Optimising the design and material interface of cervical collars used in emergency and rehabilitation settings.

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Individuals who have experienced a serious trauma to the head or neck are routinely immobilized with a cervical collar (C-collar) until potential fractures or ligamentous injury are examined. C-collars are also used in the nonacute setting to manage cervical injury by providing biomechanical support to the head and neck during musculoskeletal rehabilitation. In order to limit mobility, collars are fixed securely to the neck via strapping and height adjustment, creating points of increased pressure often associated with shear forces at the skin-device interface. These pressure and shear forces can cause a high risk of skin breakdown and the development of pressure ulcers (PUs), also termed pressure injury. Common sites of skin breakdown specifically associated with C-collars include the occiput, mandible, ears, chin, laryngeal prominence, shoulders, and sternum. Prevalence values for collar-related tissue breakdown have been reported to range from 7%-38% and documented to be as high as 55% when worn for greater than 5 days. This risk of injury from wearing the collar is down to the generic designs incorporating stiff polymer materials. It is also due to the limited guidance on the application tension of the device.