Bracing to treat dropped head syndrome in cancer patients: A retrospective review.

Abstract

ABSTRACT Introduction The objective of this study is to describe the use of postural bracing to treat dropped head syndrome (DHS) in cancer patients. The study design is a retrospective review over a 3-year period of cancer patients who presented to a cancer physiatry outpatient practice for treatment of DHS. Patients were individuals with a history of head and neck cancer, Hodgkin lymphoma, or other cancer with a diagnosis of DHS. Materials and Methods The treatment intervention was postural bracing with either a figure-of-eight orthosis with or without a lumbosacral orthosis or a thoracolumbosacral orthosis. Results Subjective, patient-reported improvements in pain, posture, and neck or back strength in addition to objective improvements in physical examination were made. Out of 41 patients initially evaluated for DHS who followed up in brace clinic, 61% reported a positive response to bracing with 17.1% reporting improvement in neck or back strength, 17.1% reporting improvement in pain, and 39% reporting improvement in posture. Discussion In this study, we present a successful alternative to treat DHS through the use of active bracing. The technique of active bracing in this population theoretically strengthens the weak muscles in head drop and improves head position. Maintenance of these achievements, although not directly studied in this project, must be performed through a regular home exercise and bracing program as patients likely have a tendency to weaken again given prior oncologic treatments. Conclusions Active postural bracing using a combination of a figure-of-eight brace with or without a lumbosacral orthosis or a thoracolumbosacral orthosis in conjunction with physical therapy can help improve the posture, pain, and neck and back strength of cancer patients with DHS.