AU2382199A - Adjustable cervical collar - Google Patents

Description

P/00/01i1 Regulation 3.2

AUSTRALIA

Patents Act 1990

ORIGINAL

COMPLETE SPECIFICATION STANDARD PATENT Invention Title: Adjustable Cervical Collar The following statement is a full description of this invention, including the best method of performing it known to me/us: FHPMELC6991O6o1 Title ADJUSTABLE CERVICAL COLLAR This invention relates to cervical collars. More specifically this invention relates to a cervical collar with an adjustable sternum and shoulder brace.

Numerous types of cervical collars have been disclosed which are designed to restrict the movement of the head and neck of a person who has suffered a neck or spinal injury. In fact, cervical S. collars are now standard equipment for emergency medical service squads and rescue units.

Originally cervical collars were constructed from relatively heavy strap-like materials such as leather or other such heavy duty materials and usually included a number of metal braces. See, for example, U.S. Patent No. 3,027,894. These bulky cervical collars were reasonably successful in immobilizing the head but presented significant problems when x-rays were needed because of the metal contained within the braces. In addition, these bulky cervical collars did not provide access to the patient's neck if a tracheotomy was necessary. Finally, because of the materials commonly used to manufacture these bulky collars, they were cumbersome to use and expensive to produce. Because of current and anticipated limitations on reuse of virtually all medical products, expense is now a significant factor in the choice of all medical equipment which may be exposed to body fluids, including Specif'ically cervical collars. Thus, these bulky cervical collars are now, too expensive as single use, medical products.

As a result of the enhanced utilization of lighter weight, plastic materials, cervical collars are flow generally constructed from relatively stiff, light-weight plastic materials that are capable of being bent to encircle the neck of the wearer and yet still provide substantial support for the wearer. Examples of these types of collars are disclosed, for example, in U.S. Patent Nos. 5,083,553, 5,060,637 and RE. 32,219.

In emergency medical situations, it may be necessary to install a low cost, cervical collar on individuals of varying sizes. For example, a cervical collar may be necessary for a child of small size or a large adult. As a result, it is important that the size of the cervical collar be adjustable and yet still effectively irmmobilize the neck of the patient. This problem has been partially addressed by providing different size cervical collars for different sized individuals.

When placing a cervical collar on an injured individual, it is also helpful to put the cervical collar in position behind the patient and then adjust the frontal portion. of the cervical collar to immobilize the neck of the patient regardless of the patient's size. As a result, a number of cervical collars have been designed which permit the neck supporting piece or sternum and shoulder brace to be expanded to better support the patient's neck. Early models of these cervical devices such as-U.S. Patent Nos. 3,024,784 and 3,060,930 allow for the vertical extension' of the neck 3 sur-porting piece or sternum and shoulder brace of the cervical collar utilizing conventional construction. In addition, modest adjustments to the location of the neck piece of a cervical collar have been disclosed more recently in U.S. Patent Nos. 4,520,801 and 5,180,361.

A common element of cervical collars and also cervical braces are structural designs for adjustment of the position of the neck support of a sternum and shoulder brace or cervical collar. In cervical braces a brace element is placed around the shoulders of the patient, a neck piece is placed under the patient's neck and the distance between those tw..o is adjusted by adjustment means such as screw and bolt, pins and other such adjustment devices. See, for example, U.S. Patent Nos. 2,102,069, 2,736,314, 3,024,784, 3,0,24 3,2,42 4,1,13 4,2,1 and British Patent

NOS.

1,132,607 and 2,233,900. Other common methods for adjusting the height and placement of the neck piece of a cervical collar have also been disclosed, for example in U.S. Patent Nos. 2,828,736, 3,027,894, 3,042,027, 3,295,516, 3,220,406, 3,313,297 and 3,916,885.

While many of these patents disclose devices which have neck support pieces or sternum and shoulder braces that are adjustable, they are not easily adaptable for placement around the patient in an emergency medical situation. In addition, these devices do not provide adjustable neck support pieces which can be adjusted in height while the back portion of the cervical collar is held in place against the patient's neck. Further, these devices fail to CD/99105025.4 4 provide adjustable neck support pieces that can be locked in position thus preventing the patient from collapsing the cervical collar after it is installed in place. Further, the disclosed devices for adjusting the neck support or sternum and shoulder brace fail to permit parallel adjustment to both sides of neck support or sternum and shoulder braces automatically.

According to the present invention, there is provided a cervical collar comprising: an elongated neck encircling band; a chin support brace secured to the elongated neck encircling band; a sternum and shoulder brace, adjustable secured to the elongated neck encircling band; an adjustment system means adjustable secured to the sternum and shoulder brace and to the elongated neck encircling band for adjusting the height of the sternum and shoulder brace in relation to the elongated S:i° neck encircling band, said adjustment system means comprising a ratchet teeth and pawl system; and a positive alignment means secured to the sternum and shoulder brace for maintaining the sternum and shoulder brace in parallel alignment with the elongated neck encircling band as the height of the sternum and shoulder brace is adjusted in relation to the elongated neck encircling band.

Further according to the present invention, there is provided a cervical collar comprising: an elongated neck encircling band; a chin support brace secured to the elongated encircling band; a sternum and shoulder brace adjustably secured to the elongated encircling band; and CD/99105025.4 an adjusting and locking means secured to the elongated neck encircling band and the chin support brace for adjusting the height of the sternum and shoulder brace in relation to the elongated neck encircling band and for locking the sternum and shoulder brace in a fixed position in relation to the elongated neck encircling band after adjustment of the height of the sternum and shoulder brace, said adjusting and locking means comprises a row of ratchet teeth, a pawl which operates in conjunction with the ratchet teeth, a row of reverse ratchet teeth, a reverse pawl and a means for adjusting the pawl and the reverse pawl so they will restrict the movement of the sternum and shoulder brace in relation to the elongated neck encircling band.

Still further according to the present invention, there is provided a process for immobilising the neck of a person by means of a cervical collar comprising: an elongated neck encircling band; a chin support brace secured to the elongated neck encircling 15 band; a sternum and shoulder brace adjustably secured to the elongated neck encircling band; and an adjusting and locking means secured to the elongated neck encircling band and the chin support brace for adjusting the height of the 20 sternum and shoulder brace in relation to the elongated neck encircling band and for locking the sternum and shoulder brace in a fixed position in relation to the elongated neck encircling band after the height of the sternum and shoulder brace has been adjusted, sand adjusting and locking means comprising ratchet teeth, a pawl which operates in conjunction with the ratchet teeth, reverse ratchet teeth, a reverse pawl and a means for adjusting the pawl and the reverse pawl so they will restrict the movement of the sternum and shoulder brace in relation to the elongated neck encircling band.

Still further according to the present invention, there is provided a cervical collar comprising: CD/99105025.4 6 a chin support brace; a chin support height adjustment means secured to the chin support brace; an elongated neck encircling band containing a sternum and shoulder brace adjustably secured to the chin support height adjustment means comprising a back portion, a frontal end portion, a back side portion and the sternum and shoulder brace, said sternum and shoulder brace containing a first cut-out section; and an adjustment system means, adjustably secured to the chin support height adjustment means and secured to the elongated neck encircling band for adjusting the height of the

S

chin support brace in relation to the sternum and shoulder brace of the elongated neck encircling band.

In accordance with one preferred embodiment of the present invention there is provided an improved cervical collar comprised of an elongated neck encircling band, a chin support brace and an adjustable sternum and shoulder brace with an adjustment system means for adjusting the height of the sternum and shoulder brace in relation to the elongated neck encircling band. The adjustable sternum and shoulder brace can be adjusted in height in relation to the chin support brace and can oe locked in a fixed position to support the neck of the patient.

While the preferred embodiment utilises a separate elongated neck encircling band, chin support brace and adjustable sternum 15 and shoulder brace, the chin support brace may be formed at the same time as or formed as an integral unit of the elongated neck encircling band.

In an alternative preferred embodiment of the present 20 invention, there is provided an improved cervical collar comprised of an elongated neck encircling band which includes as an element thereof a sternum and shoulder brace, a chin support height adjustment piece, a chin support brace secured to said chin support height adjustment piece and an adjustment system means for adjusting the height of the chin support brace in o relation to the elongated neck encircling band. The height of the chin support brace can be adjusted in relation to the elongated neck encircling band and then locked in a fixed position to support the neck of the patient.

Preferred embodiments of the invention seek to provide the following objectives: to provide an improved cervical collar whose neck sternum and shoulder brace can be adjusted; to provide an improved cervical collar with an adjustable sternum and shoulder brace which can be locked in a fixed position; to provide an improved cervical collar with an adjustable

B

S.

B

6B sternum and shoulder brace which provides positive parallel adjustment to both sides of the sternum and should brace automatically; to provide an improved cervical collar with an adjustable sternum and shoulder brace which can be adjusted in height while the back portion of the cervical collar is held in place against the patient's neck; to provide an improved cervical collar with an adjustable sternum and shoulder brace and a chin support brace wherein the chin support brace can be adjusted in height while the back portion of the cervical collar and the sternum and shoulder brace are held in place against the patient.

Embodiments of the invention will now be further described, 15 by way of example only, with reference to the accompanying drawings, in which:- Figure 1A is a front plan view of a cervical collar in its flat position.

Figure 1B is an edge view of the cervical collar in its flat position.

Figure LC is a side perspective view of the cervical collar with the chin support brace in its bowed forward position.

Figure 2 is the elongated neck encircling band of the cervical collar.

Figure 3 is an exploded side view of the chin support brace of the cervical collar.

Figure 4 is a side view of the j-shaped element of the two part chin support brace of the cervical collar.

Figure 5 is a side view of the two part chin support brace of the improved cervical collar with an alternative locking feature.

Figure 6A is a front plan view of the sternum and shoulder brace of the cervical collar.

S B Figure 6B is an end view of the sternum and shoulder brace of the cervical collar.

Figure 7A is an edge view of the locking mechanism showing the ratchet teeth and pawl system where downward movement of the sternum and shoulder brace is permitted.

Figure 7B is an edge view of the locking mechanism showing the ratchet teeth and pawl system where upward movement of the sternum and shoulder brace is permitted.

Figure 7C is an edge view of the locking mechanism showing the ratchet teeth and pawl system where no movement of the sternum and shoulder brace is permitted.

Figure 8A is the front plan view of the cover piece of the cervical collar.

Figure 8B is a side view of the cover piece of the cervical collar.

Figure 9 is the slide piece containing a pawl for use with the cervical collar.

Figure 10 is a front plan view of an alternative embodiment of the cervical collar in its flat position.

Figure 1A is a front plan view of thealternative embodiment of t .alternative embodiment of the elongated neck encircling band in its flat position with sternum and shoulder brace.

Figure 11 B is an edj view of the alternative embodiment of the elongated neck encircling band with sternum and shoulder brace.

Figure 12A is a front plan view of the chin support height adjustment piece of the alternative embodiment of the cervical 8 collar in its flat position.

Figure 12B is an edge view of the chin support height adjustment piece of the alternative embodiment of the cervical collar in its flat position.

Figure 13 is an exploded side view of one embodiment of the chin support brace of the alternative embodiment of the cervical collar.

Figure 14 is a side view of the j-shaped element of the two part chin support brace of the alternative embodiment of the cervical collar.

Figure 15 is a side view of the two part chin support brace of 0: the alternative -embodiment of the improved cervical collar with an alternative locking feature.

Figure 16A is an edge view of the alternative embodiment of the locking mechanism showing the ratchet teeth and pawl system where downward movement of the sternum and shoulder brace is permitted.

Figure 16B is an edge view of the alternative embodiment of the locking mechanism showing the ratchet teeth and pawl system where upward movement of the sternum and shoulder brace is permitted.

Figure 16C is an edge view of the alternative embodiment of the locking mechanism showing the ratchet teeth and pawl system where no movement of the sternum and shoulder brace is permitted.

Figure 17A is the front plan view of the alternative embodiment of the cover piece of the cervical collar.

Figure 17B is a side view of the alternative embodiment of the cover piece of the cervical collar.

Figure 18 is the slide piece of the alternative embodiment containing a pawl for use with the cervical collar.

Although the invention is adaptable to a wide variety of uses, it is shown in the accompanying drawings for purpose of illustration as embodied in the improved cervical collar 9 9 comprised of an elongated neck encirclina band (12) a chin support brace (14) and an adjustable sternum and shoulder brace (15) with adjustment syster. for adjusting the height of the sternum and 9. shoulder brace in relation to the elongated neck encircling band as See Figure 1A.

The elongated neck encircling band (12) is formed from' a stiff, Plastic sheet material such as high density polyethylene, Polyvinyl chloride or other such stiff, sturdy plastic material.

The elements of the cervical clla a edect xrddo vase*: prepared from molds as is conventional in the industry. For comfort there may be secured to the inner Surface of this stiff plastic at various locations soft, foam type pads (13) which are comprised of conventional soft Plastic material. These soft plastic pads are secured to the stiff plastic material by any conventional securing means such as*, an adhesive or snap fasteners. It is pref erred that these foam pads be secured by cement or other adhesive to reduce the number of parts of the cervical collar The elongated neck encircling band (12) is preferably of onepiece c)nstruction generally comprised of a frontal portion (16), a back portion a back side portion (20) and a front end portion See Figure 2. The elongated neck encircling band is asymmetrical in design with the frontal portion (16) attached to, and an integral part of, the back portion (18).

The frontal portion which has affixed to it the chin support brace will be placed against the user of the cervical collar on the front portion of the user's neck under the user's chin. The back portion (18) of the cervical collar (10) is a generally affixed to the back of the user's neck. The back side portion (20) and the front end portion (22) are integral elements of the neck encircling band (12) located at each end and are generally secured together after the improved cervical collar is secured to the wearer. See Figure 2.

The frontal portion (16) when placed flat is generally curvilinear in design, curving downward and then generally curving %too back upward from the front end portion (22) to the back portion (18) with an opposite longitudinal curved edge which runs from one side of the frontal portion to the other side. See Figure 2. The lower curved edge (24) of the frontal portion is discontinued at that point where a cut-out section which in use overlaps the Adams' apple or larynx of the wearer is formed, to permit a tracheotomy to be performed through the cut-out section (26) with the cervical collar (10) in place. The upper curved edge (28) of the frontal portion (16) runs roughly parallel to the lower curved edge (24) except that it is not discontinued as with the lower curved edge (24).

Secured to the upper curved edge (28) is a chin support tab extending upward away from the upper curved edge (28) of the frontal portion. This chin support tab (30) is used to secure the chin support brace (14) to the frontal portion (16) of the neck encircling band See Figures IA and 2.

Secured to one side of the frontal portion and an integral part of the cervical collar is the back portion (18) of the cervical collar The back portion (18) can be of any conventional shape from generally rectangle to generally oval. The back portion (18) of the elongated neck encircling band (12) contains a number of vertical elongated slots (32) and cooperating slits (34) to make the neck encircling band (12) morc: flexible.

S These slots (32) are generally cut-out sections contained in the body of the back portion (18) running horizontally from near where the frontal portion (16) joins the back portion (18) to the Opposite side of the back portion. These slots (32) are generally located in the body of the back portion (18) running approximately S. half way the distance between the top and the bottom of the back portion The height and width of these slots is not critical but should be of sufficient size to permit enhanced flexibility and bending of the elongated neck encircling band Preferably these slots are at least about 2 inches in height and about 1/4 inch in width.

The cooperating slits (34) are inscribed into the top and bottom edges of the back portion (18) and extend part of the way into the back portion. The extent of the extension of these slits (34) is not critical although it should not reach the slots (32).

The slits (34) preferably are at least about a 1/2 to 1 inch or so in length. These slots (32) and slits (34) should be arranged in such a manner as to provide adequate flexibility and bendability to the back portion (18) of the elongated neck encircling band (12) without impacting on the structural integrity of the cervical collar An integral part of the back portion (18) located distal from the frontal portion (16) is the back side portion This back side portion (20) is generally an elongated tab extending from the body of the back portion, and integrally connected to the back portion In an alternative embodiment the back side portion (18) merges into the back portion and is eliminated as a discrete element of the device. A number of elongated slots (36) similar to those contained in the body of the back portion (18) may be rovided in this back side portion Distal from the back side portion (20) of the elongated neck encircling band (12) is the front end portion (22) which extends out from the frontal portion It acts in concert with the back side portion (20) when the cervical collar is placed around a user's neck. The frontal end portion (22) is also generally only a tab of generally rectangular shape extending from the body of the frontal portion (16) of the cervical collar. In an alternative embodiment the front end portion (22) merges into the frontal portion (16) and is eliminated as a discrete element of the device. A collar retainfng means is

_I_

13 added to the elongated encircling band to assist in the securing of the back side portion (20) to the front end portion (22) to hold the improved cervical collar (10) securely in place.

The collar retaining means can be any choice of straps or fasteners which will hold the in roved cervical collar together. For example, in a preferred embodiment an elongated hook and loop fastener (40) is secured zt the back portion (18) and the back side portion (20) of the cer.':ca collar through selected elongated slots (36) on the back se portion (20) and also the body of the back portion. See Fire Corresponding hook and Sloop fasteners (42) which interact wt the hook and loop fasteners s t r p f t) a n e s e c u r e d t or strip (40) are secured to the surface of the frontal end portion (22) and the front portion (16) b conventional securing methods, such as adhesives, to per-it the hec-. and loop fasteners strip when encountering the hcok and Icop fasteners (42) to hold the S improved cervical collar (10) securely in place.

The second'major element of the cervical collar is the chin S support brace. As previous stated, the chin support brace may be S* a separate element from the elongated neck encircling band or it may be formed as one integral piece of the chin support brace, permanently secured to the elongated neck encircling band. The chin support brace can be a conventional preformed, bowed forward chin support brace or, in an alternative embodiment, the chin support brace can be adjustable and formed from two separate elements.

If a two-piece construction is utilized, the two pieces of the chin support brace are a j-shaped element (44) and a curved element See Figure 3. They are constructed from the same type of stiff plastic material as is the elongated neck encircling band The j-shaped element (44) and the curved element (46) are similar in construction except the j-shaped element has an additional end section (48) which extends the length of the jshaped element. The second end (50) of the j-shaped element which is distal from the end section (48) and the second end (52) of the curved element (46) are secured at separate locations to the back eO side of the frontal portion (16) of the elongated neck encircling band. See Figure IA. These two second ends are held securely in place by any conventional securing means such as a pin which extends through the surface of the elongated neck encircling band (12) and through the appropriate second ends of the j-shaped element (44) and the curved element They can be permanently secured in place, for example, by rivets or snap fasteners (54).

The curved element (40) and the j-shaped element (44) are also secured to the chin support tab (30) of the frontal portion (16).

The first end (56) of the curved element and a portion (58) of the j-shaped element which portion is located close to the end section (48) of the j-shaped element are secured to the chin support tab (30) of the frontal portion (16) of the elongated neck encircling band See Figure IA. They are secured to the chin support tab (30) by a securing device (60) similar to the securing devices (54) used to secure the second end (50) of the j-shaped element and the second end (52) of the curved portion to the frontal portion This second sec device be a pin, rivet or snap fastener. However, whenever a second securing device (60) is chosen, i is re d e ti second securing device (60) Permit rotation of the j-shaped element (44) and urved element e l 4 a n d c u r v e d element (46) about the axis of the second securing device secured to the chin support tab Secured to the end section (48) of the j-shaped element (44) is the means for holding the chin supo brace in a bowed forward position In a bowe d forward -osition. Any conventional means for loc:ing the two elemens in S a bowed forwnard position may be used. Preferablv th men holding is a locking device (62) for elolng the two elements or the chin support brace together in a -owed -orward pos on f -ion after they are rotated about the axis of the chin support tab (30) See F igure 3. When each of these elemer-s o h chin supot brace c are rotated about the axis of the tab, the end section (48) of the i-shaped element (44) rotates uward and foard until its top edge is above the top edge of the curved element As boh rotate, he top suace o ch o thlmn (46) As both rotate, the top surface of each of the chin support elements bows forward S' to provide the support for the chin of the wearer. As these chin support elements are rotated, each side of the frontal end portion (16) will also rotate backwad to fo the frontal d support of the improved cervical collar. After both the j-shaped element (44) and the curved elements (46) are rotated to their bowed forward Position, the locking device (62) holds them in this bowed forward osition. n a preferred embodiment this locking device (62) is a c-shaped locking device element with a top hook portion (64) and a bottom snap portion (66) which are integral parts of the j-shaped element. See Figures 3 and 4. The second end (52) of the curved chin support element hooks under the top hook portion (64) of the c-shaped locking device and above the bottom snap portion (66).

The top of the curved chin support slides under the top hook portion (64) of the lcci-no device and snaps in place under the bottom snap portion of the locking device (62) to hold the two piece chin support brace in its bowed forward position. See Figure

IC.

In an alternative preferred embodiment, the means for holding Sthe chin support brace in a bowed forward position is comprised of a hook and tab piece (68) secured to the j-shaped element (44) which will fit into a slo, (70) in the second end of the curved element (46) to hold the chin support elements in their bowed forward position. See Figure The third element of the cervical collar is the sternum and shoulder brace See Figures 6A, 6B and 1. The sternum and shoulder brace is adjustably secured to the frontal portion of the elongated neck encircling band. Its shape is roughly similar to shape of the frontal portion except where the frontal portion forms the cut-out section As previously stated, the lower curved edge (24) of the frontal portion is discontinued at the point where the cut-out section overlaps the larynx. At that same cut-out section (26) the lower curved edge (72) of the sternum and shoulder brace (15) continues in a form roughly parallel with the upper curved edge (28) of the elongated neck encircling band, but located instead at the lower cutrved edge of the sternum and shoulder brace.

In addition, at the location where the upper curved edge of the sternum and shoulder brace meets the cut-out section, the upper curved edge (74) of the sternum and shoulder brace is discontinued. By this design the cut-out section (26) continues uninterrupted from.the elongated neck encircling band (28) to the sternum and shoulder brace By this arrangement the cut-out section extends uninterrupted regardless of the adjustment of the height of the sternum and shoulder brace (15) in relation to the elongated neck encircling band (112) thus providing at least one aperture which exposes the neck muscles at the level of the Adams' apple or larynx regardless of adjustment to the height of the sternum and shoulder brace.

Located on each side edge of the cut-out section (26) is positive alignment tracking means comprised of an overlap sectic: (76) of the sternum and shoulder brace. See Figures lA, 1B, 6A and 6B. This overlap section (76) extends over and around the side edges (78) of the frontal portion of the elongated neck encircling band which fcrm the cut-out section This overlap section (76) is located on each side edge (78) of the cut-out section (26) such that as the sternum and shoulder brace moves vertically upward and downwar, ithe overlap section (76) rests against the side edges (78) of theifrontal portion (16) of the elongated neck encircling band As the sternum and shoulder brace is extended downward, the overlap section rests securely against the cut-out section.

This arrangement prevents the elongated neck encircling band (12) 1S from twisting out of parallel alignmenz as the sternum and shoulder brace (15) is extended downward. An- movement by one side of the sternum and shoulder brace dow:nward automatically result in a corresponding and parallel moverenr- dc:.nward-bn the opposite side of the sternum and shoulder brace By this arrangement it is assured that the szernu- and sh~cler brace will always extend downward equally on both the left _te right side automatically.

The sternum and shoulder br. -15) is preferably located behind the frontal portion (16) c; .he elongated encircling band when the cervical collar is viewed r: he front. The sternum and shoulder brace (15) is designed pproximately the same size o- of the frontal portion (16) and t-h fr-n- end portion (22) of the S elongated neck encirclin band In particular, when the sternum and shoulder brace is secur.d behind the frontal portion (16) of the elongated neck enc n band, the sternum and shoulder brace aenerally does not z.'erlap other sections of the elongated neck encircling band this arrangement the back portion (18) of the elongated neck encircling band can be placed against the patient's neck and the sternu and shoulder brace can be adjusted without moving t-e back portion (18) of the elongated neck encircling band (12).

The sternum and shoulder brace (15) slides up and down behind the frontal portion (16) of the elongated neck encircling band on a plurality of posts (80) which ride within slots (82) either in the body of the frontal portion of the elongated encircling band or the body of the sternum and shoulder brace (15) or both.

19 Preferably, a pair of slots are provided on either side of the cut-out section (26) in the sternum and shoulder brace which operate in cooperation with a pair of posts (80) secured to the frontal portion (16) of the elongated neck encircling band on either side of the cut-out section Appropriate rivets and heads for the posts are utilized to hold the sternum and shoulder brace in place while still permitting the sliding movement of the sternum and shoulder brace. In addition, preferably a second Pair of vertical slots (84) is provided in the elongated neck encircling band closer to the cut-out section (26) than the first pair of slots. See Figures 1A, 6A and 6B. Appropriate posts with rivets and heads operate in conjunction with these slots to permit the **szernum and shoulder brace -o move vertically in relation to the frontal portion (16) of the elongated neck encircling band. Thie combination of those four slots and posts operating in conjunction with the overlap sections (76) to permit the sternum and shoulder brace to move smoothly, vertically in relat'ion to the frontal portion (16) of the elongated neck encircling, band. By this adj ustment mechanism, an appropriate distance between the patient Is S sternum and shoulder and the-underside of the patient's jaw at the chin can be maintained which will effectively support the patient's jaw. By modifying the location of the sternum and shoulder brace as it relates to the elongated neck encircling band (12) on the patient, adequate support for the patient's neck can be achieved.

While the location of the sternum and shoulder brace (15) can be adjusted vertically by this system of slots and posts, it is necessary that the precise location of the sternum and shoulder brace (15) in relation to the frontal portion (16) of the elongated neck encircling band (12) be fixed by a locking mechanism which will prevent the sternum and shoulder brace (15) from collapsing under pressure from the patient. This positive locking system can be any of a number of existing systems. However, preferably, a new ratchet teeth system (86) is utilized to provide this positive locking system. See Figure lA.

In one preferred embodiment the ratchet teeth system (86) is designed to permit the sternum and shoulder brace (15) of the cervical collar to be extended downwardly but not to allow it to ascend after its extension. This type of positive locking system is cruick to use and provides safety for the patient. In this p. referred system, one or preferably a pair of rows of ratchet teeth (88) are secured to the outer surface of the elongated neck ^encircling band, preferable one of each is located on either side of the second set of slots (84) on the frontal portion (16) of the a elongated neck encircling band These rows of ratchet teeth (88) are cut such that a pawl (90) located in a cover piece (92) which covers the ratchet teeth will permit downward movement of the sternum and shoulder brace only. See Figure 7A. Upward movement of the sternum and shoulder brace (15) is prevented by the interaction of the pawl (90) with the ratchet teeth. The cover piece (92) which covers and holds the pawl can be any conventional design such that it will move in relation to the ratchet teeth in 21 line with the movement of the ster-.u and shoulder brace itself.

In one embodiment the cover piece is secured at its top portion to the sternum and shoulder brace as an element of the post which passes through the slot (84) and a- its bottom portion by a second post with rivet :and hook secured tc= :e sternum and shoulder brace.

Various other arrangenen-s can be cznzceved all within the confines of the instant invention. Preferably, the pawl (90) will be located within a slot (96) in the c:ver piece See Figures 8A and 8B. As the cover piece (92) vertically in relation to the first set of ratchet teeth his allows the pawl (90) to move vertically in relaiocn to the r set of ratchet teeth (88).

This permits the teeth (9o) of the -o slide over the first set e -0 slide over the first set of ratchet teeth (88) interacting r.rewith.

As an improvement on t.is syste: the pawl (90) can be located on a separate slide piece (100) sliLabiy secured within the cover iece (92) such that the pawl (90) may be pulled out of line with S the first set of ratchet teeth thus permitting the sternum and shoulder brace (15) to move u,::ard as well as downward. See Figure 9. Preferably, the slide pie=e (100) is engaged in a system which will lock the teeth of the pa.1 in place preventing vertical movement of the sternum and shoulder brace (15) after the sternum and shoulder brace has been secured to the patient but which can be slidably adjusted to permit the movement of the sternum and shoulder brace upward after it is re-oved from the patient.

As a further improvement upon this system a second group of ratchet teeth (102) is cut into the surface of the frontal portion c 22 (16) of the elongated neck encircling band (12) running in a row parallel to the first set of ratchet teeth rows (88) previously discussed. See Figure 1A and Figures 7A, 7B and 7C. The direction of the cut of this second row of ratchet teeth (102) is reversed from the cut of the previously discussed ratchet teeth. This second group of ratchet teeth (102) are angled in the opposite direction from the first set of ratchet teeth. With this arrangement the cover piece (92) also contains a second pawl (104), the direction of the cut of the teeth of which is also reversed from that of the first pawl This second pawl (104) is movable so that it can be moved into and out of alignment with the second set of ratchet teeth (102). Thus, when the second pawl (104) and the second set of ratchet teeth (102) are aligned, movement of the sternum and shoulder brace is prevented in the direction opposite from the movement prevented by the first set of ratchet teeth (88) and first pawl See Figure 7B.

Preferably, when this second set of ratchet teeth (102) and second pawl (104) are engaged, they will prevent the sternum and shoulder 9 brace from being further extended downward. If the first set of ratchet teeth (88) and the first pawl (90) are also engaged, this arrangement provides a complete locking system for the sternum and shoulder brace, thus preventing not only retrograde movement vertically but also additional movement downward of the sternum and shoulder brace. See Figure 7C.

In this alternative embodiment it is critical that both sets of pawls (90, 104) be moveable horizontally so that each pawl can not only be engaged with the appropriate,- ratchet teeth to prevent movement in one direction but that each pawl can be moved horizontall1y out of alignment with the corresponding ratchet teeth to permit appropriate vertical movement of the sternum and shoulder brace. By having the pawls independently moveable in a horizontal direct-ion within the cover piece the greatest degree of adjustment capacity for the sternum and shoulder brace is provided while at the same time providing a positive locking of the sternum and shoulder brace in place. The alter-native arrangements are shown in Figures 7A, 7B and 7C. In Figure 7A the f irst set of *ratchet teeth rows (88) are lined up with the first pawl (0 Wihti arrangement of the pawl and ratchet teeth,thseru :and shoulder brace (15) can be extended downward moving the sternum and shoulder brace closer to the patient's chest. Retrograde movement upward is prevented by the interaction of the first set of ratchet teeth (88) and the fir-'st pawl In this embodiment the secon pawlin h second se fratchet teeth (102) are not in alignment. once ;the correct position of the sternum and shoulder *9*brace is achieved for the patient, the second pawl (104) is moved 99.9in a horizontal direction until1 it is in alignment with the second set of ratchet teeth (102). see Figure 7C. At this point the sternum and shoulder brace can neither move further downward nor can it move. upward. Moving the first pawl (90) out of alignment with the first set of ratchet teeth rows (88) will permit the sternum and shoulder brace to be retracted upward. See Figure 7B.

Once the precise location for the sternum and shoulder brace 24 in relation the frontal portion (16) of the elongated neck encircling band is achieved, both pawls are placed in alignment with their respective ratchet teeth thus preventing any further movement of the sternum and shoulder brace. See Figure 7C.

Preferably the set of pawls are arranged in a positive locking system such that they will be Lccked in alignment with the respective ratchet teeth. In one e-mbdiment of this system, each set of pawls (90, 104) has attached to its outside edge a tab system which will assist in looking -the pawls into a predetermined height after final adjustment of the location of the sternum and shoulder brace of the cer-ical collar. A number of different tab systems can be utilized. In one preferred embodiment, the outside end of each pawl attaches to a tab o106) which is rotatably over the cover piece (92) and locks in place to the top surface of the cover piece. When properly designed, these tabs will only lock in position to the cover piece when the sternum and shoulder brace may move neither upward nor do,:nward. :n this embodiment, both sets of pawls will engage both sets of ratchet teeth rows to lock the S sternum and shoulder brace (15) securely in place. Other systems can be designed which will lock the cooperating pawls and ratchet teeth in place, all of which are covered by this invention.

In the preferred system, a pair of ratchet teeth rows run vertically on both sides of one of the slots. Within this slot is the post which holds the cover piece (92) over the locking system and which is secured to the back side of the sternum and shoulder brace. Preferably the two sets of ratchet teeth rows are located one on either side of the slot These ratchet teeth (88), when operating with the corresponding pawl permit the sternum and shoulder brace to extend downward but do not permit it to move back upward. A third row of ratchet teeth (102) is located outside of the first two rows of ratchet teeth away from the cut-out section These ratchet teeth are cut with the opposite angle from the teeth in the first two rows. This third row of ratchet teeth (102) when operating in conjunction with a cooperating reverse pawl (104) prevent further extension of the sternum and shoulder brace downward from the elongated neck encircling band.

See Figure 1A.

In an alternative embodiment an alternative improved cervical collar (110) is comprised of an elongated neck encircling band (112) containing as an integral element thereof a sternum and shoulder brace (115), a chin support height adjustment piece (117) and a chin support brace (114) with an adjustment system for adjusting the height of the chin support brace in relation to the elongated neck encircling band (112). See Figure The elongated neck encircling band (112) is formed from a stiff, plastic sheet material such as high density polyethylene, polyvinyl chloride or other such stiff, sturdy plastic material.

The elements of the cervical collar may be die cut, extruded or prepared firo giolds as is conventional in the industry. For comfort there may be :secured to the inner surface of this stiff plastic at various locations soft, foam type pads (not shown) which are comprised of conventional soft plastic material. These soft plastic pads are secured to the stiff plastic material by any conventional securing means such as an adhesive or snap fasteners.

It is preferred that these foam pads be secured by cement or other adhesive to reduce the number of parts of the cervical collar (110) The elongated neck encircling band (12) is preferably of onepiece construction generally comprised of a sternum and shoulder brace (115), a back portion (116), a back side portion (120) and a front end portion (122). See Figures 11A and 11B. The elongated neck encircling band (112) is asymmetrical in design.

The sternum and shoulder brace (115) when placed flat is generally curvilinear in design, curving downward and then generally curving back upward from the front end portion (122) to the back portion (118) with an opposite longitudinal curved edge which runs from one side of the frontal portion to the other side.

See Figure 11A. The upper curved edge (128) of the sternum and shoulder brace is discontinued at that point where a cut-out section (126), which in use overlaps the Adams' apple or larynx of the wearer is formed, to permit a tracheotomy to be performed through the cut-out section (126) with the cervical collar (110) in place. The lower curved edge (124) of the sternum and shoulder brace (115) runs roughly parallel to the upper curved edge (128) except that it is not discontinued as with the upper curved edge (128).

Secured to one side of the chin support height adjustment piece (117) and an integral part of the cervical collar is the back portion (118) of the cervical collar (110). The back portion (118) can be of any conventional shape from generally rectangle to generally oval. The back portion (118) of the elongated neck encircling band (112) contains a number of vertical elongated slots (132) and cooperating sli-s (134) to make the neck encircling band (112) more flexible. These slots (132) are generally cut-out sections contained in the body of _te back portion (118) running horizontally from near where the szern-.um and shoulder brace (115) joins the back portion (118) to the opposite side of the back portion. These slots (132) are generally located in the body of the back portion (118) running apprz.:.ately half way the distance between the top and the bottom o the back portion (118) The height and width of these slots is nc' critical but should be of sufficient size to permit enhanced flexibility and bending of the elongated neck encircling band (ll. referabl these slots are Preferably these slots are S at least about 2 inches in height an about 1/4 inch in width.

The cooperating slits (134) are inscribed into the tot and S bottom edges of the back portion and extend part of the way into the back portion. The extent of the extension of these slits (134) is not critical although it should not reach the slots (132) The slits (134) preferably are at least about a 1/2 to 1 inch or so in length. These slots (132) and slits (134) should be arranged in such a manner as to provide adequate flexibility and bendability to the back portion (118) of the elongated neck encircling band (112) without impacting on the structural integrity of the cervical collar (110).

An integral part o-f the back portion .(118) located distal from the sternum and shoulder brace (115) is the back side portion (120) This back side portion (120) is generally an elongated tab extending from the body of the back portion, and integrally connected to the back portion (118). In an alternative embodiment the back side portion (118) merges into the back portion and is eliminated as a discrete element of the device. A number of elongated slots (136) similar to those contained in the body of the back portion (118) may be provided in this back side portion (120).

Distal from the back side portion (120) of the elongated neck encircling band (112) is the front end portion (122) which extends out frmthe sternum and shoulder brace (115). It acts in concert With the back side portion (120) when the cervical collar is placed around a user's neck. The frontal end portion (122) is aliso generally only a tab of generally rectangular shape extending from the ster"num and shoulder brace (115) of the cervical collar. in an alternative embodiment the front end portion (122) merges into the sternum and shoulder brace (115) and is eliminated as a discrete element of the device. A -collar retaining means is added to the elongated encircling band to assist in the securing of the back side portion (120) to the front end portion (122) to hold the improved cervical collar (110) securely in place.

The collar retaining means can be any choice of straps or fasteners which will hold the improved cervical collar (110) together. For example, in a preferred embodiment an elongated hook and loop fastener (140) is secured to the bdck portion (118) and the back side portion (120) 0of the cerv'ical collar through selected elongated slots (136) on the back side portion (120) and also the body of the back portion. See Fiacure 10. Corresponding hook and 1ooP fasteners (142) which interazz with the hook and loop fasteners strip (140) are secured zc zhe surface of the frontal end Portion (122) and the sternum ani shoulder brace (115) by conventional securing methods, suc" as adhesives, to permit the hook and loop fasteners strzip (140) encountering the hook and loop fasteners (142) to hold the U'.-:roved cervical colar (110) securely in place.

The sternum and shoulder brace is an integral part of the elongated neck encircling band The shape o h tru and shoulder brace is roughly~ similar shape of the chin support *::::height adjustment piece (117) excenz .:here the sternum and shoulder brace forms the cut-out section (126). The upper curved edge (128) of the sternum and shoulder brace (12.5) is discontinued at the point where the cut-out section (126) overlaps the larynx. At that same cut-out section (126) the upper curv ed edge (172) of the chin support height adjustment piece (117) continues in a form roughly Parallel with the lower curved edge (124) of the sternum and shoulder brace (115). In addition, at the lo cation where the lower curved edge of the chin support height adjustment piece (117) maeets the cut-out Isection, the lower curved edge (174) of the chin support height adjustment piece (117) is discontinued. By this design the cut-out section (126) continues uninterrupted from the chin support height adjustment piece (117) to the sternum and shoulder brace (115) By this arranraement the cut-out section extendjs uninterrupted regardless the adjustmenrt of the height of the sternum and shoulder brace (115) in relation to the chin support height adjustment piece (117) thus providing at least one aperture which exposes the neck muscles at the level of the Adams' apple or larynx regardless of the adj4uszment to the height of the sternum and shoulder brace.

Located on each side edge of t!-e cut-out section (126) is a positive alignment tracking means cc-.rise d of an overlap section (17-6) of the chin support height atjuszment p)iece (117) .See **Figures 10 and 12A. This overlap seczion (176) extends over and arun the side edes(18 of the sternun and shoulder of the elongated neck encircling band which form the cut-out section (126) .This overlap section (176) is located on each side edge (178) of the cut-out section (126) such that as the chin support height adjustment piece (117) moves vertically upward and downward, the overlap section (176) rests against the side edges (178) of the sternum and shoulder brace (115). As the sternum and too": shoulder brace is extended downward, tChe overlap section (176) rests securely against the cut-out section. This arrangement prevents the sternum and shoulder brace (115) from twisting out of parallel alignment as the chin support height adjustment piece (117) is extended upward. Any movement by one side of the sternum and shoulder brace downward will automatically result in a corresponding and parallel movement downward on the opposite side of the sternum and shoulder brace (115) By this arrangement it is assun !d that the sternum and shoulder brace will always extend downward equally on both the left and the right side automatically.

Located behind the sternum and shoulder brace (115) of the elongated encircling band when the cervical collar is viewed from the front is the chin support height adjustment piece (117) The chin support height adjustment piece (117) is designed to be approximately the same size as the combined sternum and shoulder brace (115) and the front end portion (122) of the elongated neck enci.-c-ling band (112). The chin support height adjustment piece (117) has an upper curvilinear edge (172) which runs approximately parallel to the upper curved edge (128) of the sternum and shoulder brace. In addition, the lower curved edge 1174) of the chin support height adjustment piece runs approximately parallel to the lower curved edge (124) of the sternum and shoulder brace. As previously stated, at the point where the lower curved edge (174) of the chin support height adjustment piece meets the cut-out section (126) the lower curved edge is discontinued. Thus, the cut-out section (126) extends uninterrupted regardless of the adjustment of the height of the sternum and shoulder brace (115) in relation to the chin support height adjustment piece thus providing at least one aperture which exposes the neck muscles at the level of the Adams' apple or larynx regardless of the adjustment to the height of the sternum and shoulder brace.

Secured to the upper curved edge (172) of the chin support height adjustment piece (117) is a chin support tab (130) extending upward away from the upper curved edge (172). This chin support tab (130) is used to secure the chin support brace (114) to the chin support height adjustment piece (117). See Figures 0 and 12A.

The chin support height adjusztent piece (117) slides up and down behind the sternum and shoulder brace (115) of the elongated neck encircling band on a pluralit-, of posts (180) which ride within slots (182) either in the bod,- of the sternum and shoulder brace (115) of the elongated encirling band or the body of the, chin support height adjustment piece (117) or both. Preferably, a pair of slots (182) are provided on either side of the cut-out section (126) in the sternum and shoulder brace (115) which operate in cooperation with a pair of oss slidabl secured to the C. air slidably secured to the sternum and shoulder brace (115) of the elongated neck encircling band s elongated neck encirclin Sband on either side of the cut-ou- section (126). Appropriate S rives and heads for the posts are utilized to hold the chin support height adjustment piece (117) in place hile still 7 in place while still permzting the sliding movement of the sternum and shoulder brace S (115). In addition, preferably a second pair of vertical slots (4 is poi i the (184) is provided in the sternum and shoulder brace (115) closer to the cut-out section (126) than the first pair of slots. See Figures 10 and 11A. Appropriate posts with rivets and heads operate in conjunction with these slots to ermit the chin support height adjustment piece (117) to move vertically in relation to the sternum and shoulder brace (115) of the elongated neck encircling band. The combination of those four slots and posts operating in conjunction with the overlap sections (176) to perait the chin support height adjustment piece to move smoothly, vertically in relation to the sternum and shoulder brace of the elongated neck encircling band. By this adjustment mechanism, an appropriate distance between the patient's sternum and shoulder and the underside of the patient's jaw at the chin can be maintained which will effectively support the patient's jaw. By modifying the location of the chin support height adjusment piece (117) on the patient as it relates to the elongated neck encircling band (112) adequate support for the patient's neck can be achieved.

h l e the location of th While thelocation of the sternum and shoulder brace (115) can S be adjusted vert.:ally by this system of slots and posts, it is necessary that the precise locatione sternum c 1f thcatin e s t e r n um and shoulder brace (115) in relation to the chin suppor height adjustment piece (I17) be fixed by a 3n mec^. Sixedby a ocking mechanism which will prevent he sternum and shoulder brace (115) from cclapsing under pre e ssure from the patient Th c"la'psing under pressure Sfrom the patient. This positive locking system can be any of a S number of existing systems. However, preferably, a new ratchet teeth system (186) is utilized to provide this positive locking system. See Figures 10, 16A, 16B and 16C.

In one preferred embodiment the ratchet teeth system (186) is designed to permit the sternum and shoulder brace (115) of the cervical collar to be extended downwardly but not to allow it to ascend after! is extension. This pe of ositive t o l l o i t t o Sto satype of positive locking system is quick to use and provides safety for the patient. In this preferred system, one or preferably a Pair of rows of ratchet teeth (188) are secured to the outer surface of the elongated neck surfce o th elongated neck 34 encircling band, preferable one of each is located on either side of the second set of slots (184) on the sternum and shoulder brace (115) of the elongated neck encircling band (112) These rows of ratchet teeth (188) are cut such that a pawl (190) located in a cover piece *(192) which covers the ratchet teeth will permit downward movement of the sternum and shoulder brace only. See Figures 10 and 16A. Upward movement of the sternum and shoulder brace (115) is prevented by the interaction of the pawl (190) with the ratchet teeth. The cover piece (192) which covers and holds 9* the pawi., can be any conventional design such that it will move in relation to the ratchet teeth in line with the movement of the S sternum and shoulder brace itself. In one embodiment the top pcrtion off the cover piece is secured to the chin support height **adjust-ment piece (117) as an element of the post which passes *999* through the slot (184) and at its bottom portion by a second post with rivet and hook secured to the chin support height adjustment piece. Various other arrangements can be conceived all within the confines of the instant invention. Preferably, the pawl (190) will be located within a slot (196) in the cover piece (192). See Figures 16A, 16B, 16C, 17A and 17B. As the cover piece (192) moves vertically in relation to the first set of ratchet teeth (188), this allows the pawl (190) to move vertically in relation to the first set of ratchet teeth (188). This permits the teeth (198) of the pawl to slide over the first set of ratchet teeth (188) interacting therewith.

As an improvement on this system the pawl (190) c~n be located on a separate slide piece (200) slidably secured within the cover piece (192) such that the pawl (190) may be pulled out of line with the first set of ratchet teeth (188), thus permitting the sternum and shoulder brace (115) to move upward as well as downward. See Figures 16A, 16B, 16C and 18. Preferably, the slide piece (200) is engaged in a system which will lock the teeth of the pawl in place preventing vertical movement of the szernum and shoulder brace (115) after the sternum and shoulder brace has been secured to the patient but which can be slidably adjusted to permit the movement of the sternum and shoulder brace upward after it is removed from S the patient.

.As a further improvement upon zh.s system a second group of ratchet teeth (202) is cut into the surface of the elongated neck encircling band (112) running in a row parallel to the first set of ratchet teeth rows (188) previously discussed. See Figures 10 and 11A. The direction of the cut of this second row of ratchet teeth (202) is reversed from the cut of the previously discussed ratchet S• teeth. This second group of ratchet teeth (202) are angled in the opposite direction from the first set of ratchet teeth. With this arrangement the cover piece (192) also contains a second pawl (204), the direction of the cut of the teeth of which is also reversed from that of the first pawl (190) This second pawl (204) is movable so that it can be moved into and out of alignment with the second set of ratchet teeth (202). Thus, when the second pawl (204) and the second set of ratchet teeth (202) are aligned, movement of the sternum and shoulder brace is prevented in the direction opposite from the movement prevented by the first set of ratchet teeth (188) and first pawl (190). See Figure 16B.

Preferably, when this second set of ratchet teeth (202) and second pawl (204) are engaged, they will prevent the sternum and shoulder brace from being further extended dow~nward. If the first set of ratchet teeth (188) and the first pawl (190) are also engaged, this arrangement provides a complete loc:-ing system for the sternum and shoulder brace, thus preventing not only retrograde movement vertically but also additional movement downward of the sternum and shoulder brace. See Figure 16C.

In this alternative embodimen it is critical that both sets of pawls (190, 204) be moveable horizontally so that each pawl can not only be engaged with the appropriate ratchet teeth to prevent movement in one direction but a each pawl can be moved horizontally out of alignment with the corresponding ratchet teeth S to permit appropriate vertical movement of the sternum and shoulder brace. By having the pawls independently moveable in a horizontal direction within the cover piece (192), the greatest degree of adjustment capacity for the sternum and shoulder brace is provided while at the same time providing a positive locking of the sternum and shoulder brace in place. The alternative arrangements are shown in Figures 16A, 16B and 16C. In Figure 16A the first set of ratchet teeth rows (188) are lined up with the first pawl (190).

With this arrangement of the pawl and ratchet teeth, the sternum and shoulder brace (115) can be extended downward moving the sternum and shoulder brace closer to the patient's chest.

Retrograde movement upward is prevented by the interaction of the first set of ratchet teeth (188) and the first pawl (190). In this embodiment the second pawl and the second set of ratchet teeth (202) are not in alignment. once the correct position of the sternum and shoulder brace is achieved for the patient, the second pawl (204) is moved in a horizontal direction until it is in alignment with the second set of ratchet teeth (202). See Figure 16C. At this point the sternum and shoulder brace can neither move further downward nor can it move upward. Moving the first pawl (190) out of alignment with the first set of ratchet teeth rows (188) will permit the sternum and shoulder brace to be retracted upward. See Figure 16B. Once the precise location for the sternum and shoulder brace (115) in relation the chin support height adjustment piece (117) is achieved, both pawls are placed in alignment with their respective ratchet teeth thus preventing any S- further movement of the sternum and shoulder brace. See Figure 16C.

Preferably the set of pawls are arranged in a positive locking system such that they will be locked in alignment with the respective ratchet teeth. In one embodiment of this system, each set of pawls (190, 204) has attached to its outside edge a tab system which will assist in locking the pawls into a predetermined height afteri final adjustment of the location of the sternum and shoulder brace of the cervical collar. A number of different tab systems can be utilized. In one preferred embodiment, the outside end of each pawl attaches to a tab (206) which is rotatably over the cover piece (192) and locks in place to the top surface of the cover piece. When properly designed, these tabs will only lock in position to the cover piece when the sternum and shoulder brace may move neither upward nor downward. In this embodiment, both sets of pawls will engage both sets of ratchet teeth rows to lock the sternum and shoulder brace (115) securely in place. Other systems can be designed which will lock the czoperating pawls and ratchet teeth in place, all of which are ccvered by this invention.

In the preferred system, a pair of ratchet teeth rows run Svertically on both sides of one of the slots. Within this slot is the post which holds the cover piece (1S2) over the locking system and which is secured to the back side of the chin support heicht adjustment piece (117). Preferably the z~o sets of ratchet teeth rows are located one on either side of the slot (184). These ratchet teeth (188), when operatinq with the corresponding pawl (190), permit the sternum and shoulder brace to extend downward but o not permit it to move back upward. A third row of ratchet teeth (202) is located outside of the first t*.o rows of ratchet teeth away from the cut-out section (126). These ratchet teeth are cut with the opposite angle from the teeth in the first two rows. This third row of ratchet teeth (202) when operating in conjunction with a cooperating reverse pawl (204) prevent further extension of the sternum and shoulder brace downward from the elongated neck encircling band.

The third major element of the cervical collar is the chin support brace. As previously stated, the chin support brace may be 39 a separate element fromi :t"e C"in suP.Pcr height adjustment piece (117) Or it may be formed as one inteq.al piece permanently secured to t."e chin support heiq.-ht a djuszmen-- piece. The chin support brace can be a conventio-al prefacrmd bowed forward chin Support brace or, in an alternaj e zoc--te chin support brace can be adjustable and formed zr:n se=zara-e elements.

If a two-piece consz:uz-'on 'Su-___"ethe two pieces of the chin support brace are a J-hpej ement (144) and a cur-ved element See Figu,_re constructed from .the same *type of stiff P .lastic materia! as e elongated neck ec-ln band (112). The j-shaced: ele:n:ent _44 and the curved element (146) are similar in coZth-e~z~ ~e 3-shaped element hlas an additional end section t,46) hi e:.:ends the length of 'the jshaped element. The seccnd.-- end (1 c f zhe j-shaped element which :is 'distal from the end secti on (14E) and the second end (152) of the curved element (146) are secured at separate locations to the back Side of the chin suPPOrt adj4-ustment piece (117). See Figure 10. These two sec-n4 ends are hedsecurel y in place by any conventional securing means such as a iwhcexndtrogte surf ace of .the chin supoPort he ic adj;ustment piece (117) and through the appropriate second ends Of the j-shaped element (144) and 'the curved element (146). They can be permanently secured in place, for example, by rivets or snap fasteners (154).

The curved element (140) and the i-shapec element (144) are also secured to the chin sup-Port tab (130) of the chin support height adjustment piece (11-7) The first end (156) of the curved element and a portion (158) of the j-shaped element (144), which portion is located close to the end section (148) of the j-shaped element (144), are secured to the chin support tab (130) of the chin support height adjustment piece (117). See Figure 10. They are secured to the chin support tab (130) by a securing device (160) similar to the securing devices (154) used to secure the second end (150) of the j-shaped element and the second end (152) of the curved portion to the chin support height adjustment piece (117). This second securing device (160) may be a pin, rivet or snap fastener. However, whenever a second securing device (160) is chosen, it is required that this second securing device (160) permit rotation of the j-shaped element (144) and curved element (146) about the axis of the second securing device (160) secured to the chin support tab (130).

Secured to the end section (148) of the j-shaped element (144) is the means for holding the chin support brace in a bowed forward position. Any conventional means for locking the two elements in a bowed forward position may be used. Preferably the means for holding is a locking device (162) for locking the two elements of the chin support brace together in a bowed forward position after they are rotated about the axis of the chin support tab (130). See Figure 13. When each of these elements of the chin support brace are rotated about the axis of the tab, the end section (148) of the j-shaped element (144) rotates upward and forward until its top edge is above the top edge of the curved element (146). As both rotate, the top surface of each of the chin support elements bows forward to provide the support for the chin of the wearer. As these chin support elements are rozated, each side of the chin support height adjustment piece (117) will also rotate backward to form the frontal support of the in:roved cervical collar. After both the j-shaped element (144) and the curved elements (146) are rotated to their bowed forward posit.ion, the locking device (162) holds them in this bowed forward position. In a preferred embodiment this locking device (162) is a c-shaped locking device element with a top hook portion (164) and a bottom snap portion (166) which are integral parts of the i-shaped element. See Figures 13 and 14. The second end (152) of the curved chin support element hooks under the ton hook porzion (164) of the c-shaped locking device and above the bottom snap portion (166) The ton o1 the curved chin support slides under the top hook portion (164) of the locking device and snaps in place under the bottom snap portion (166) of the locking device (162) to hold the two piece chin support brace in its bowed forward position, In an alternative preferred embodiment the means for holding the chin support brace in a bowed forward position is comprised of a hook and tab piece (168) secured to the j-shaped element (144) which will fit into a slot (170) in the second end of the curved element (146) to hold the chin support elements in their bowed forward pos ;.tj n. See Figure In operation, when the first embodiment of the cervical collar is to be used, the back portion (18) of the elongated neck encircling band is wrapped around the back of the patient's neck.

The frontal portion (16) is held in place against the patient's neck and chest. The collar retaining element such, as an elongated hook and loop fastener (40) which is attached to the back side portion is secured firmly in place against, one or more hook and loop fasteners (42) which are secured to the frontal end portion (22) and, if necessary, on the top surface of the frontal portion of the elongated neck encircling band. If the cervical collar does not have a two-piece adjustable chin support, a single S piece chin support is placed against the patient's neck. If a twopiece adjustable chin support is an element, the various elements of the curved chin support are rotated and formed into a bowed forward position using the appropriate locking systems. This results in the chin support brace being bowed forward to more easily support the wearer's chin. The respective pawls (90, 104) are slid to a position which permits the sternum and shoulder brace to be pulled downward until it is firmly in place against the .9 patient's sternum. If a single set of ratchet teeth rows (88) and pawl (90) are present, no further operation is necessary. However, if a reverse ratchet teeth (102) and reverse pawl (104) is present, the tab (106) secured to the reverse pawl is pulled such that the reverse pawl (104) and the row of reverse ratchet teeth (102) interact, thus preventing further downward movement of the sternum and shoulder brace. Tabs (106) connected to both pawls are then locked in place against the cover piece By this mechanism additional upward or additional downward movement of the sternum and shoulder brace is prevented. After the user no.longer needs S43 the cervical collar, the hook and loop material strip used as a collar retaining element is removed from the fasteners attached to the frontal portion and the frontal end portion. This removes the cervical collar from the patient's neck.

In operation in the alternative embodiment, when the cervical collar is to be used, the back portion (118) of the elongated neck encircling band is wrapped around the back of the patient's neck.

The sternum and shoulder brace (115) is held in place against the atient's chest. The collar retaining element such, as an elongated hook and loop fastener (140) which is attached to the .back side portion (120), is secured firmly in place against one or more hook and loop fasteners (142) which are secured to the frontal end portion (122) and, if necessary, on the top surface of the *frontal portion of the elongated neck encircling band. If the cervical collar does not have a two-piece adjustable chin support, a. single piece chin support is placed against the patient's neck.

If a two-piece adjustable chin support is an element, the various elements of the curved chin support are rotated and formed into a bowed forward position using the appropriate locking systems. This results in the chin support brace being bowed forward to more easily support the wearer's chin. The respective pawls (190, 204) are slid to a position which permits the chin support brace (114) secured to the chin support height adjustmen piece (117) to be pulled upward until it is firmly in place against the patient's chin. If a single set of ratchet teeth rows (188) and pawl (190) are present, no further operation is necessary. However, if a reverse ratchet teeth 1202) and reverse nawl (204) is present, the tab (206) secured to the reverse pawl is pulled such that the reverse pawl (204) and the row of reverse ratchet teeth (202) interact, thus preventing further upward movement of the sternum and shoulder brace. Tabs (206) connected to both pawls are then locked in place against the cover piece (192). By this mechanism additional upward or downward movement of the sternum and shoulder brace is prevented. After the user no longer needs the cervical collar, the hook and loop material strip used as a collar retaining element is removed from the fasteners attached to the frontal portion and the frontal end portion. This removes the cervical S. collar from the patient's neck.

Throughout this specification and claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" or "comprising" will be understood to imply the inclusion of a stated integer or group of integers or steps but not the exclusion of any other integer or group of integers.