# Clinical Application of Custom Neck Collar with Negative Sensory Feedback in Children with Intractable Torticollis

## TL;DR

A custom neck collar with negative sensory feedback helped reduce torticollis in children who did not respond to other treatments.

## Contribution

A novel tactile feedback orthosis was developed and shown to be effective for intractable torticollis in children.

## Key findings

- The torticollis angle significantly decreased after using the collar in two stages.
- The treatment was found to be feasible, effective, and safe for children with intractable torticollis.
- Stage 2 of the treatment, with a rough surface, showed greater improvement than stage 1.

## Abstract

Background/Objectives: The aim of this study was to investigate the effect of a custom neck collar with negative sensory feedback for the treatment of torticollis that was previously unresponsive to conservative or surgical treatment. Methods: Twenty-four children diagnosed with unresponsive or intractable torticollis were enrolled in this two-stage, single-arm study. The ipsilateral aspect of the orthosis is adjustable in height and designed to provide support between the clavicle and the mandibular angle on the tilted side. In stage 1 (the adjustment period), the orthosis with a smooth surface was applied for 2 h per day for 3 months. In stage 2, a rough surface with a hook-and-loop fastener (Velcro©) was attached to the collar, and it was worn for a further 2 h a day for 3 months. Twenty children (mean age 63.95 ± 13.44 months) were included in the analysis. Results: The mean torticollis angle was 17.60 ± 5.65° (mean ± SD) at baseline; 14.15 ± 3.62° directly after stage 1; and 6.00 ± 3.67° directly after stage 2 (X2 = 36.685, df = 19, p = 0.000). Conclusions: This study demonstrated the feasibility, therapeutic effect, and safety of a novel tactile feedback orthosis for the treatment of children with torticollis. The use of a custom neck collar with negative sensory feedback may be a viable therapeutic option for the treatment of unresolved or intractable torticollis.