiation-induced DHS (Stubblefield 2011 ).…”

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

“…Pain associated with neck extensor weakness is assumed to be multifactorial due to fatigue and painful spasm of the muscles as well as functional overload and muscle imbalance [25]. Consequently, the mainstay of neck extensor weakness treatment is physical therapy to emphasize postural retraining although, as the brotic process cannot be directly affected, weakness and dysfunction often progresses over time so that ultimately, some patients need a cervical orthotic to maintain the head in an upright position [25,29]. In our cohort, no patient showed severe weakness requiring prescription of a headmaster cervical collar although several survivors reported worsening of pain and muscle weakness as the day progresses which has been described as a typical feature of radiation-induced DHS [25].…”