TOT Collar
A loop of soft PVC tubing is bridged by two short nylon tubes. Varying sizes of tubes are packaged with the TOT Collar. These tubes are positioned anterior and posterior to the crest of the trapezius. The pvc tubing is fastened with a connecting strap. A spare Velcro Strap is included. The TOT Collar is non toxic and washable.
The TOT Collar is pre-assembled and ready to fit. Adult and Child Sizes.
The TOT Collar is designed to provide a noxious stimulus to the lateral aspect of the skull. The user moves away from this stimulus towards a new, central corrected position. Adoption of a new, normal head position provides the ability to reset perception of horizontal and so maintain the corrected head position.
The TOT Collar use is added to the conservative treatment of infants with congenital muscular torticollis if they are 4 months of age or older and show a consistent head tilt of 5 degrees or more. The infant must have adequate ROM (range of motion) and lateral head righting reaction (head control and strength) to lift his or her head away from the side of the Collar.
TOT Collar
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The TOT Collar is simple to fit, easy adjustment using interchangeable tubes, longer tubes can be inserted to accommodate improved alignment and all parts for the Collar are available as replacements
It is a cool, comfortable collar, easy to put on and remove, low profile; unobtrusive appearance, easy to keep clean (soap and water) and amount of support set to wearer needs
Fitting the TOT Collar
The TOT Collar is pre-assembled and ready to fit. There are two sizes: Adult and Child.
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The clear pvc tubing of the Collar is supplied at twice the circumference of the neck, plus 4?-6? (10cm-15cm). The tubing is joined with an end connector. The white tubes or struts are selected according to the amount of lateral tilt of the head. Extra tubes are supplied with the TOT Collar to allow for change in lateral tilt. |
 | Tube A spans from posterior to the crest of the trapezius to the occiput. Tube B from anterior to the crest of the trapezius to below the tip of the mastoid process. Avoid pressure on the mandible. The tubes are short to start with and replaced by longer tubes as correction is achieved. If there is a significant amount of tilt then use very short tubes initially. Tubes can be trimmed to the exact length required. |
 | For correct fit, the infant should be holding his or her head in midline, slightly away from the struts, and there should be room for at least one adult finger to fit between the top clear pvc tubing and the neck. Fit the Collar loosely at first and ensure that the lateral tubes are the correct length and on the correct side. Snug up the TOT Collar by hand to check the fit. |
 | Remove the Collar from the child. Pull through the clear pvc tubing to remove the excess. Trim this tubing to length with scissors and reconnect with the end connector. Replace the Collar after each trim to check the fit. Note: Be careful not to cut off too much of the clear tubing. It cannot be reconnected if cut too short. |
TOT Collar Final Checks
- Ensure the white tubes are in position relative to the crest of the trapezius
- Ensure the parent or caregiver can position the Collar correctly ? mark the top of the Collar if required
- Check for redness where struts touch skin
- The Collar may be covered with 2 inch stockinette or a knee high nylon to improve comfort
- Clean collar regularly with soap & water
- Remove collar when wearer is asleep
Use the TOT Collar with a stretching regime for best results. Caution: Do not leave the child unattended while wearing this Collar!
About Torticollis
Congenital Muscular Torticollis is usually discovered in the first 6 to 8 weeks of life. It is characterized by a contracture of the sternocleidomastoid muscle, causing the head to be laterally flexed to the affected side and rotated to the opposite shoulder. If uncorrected, this posture may lead to plagiocephaly and a high thoracic scoliosis.
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References, articles and clinical examples, with more information on Congenital Muscular Torticollis as well as studies and papers on treatment.
Tubular Orthosis for Torticollis: A new approach to the Correction of Head Tilt in Congenital Muscular Torticollis, Mosterman et all, B.C.H.R.F. Study, 1985 - 1986.
The Determinants of Treatment Duration for Congenital Muscular Torticollis, Emery, C., Physical Therapy - Vol. 74, #10, October 1994, pp 921 - 929.
Torticollis: Differential Diagnosis, Assessment and Treatment, Surgical Management and Bracing, ISBN 0-7890-0317-1, Karen Karmel-Ross: Published by Haworth Press.
Identification and Treatment of Congenital Muscular Torticollis in Infants, Susan Scott Freed, DPT, MMSc, PCS, Colleen Coulter-O'Berry, PT, MS, PCS Journal of Prothetics & Orthotics, 2004 Vol. 16, Num 4S> pp. 18-23
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