Micha Holla - Academia.edu (original) (raw)
Papers by Micha Holla
Anatomical Sciences Education, 2022
Binocular disparity provides one of the important depth cues within stereoscopic three-dimensiona... more Binocular disparity provides one of the important depth cues within stereoscopic three-dimensional (3D) visualization technology. However, there is limited research on its effect on learning within a 3D augmented reality (AR) environment. This study evaluated the effect of binocular disparity on the acquisition of anatomical knowledge and perceived cognitive load in relation to visual-spatial abilities. In a double-center randomized controlled trial, first-year (bio)medical undergraduates studied lower extremity anatomy in an interactive 3D AR environment either with a stereoscopic 3D view (n = 32) or monoscopic 3D view (n = 34). Visual-spatial abilities were tested with a Mental Rotation Test (MRT). Anatomical knowledge was assessed by a validated 30-item written test and 30-item specimen test. Cognitive load was measured by the NASA-TLX questionnaire. Students in the stereoscopic 3D and monoscopic 3D groups performed equally well in terms of percentage correct answers (written test: 47.9 ± 15.8 vs 49.1 ± 18.3; P = 0.635; specimen test: 43.0 ± 17.9 vs 46.3 ± 15.1; P = 0.429), and perceived cognitive load scores (6.2 ± 1.0 vs 6.2 ± 1.3; P = 0.992). Regardless of intervention, visual-spatial abilities were positively associated with the specimen test scores (η2 = 0.13, P = 0.003), perceived representativeness of the anatomy test questions (P = 0.010) and subjective improvement in anatomy knowledge (P < 0.001). In conclusion, binocular disparity does not improve learning anatomy. Motion parallax should be considered as another important depth cue that contributes to depth perception during learning in a stereoscopic 3D AR environment.
European Journal of Trauma and Emergency Surgery, 2016
The characteristics and pre-hospital management of blunt trauma patients with suspected spinal co... more The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries
Nederlands tijdschrift voor geneeskunde, Jan 25, 2006
In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks... more In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks after birth. Kinesiotherapy, given for a period of 1 year and 6 months, respectively, had little effect. Both girls were then referred to the Orthopaedic Outpatient Clinic where a shortened sternocleidomastoid muscle and an asymmetrical face were diagnosed. The shortened muscle was cleaved surgically. Over half a year later, the face of the older child was still asymmetrical but that of the younger child symmetric. It is recommended that children with torticollis due to a shortened sternocleidomastoid muscle first be given stretch exercises under the guidance of a physiotherapist. If the result at the age of 1 year is unsatisfactory, an orthopaedic surgeon can then cleave the muscle.
Contains fulltext : 50494.pdf (publisher's version ) (Closed access
Nederlandsch tijdschrift voor geneeskunde, Apr 25, 2009
A healthy 3-month-old girl died after manipulation of the cervical and thoracolumbar spine by a s... more A healthy 3-month-old girl died after manipulation of the cervical and thoracolumbar spine by a so-called craniosacral therapist. During persistent forced deep flexion of the neck and spine, the infant developed faecal incontinence, atonia and apnoea followed by an asystole. A physical examination, additional MRI studies and an autopsy indicated that the infant probably died as a consequence of local neurovascular lesions of the cervical spine or a mechanically-induced respiratory problem. This is the second reported case of an infant dying after forced manipulations of the neck. Until there is scientific evidence for the effectiveness and safety of forced manipulations of the vertebral column, we advise against this treatment in neonates and infants.
Skeletal Radiology
Objective To evaluate accuracy of fracture detection and therapeutic impact of a single-shot CT p... more Objective To evaluate accuracy of fracture detection and therapeutic impact of a single-shot CT protocol as a primary imaging tool in all patients with clinical suspicion of wrist injury, and evaluate the resulting impact on therapy. Materials and methods We performed a single-institution study on all patients with suspicion of fractures of the wrist and carpus. All patients underwent conventional radiography, thereafter single-shot wrist CT, and then 1-year follow-up. Physicians and radiologists prospectively scored likelihood of fracture presence on a five-point scale before and after CT. Three surgeons proposed a treatment regimen (functional, cast, reduction, or operative) based on clinical and radiological data, first with knowledge of conventional radiography, and then with knowledge of CT. The reference standard for fracture presence was based on all data. We performed receiver operating characteristic (ROC) analyses and calculated proportion of wrists with treatment changes due to CT imaging. Results Ninety-eight patients participated (63% female, mean age 53, range, 18-87 years old) with 100 wrist CTs. Conventional radiography detected true-positive fractures in 45, and CT in 61 wrists. The areas under the curve for fracture detection were 0.85 (95% CI 0.77-0.93) for conventional radiography and 0.97 (95% CI 0.93-1.00) for CT. Treatment changed in 24 (24%, 95% CI 16-33%)-31 (31%, 95% CI 23-41%) wrists, mostly involving a decrease in the rate of cast immobilization. Conclusions Single-shot CT in patients with clinical suspicion of wrist injury increases accuracy of fracture detection. This has a significant impact therapy in this population, mainly on cast immobilization. Trial Registration We registered the study at www.clinicaltrials.gov, NL43482.091.13.
Journal of Trauma Nursing
SPINE, 2017
Cadaveric radiostereometric analysis study. To quantify the ability of 5 commonly used immobilize... more Cadaveric radiostereometric analysis study. To quantify the ability of 5 commonly used immobilizers to restrict cervical spine movement, including intervertebral movement, in three directions. Evidence about the ability of many clinically used cervical immobilizers to restrict cervical movement is limited. Furthermore, their effect on intervertebral movement is unknown. Radiographic inert beads were implanted in the cervical vertebral bodies of five fresh-frozen human cadavers. After application of different immobilizers (Stifneck, SOMI, halo-traction, spineboard, halo-vest) and controlled flexion-extension, lateral bending and rotation torques, radiostereometric analysis was used to determine the overall and intervertebral 3D movement of each vertebral level. Restriction of cervical movement was described as a mean restriction percentage (MRP) and classified on an arbitrary basis (poor:<20%, fair:20-40%, moderate:40-60%, substantial:60-80%, nearly complete: >80%). Most of the restriction of flexion/extension was observed at C0-C1 while most rotational restriction was seen at C1-C2. Lateral bending was restricted at C1 to C7.The Stifneck provided the least immobilization with a moderate restriction of flexion-extension (MRP:41%,SD:14%), fair restriction of lateral bending (MRP:29%,SD:13%) and substantial restriction of rotation (MRP:64%,SD:15%). The halo-vest was most the most restrictive immobilizer and reduced movement of the cervical spine substantially for flexion-extension (MRP:70%,SD:11%), substantially for lateral bending (MRP:77%,SD:14%) and nearly complete for rotation (MRP:92%,SD:3%). The restriction of movement from lowest to highest was: Stifneck, SOMI, halo-traction, head blocks on a spine board, and halo-vest. Notably, the standard deviations of the restrictions were smaller for the cranio-thoracic devices than for the cervico thoracic devices. With this new knowledge of external immobilizers and their ability to restrict intervertebral cervical movement, their indication and application in clinical practice can be improved for all patients with (suspected) cervical injury. N/A.
Journal of Educational Issues, 2016
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Nederlands Tijdschrift Voor Traumatologie, 2006
European Spine Journal, 2016
Purpose To review the ability of various types of external immobilizers to restrict cervical spin... more Purpose To review the ability of various types of external immobilizers to restrict cervical spine movement. Methods With a systematical review of original scientific articles, data on range of motion, type of used external immobilization device and risk of bias were extracted. The described external immobilization devices were grouped and the mean restriction percentage and standard deviation were calculated. Finally, each device was classified based on its ability to restrict movement of the cervical spine, according to five levels of immobilization: poor (MIL \20 %), fair (MIL 20-40 %), moderate (MIL 40-60 %), substantial (MIL 60-80 %), and nearly complete (MIL C80 %). Results The ability to reduce the range of motion by soft collars was poor in all directions. The ability of cervicohigh thoracic devices was moderate for flexion/extension but poor for lateral bending and rotation. The ability of cervico-low thoracic devices to restrict flexion/extension and rotation was moderate, while their ability to restrict lateral bending was poor. All cranio-thoracic devices for non-ambulatory patients restricted cervical spine movement substantial in all directions. The ability of vests with non-invasive skull fixation was substantial in all directions. No studies with healthy adults were identified with respect to cranial traction and halo vests with skull pins and their ability to restrict cervical movement. Conclusions Soft collars have a poor ability to reduce mobility of the cervical spine. Cervico-high thoracic devices primarily reduce flexion and extension, but they reduce lateral bending and rotation to a lesser degree. Cervico-low thoracic devices restrict lateral bending to the same extent as cervico-high thoracic devices, but are considerably more effective at restricting flexion, extension, and rotation. Finally, cranio-thoracic devices nearly fully restrict movement of the cervical spine.
Nederlands Tijdschrift voor Traumatologie, 2011
Investigative Radiology, 1998
The authors have investigated dysprosium [Dy]-DOTA-PAMAM, generation 5 (G = 5) dendrimers as a po... more The authors have investigated dysprosium [Dy]-DOTA-PAMAM, generation 5 (G = 5) dendrimers as a possible new class of macromolecular T2 contrast agents. The use of DOTA provides a metal complex with greater stability than can be achieved using DTPA as ligand, an important factor in the design of blood pool agents with long half-lives. Generation 5 ammonia-core PAMAM dendrimers were linked to the bifunctional ligand p-SCN-Bz-DOTA. After determination of the number of conjugated DOTA molecules by 1H nuclear magnetic resonance, Dy3+ was titrated at a 90% molar ratio. For comparison, single ionic chelates of Dy-DTPA and Dy-DOTA also were prepared. Using a variable field relaxometer, T1 and T2 relaxation times were measured at 13 different field strengths from 0.05 to 1.5 T and temperatures of 3, 10, 20 and 37 degrees C. The synthesis resulted in a preparation with 76 DOTA and 68 Dy3+ ions per dendrimer molecule. The T1 relaxivity values for Dy-DTPA, Dy-DOTA, and the Dy-DOTA-based dendrimer all were independent of field strength, with values between 0.12 and 0.20 mM-1 sec-1. At lower fields (0.05-0.1 T), 1/T2 was identical to 1/T1. At higher fields, however, 1/T2 increased quadratically with field strength, with a strong dependence on temperature. The field-dependent component of 1/T2 was up to three times higher for the Dy-DOTA-based dendrimer compared with the single chelate molecules, with coefficients of 0.37 to 0.03 sec-1/Tesla2 for T = 3 to 37 degrees C. The results are interpreted with the "inner sphere" theory of susceptibility effects (Curie spin relaxation). The large temperature dependence suggests that the dominant mechanism of relaxation is the contact interaction effect, with the proton residence time as the primary time constant. This largely unexplored relaxation mechanism has the potential to create a new class of T2-selective contrast agents.
Emergency Medicine Journal, 2012
All trauma patients with a cervical spinal column injury or with a mechanism of injury with the p... more All trauma patients with a cervical spinal column injury or with a mechanism of injury with the potential to cause cervical spinal injury should be immobilised until a spinal injury is excluded. Immobilisation of the entire patient with a rigid cervical collar, backboard, head blocks with tape or straps is recommended by the Advanced Trauma Life Support guidelines. However there is insufficient evidence to support these guidelines. To analyse the effects on the range of motion of the addition of a rigid collar to head blocks strapped on a backboard. The active range of motion of the cervical spine was determined by computerised digital dual inclinometry, in 10 healthy volunteers with a rigid collar, head blocks strapped on a padded spine board and a combination of both. Maximal opening of the mouth with all types of immobiliser in place was also measured. The addition of a rigid collar to head blocks strapped on a spine board did not result in extra immobilisation of the cervical spine. Opening of the mouth was significantly reduced in patients with a rigid collar. Based on this proof of principle study and other previous evidence of adverse effects of rigid collars, the addition of a rigid collar to head blocks is considered unnecessary and potentially dangerous. Therefore the use of this combination of cervical spine immobilisers must be reconsidered.
Nederlands tijdschrift voor geneeskunde
Nederlands tijdschrift voor geneeskunde
In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks... more In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks after birth. Kinesiotherapy, given for a period of 1 year and 6 months, respectively, had little effect. Both girls were then referred to the Orthopaedic Outpatient Clinic where a shortened sternocleidomastoid muscle and an asymmetrical face were diagnosed. The shortened muscle was cleaved surgically. Over half a year later, the face of the older child was still asymmetrical but that of the younger child symmetric. It is recommended that children with torticollis due to a shortened sternocleidomastoid muscle first be given stretch exercises under the guidance of a physiotherapist. If the result at the age of 1 year is unsatisfactory, an orthopaedic surgeon can then cleave the muscle.
Anatomical Sciences Education, 2022
Binocular disparity provides one of the important depth cues within stereoscopic three-dimensiona... more Binocular disparity provides one of the important depth cues within stereoscopic three-dimensional (3D) visualization technology. However, there is limited research on its effect on learning within a 3D augmented reality (AR) environment. This study evaluated the effect of binocular disparity on the acquisition of anatomical knowledge and perceived cognitive load in relation to visual-spatial abilities. In a double-center randomized controlled trial, first-year (bio)medical undergraduates studied lower extremity anatomy in an interactive 3D AR environment either with a stereoscopic 3D view (n = 32) or monoscopic 3D view (n = 34). Visual-spatial abilities were tested with a Mental Rotation Test (MRT). Anatomical knowledge was assessed by a validated 30-item written test and 30-item specimen test. Cognitive load was measured by the NASA-TLX questionnaire. Students in the stereoscopic 3D and monoscopic 3D groups performed equally well in terms of percentage correct answers (written test: 47.9 ± 15.8 vs 49.1 ± 18.3; P = 0.635; specimen test: 43.0 ± 17.9 vs 46.3 ± 15.1; P = 0.429), and perceived cognitive load scores (6.2 ± 1.0 vs 6.2 ± 1.3; P = 0.992). Regardless of intervention, visual-spatial abilities were positively associated with the specimen test scores (η2 = 0.13, P = 0.003), perceived representativeness of the anatomy test questions (P = 0.010) and subjective improvement in anatomy knowledge (P < 0.001). In conclusion, binocular disparity does not improve learning anatomy. Motion parallax should be considered as another important depth cue that contributes to depth perception during learning in a stereoscopic 3D AR environment.
European Journal of Trauma and Emergency Surgery, 2016
The characteristics and pre-hospital management of blunt trauma patients with suspected spinal co... more The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries
Nederlands tijdschrift voor geneeskunde, Jan 25, 2006
In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks... more In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks after birth. Kinesiotherapy, given for a period of 1 year and 6 months, respectively, had little effect. Both girls were then referred to the Orthopaedic Outpatient Clinic where a shortened sternocleidomastoid muscle and an asymmetrical face were diagnosed. The shortened muscle was cleaved surgically. Over half a year later, the face of the older child was still asymmetrical but that of the younger child symmetric. It is recommended that children with torticollis due to a shortened sternocleidomastoid muscle first be given stretch exercises under the guidance of a physiotherapist. If the result at the age of 1 year is unsatisfactory, an orthopaedic surgeon can then cleave the muscle.
Contains fulltext : 50494.pdf (publisher's version ) (Closed access
Nederlandsch tijdschrift voor geneeskunde, Apr 25, 2009
A healthy 3-month-old girl died after manipulation of the cervical and thoracolumbar spine by a s... more A healthy 3-month-old girl died after manipulation of the cervical and thoracolumbar spine by a so-called craniosacral therapist. During persistent forced deep flexion of the neck and spine, the infant developed faecal incontinence, atonia and apnoea followed by an asystole. A physical examination, additional MRI studies and an autopsy indicated that the infant probably died as a consequence of local neurovascular lesions of the cervical spine or a mechanically-induced respiratory problem. This is the second reported case of an infant dying after forced manipulations of the neck. Until there is scientific evidence for the effectiveness and safety of forced manipulations of the vertebral column, we advise against this treatment in neonates and infants.
Skeletal Radiology
Objective To evaluate accuracy of fracture detection and therapeutic impact of a single-shot CT p... more Objective To evaluate accuracy of fracture detection and therapeutic impact of a single-shot CT protocol as a primary imaging tool in all patients with clinical suspicion of wrist injury, and evaluate the resulting impact on therapy. Materials and methods We performed a single-institution study on all patients with suspicion of fractures of the wrist and carpus. All patients underwent conventional radiography, thereafter single-shot wrist CT, and then 1-year follow-up. Physicians and radiologists prospectively scored likelihood of fracture presence on a five-point scale before and after CT. Three surgeons proposed a treatment regimen (functional, cast, reduction, or operative) based on clinical and radiological data, first with knowledge of conventional radiography, and then with knowledge of CT. The reference standard for fracture presence was based on all data. We performed receiver operating characteristic (ROC) analyses and calculated proportion of wrists with treatment changes due to CT imaging. Results Ninety-eight patients participated (63% female, mean age 53, range, 18-87 years old) with 100 wrist CTs. Conventional radiography detected true-positive fractures in 45, and CT in 61 wrists. The areas under the curve for fracture detection were 0.85 (95% CI 0.77-0.93) for conventional radiography and 0.97 (95% CI 0.93-1.00) for CT. Treatment changed in 24 (24%, 95% CI 16-33%)-31 (31%, 95% CI 23-41%) wrists, mostly involving a decrease in the rate of cast immobilization. Conclusions Single-shot CT in patients with clinical suspicion of wrist injury increases accuracy of fracture detection. This has a significant impact therapy in this population, mainly on cast immobilization. Trial Registration We registered the study at www.clinicaltrials.gov, NL43482.091.13.
Journal of Trauma Nursing
SPINE, 2017
Cadaveric radiostereometric analysis study. To quantify the ability of 5 commonly used immobilize... more Cadaveric radiostereometric analysis study. To quantify the ability of 5 commonly used immobilizers to restrict cervical spine movement, including intervertebral movement, in three directions. Evidence about the ability of many clinically used cervical immobilizers to restrict cervical movement is limited. Furthermore, their effect on intervertebral movement is unknown. Radiographic inert beads were implanted in the cervical vertebral bodies of five fresh-frozen human cadavers. After application of different immobilizers (Stifneck, SOMI, halo-traction, spineboard, halo-vest) and controlled flexion-extension, lateral bending and rotation torques, radiostereometric analysis was used to determine the overall and intervertebral 3D movement of each vertebral level. Restriction of cervical movement was described as a mean restriction percentage (MRP) and classified on an arbitrary basis (poor:<20%, fair:20-40%, moderate:40-60%, substantial:60-80%, nearly complete: >80%). Most of the restriction of flexion/extension was observed at C0-C1 while most rotational restriction was seen at C1-C2. Lateral bending was restricted at C1 to C7.The Stifneck provided the least immobilization with a moderate restriction of flexion-extension (MRP:41%,SD:14%), fair restriction of lateral bending (MRP:29%,SD:13%) and substantial restriction of rotation (MRP:64%,SD:15%). The halo-vest was most the most restrictive immobilizer and reduced movement of the cervical spine substantially for flexion-extension (MRP:70%,SD:11%), substantially for lateral bending (MRP:77%,SD:14%) and nearly complete for rotation (MRP:92%,SD:3%). The restriction of movement from lowest to highest was: Stifneck, SOMI, halo-traction, head blocks on a spine board, and halo-vest. Notably, the standard deviations of the restrictions were smaller for the cranio-thoracic devices than for the cervico thoracic devices. With this new knowledge of external immobilizers and their ability to restrict intervertebral cervical movement, their indication and application in clinical practice can be improved for all patients with (suspected) cervical injury. N/A.
Journal of Educational Issues, 2016
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Nederlands Tijdschrift Voor Traumatologie, 2006
European Spine Journal, 2016
Purpose To review the ability of various types of external immobilizers to restrict cervical spin... more Purpose To review the ability of various types of external immobilizers to restrict cervical spine movement. Methods With a systematical review of original scientific articles, data on range of motion, type of used external immobilization device and risk of bias were extracted. The described external immobilization devices were grouped and the mean restriction percentage and standard deviation were calculated. Finally, each device was classified based on its ability to restrict movement of the cervical spine, according to five levels of immobilization: poor (MIL \20 %), fair (MIL 20-40 %), moderate (MIL 40-60 %), substantial (MIL 60-80 %), and nearly complete (MIL C80 %). Results The ability to reduce the range of motion by soft collars was poor in all directions. The ability of cervicohigh thoracic devices was moderate for flexion/extension but poor for lateral bending and rotation. The ability of cervico-low thoracic devices to restrict flexion/extension and rotation was moderate, while their ability to restrict lateral bending was poor. All cranio-thoracic devices for non-ambulatory patients restricted cervical spine movement substantial in all directions. The ability of vests with non-invasive skull fixation was substantial in all directions. No studies with healthy adults were identified with respect to cranial traction and halo vests with skull pins and their ability to restrict cervical movement. Conclusions Soft collars have a poor ability to reduce mobility of the cervical spine. Cervico-high thoracic devices primarily reduce flexion and extension, but they reduce lateral bending and rotation to a lesser degree. Cervico-low thoracic devices restrict lateral bending to the same extent as cervico-high thoracic devices, but are considerably more effective at restricting flexion, extension, and rotation. Finally, cranio-thoracic devices nearly fully restrict movement of the cervical spine.
Nederlands Tijdschrift voor Traumatologie, 2011
Investigative Radiology, 1998
The authors have investigated dysprosium [Dy]-DOTA-PAMAM, generation 5 (G = 5) dendrimers as a po... more The authors have investigated dysprosium [Dy]-DOTA-PAMAM, generation 5 (G = 5) dendrimers as a possible new class of macromolecular T2 contrast agents. The use of DOTA provides a metal complex with greater stability than can be achieved using DTPA as ligand, an important factor in the design of blood pool agents with long half-lives. Generation 5 ammonia-core PAMAM dendrimers were linked to the bifunctional ligand p-SCN-Bz-DOTA. After determination of the number of conjugated DOTA molecules by 1H nuclear magnetic resonance, Dy3+ was titrated at a 90% molar ratio. For comparison, single ionic chelates of Dy-DTPA and Dy-DOTA also were prepared. Using a variable field relaxometer, T1 and T2 relaxation times were measured at 13 different field strengths from 0.05 to 1.5 T and temperatures of 3, 10, 20 and 37 degrees C. The synthesis resulted in a preparation with 76 DOTA and 68 Dy3+ ions per dendrimer molecule. The T1 relaxivity values for Dy-DTPA, Dy-DOTA, and the Dy-DOTA-based dendrimer all were independent of field strength, with values between 0.12 and 0.20 mM-1 sec-1. At lower fields (0.05-0.1 T), 1/T2 was identical to 1/T1. At higher fields, however, 1/T2 increased quadratically with field strength, with a strong dependence on temperature. The field-dependent component of 1/T2 was up to three times higher for the Dy-DOTA-based dendrimer compared with the single chelate molecules, with coefficients of 0.37 to 0.03 sec-1/Tesla2 for T = 3 to 37 degrees C. The results are interpreted with the "inner sphere" theory of susceptibility effects (Curie spin relaxation). The large temperature dependence suggests that the dominant mechanism of relaxation is the contact interaction effect, with the proton residence time as the primary time constant. This largely unexplored relaxation mechanism has the potential to create a new class of T2-selective contrast agents.
Emergency Medicine Journal, 2012
All trauma patients with a cervical spinal column injury or with a mechanism of injury with the p... more All trauma patients with a cervical spinal column injury or with a mechanism of injury with the potential to cause cervical spinal injury should be immobilised until a spinal injury is excluded. Immobilisation of the entire patient with a rigid cervical collar, backboard, head blocks with tape or straps is recommended by the Advanced Trauma Life Support guidelines. However there is insufficient evidence to support these guidelines. To analyse the effects on the range of motion of the addition of a rigid collar to head blocks strapped on a backboard. The active range of motion of the cervical spine was determined by computerised digital dual inclinometry, in 10 healthy volunteers with a rigid collar, head blocks strapped on a padded spine board and a combination of both. Maximal opening of the mouth with all types of immobiliser in place was also measured. The addition of a rigid collar to head blocks strapped on a spine board did not result in extra immobilisation of the cervical spine. Opening of the mouth was significantly reduced in patients with a rigid collar. Based on this proof of principle study and other previous evidence of adverse effects of rigid collars, the addition of a rigid collar to head blocks is considered unnecessary and potentially dangerous. Therefore the use of this combination of cervical spine immobilisers must be reconsidered.
Nederlands tijdschrift voor geneeskunde
Nederlands tijdschrift voor geneeskunde
In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks... more In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks after birth. Kinesiotherapy, given for a period of 1 year and 6 months, respectively, had little effect. Both girls were then referred to the Orthopaedic Outpatient Clinic where a shortened sternocleidomastoid muscle and an asymmetrical face were diagnosed. The shortened muscle was cleaved surgically. Over half a year later, the face of the older child was still asymmetrical but that of the younger child symmetric. It is recommended that children with torticollis due to a shortened sternocleidomastoid muscle first be given stretch exercises under the guidance of a physiotherapist. If the result at the age of 1 year is unsatisfactory, an orthopaedic surgeon can then cleave the muscle.