Michelle L. Lange, OTR/L, ATP/SMS

FAQ: A client I work with has broken about 4 head support systems.  He is in a molded seating system but laterally flexes his neck to the right, rotates to the left, and extends. His neck is only partially reducible to a neutral midline position.  I really want to try dynamic head support hardware…but the supplier is worried about reimbursement.  He has State Medicaid only. Thoughts?

 In a recent webinar, Maintaining Posture by Providing Movement, one of the participants asked about a client who exerts strong extension and rotation at the neck, who has broken past equipment, and has a suboptimal head position.

Thanks for advocating for this client! I have several suggestions:

1. If a client has broken any portion of their head support in the past due to significant forces, dynamic head support hardware is definitely indicated. This dynamic component will absorb and diffuse these forces to protect both the equipment, as well as the client.
2. It sounds like this client has a very complex head position. In addition to the dynamic hardware, the client will most likely need a more complex head support to align him as close to neutral as possible. The neck lateral flexion can often be corrected through use of lateral head pads. As he is flexing towards his right, he may benefit from a lateral pad at the right side of his head, as well as a suboccipital pad to provide a point of contact at each side of the neck/jaw. This provides 3 points of contact to improve alignment in that plane. This support can also limit neck rotation and hyperextension, in combination with an occipital pad. The Seating Dynamics dynamic head support hardware is compatible with suboccipital pads (using our sub-occipital pad adaptor) and lateral pads (using our lateral component hardware).
3. Funding is often a perceived barrier. With adequate justification, this hardware is typically covered. I recommend you explore our sample justification wording here. Personally, I believe quite strongly that if the complex rehab supplier stops submitting orders for anything that may not be funded, we are limiting client access to needed solutions. We have an ethical responsibility to try. Further, each equipment request is also an opportunity to educate a funding source.

It is possible to absorb forces at the neck, as well as support the head in multiple planes, when needed. Feel free to comment below if you need assistance with a similar situation!