An Improved Technique on Existing
Neck and Head Support Systems
for Cervical Dystonia
Rahul Dubey, Rahul Vishwakarma and Ashish Mishra
Abstract Recently, a new technology has improved many folds and is supposed to
grow at a much faster pace in near future. Application of technology in medical and
healthcare fields has not only made the life of patients much easier but has also helped
doctors to implement any treatment very easily. The advance in the field of computing
and technology has been a beneficiary in the field of the medical sciences. As far as we
all can agree that both the field are not mutually exclusive and complement each other
at every step. Instances of this particular statement are the support systems are cervical
orthosis that are used for providing stability to the patients suffering from the cervical
injuries or spasms. Although these support systems were mainly designed to support
the head and neck by immobilizing them and giving time to recover from injuries or
spasms, the same can be used for the patients suffering from widely known defect
cervical dystonia. Little tweaks are required to enhance the existing support braces
to transmute into mobilizer from immobilizers. We have developed a new method
AutoNeck in this paper for the treatment of cervical dystonia. AutoNeck basically
works by controlling the neck movement of patients with the help of controlling the
neck movement (specifically rotation) not only reliefs them on a daily basis but also
helps in the overall treatment in the long run. We augmented the support system to
provide the freedom of rotating the head and neck by using the mobile application
as an input device. The sole purpose of implementation of the idea is to work against
the effort produced by the involuntarily contracted cervical muscles which tries to
keep the head in a certain direction. The results obtained reflect that the support
system can make the head rotate almost in a desired direction by working against the
involuntarily effort of the cervical muscles to provide mobility to the patient. The
R. Dubey · R. Vishwakarma
Gyan Ganga Institute of Technology and Sciences, Jabalpur 482003, Madhya Pradesh, India
e-mail: rahuldubey391@gmail.com
R. Vishwakarma
e-mail: rahulvishwakarma485@gmail.com
A. Mishra (B)
Computer Science and Engineering Department, Gyan Ganga Institute of Technology and
Sciences, Jabalpur 482003, Madhya Pradesh, India
e-mail: ashish.mish2009@gmail.com
© Springer Nature Singapore Pte Ltd. 2020
A. Khanna et al. (eds.), International Conference on Innovative Computing
and Communications, Advances in Intelligent Systems and Computing 1087,
https://doi.org/10.1007/978-981-15-1286-5_32
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effectiveness of the system can be improved if the expected values coincide with the
obtained values of the result. We propose that this approach is very effective and
easy to use interface provides the patient with an android application.
Keywords AutoNeck · Cervical dystonia · Static system · Dynamic system
1 Introduction
Cervical dystonia device is primarily based on the above-mentioned support systems and it is basic mechanical frame originate from these systems but with an
advancement in mobility using technology and transmutability of signals to control
the movement of the head gear and dampening the effort to rotate the head around.
Spasmodic torticollis affects the basil ganglia which are the major part and source
for moving the head. cervical dystonia is a chronic neurological disorder that lasts
for a longer time and it involuntarily turns the head in any direction [1]. It is the
most common form of local dystonia. Horizontal turning and head tremors are the
most common symptoms which are caused by the sternocleidomastoid, trapezius
and posterior cervical muscles variable involvement. The muscles surrounding neck
contract simultaneously causing a dystonic movement. The causes of the condition
are idiopathic [2]. An idiopathic cervical dystonia can be defined by the intermittent
or sustained contractions of muscles which cause the abnormality in posture and
often cause repetitive movement. Another disease or condition sometimes triggers
the cervical dystonia. The symptoms occur during the midlife time. Common remedy
for the condition which provides relief to the patients is the use of Botulinum toxin
type A. Initial symptoms of spasmodic torticollis is usually mild. Some feel an unnoticeable tremor of their head for a few months at onset. Then, the head may turn, pull
or tilt in jerky movements, or sustain a prolonged position involuntarily. The muscle
spasm frequency increases overtime and the strength of the contraction increases up
to a threshold is reached. The stress can be a major factor in triggering the symptoms
of the condition. The contraction for a prolonged period causes muscle hypertrophy,
dysarthria and tremor and pain. Spasmodic torticollis causes a poor posture which
can ruin the cosmetic aspects and appear to be clumsy. The condition can be categorized into two ways: one is the onset and another is the cause. If the diagnosis of
the condition is done before 27 years of age then the category is Onset. The other
way of categorization is done by the cause which can be primary (idiopathic) or it
can be secondary (symptomatic). Another way of categorization is according to the
rotation of the head movement and direction of the head. The word “Auto Neck” is
taken as the patient now do not use his/her hand to rotate his/her head if he/she is
wearing this device on his/her back. The best part of the device is that there are no
side effects of the device if the person is putting that thing on his/her shoulder but
the patient always has to carry his smart phone if he/she wants to operate the device
manually.
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2 Related Work
The defect of cervical dystonia is primarily characterized on the basis of the involuntarily contractions of the neck muscles which controls the rotations and movements
of the neck and head [1]. The term “Dystonia” was first used by the Oppenheim a
century ago. Dystonia is further classified into three categories but we will discuss
it later after describing the defect dystonia. It is delineated as hyperkinetic movement disorder which is caused by the involuntary sustained muscle contractions. The
contractions of the muscles cause deformed postures and recurring movements of
the affect site. Since the complexity of dystonia has been increasing overtime due
to continuous research being done on the topic, the classification schemes are of
controversial nature [3]. Grouping of many different disorders where the features of
dystonia occur and the goals of subdivision determine the design of classification
system [1]. There are basic approaches to the classification which are based on the
age of onset, distribution of the affected body parts and the causes [1]. Diagnosis of
Dystonia: The clinicians use the characteristics of postural abnormalities and specific features to determine the presence of dystonia. The results of electromyogram
(EMG) and ultrasounds are used to monitor/target the deep muscles [4]. Despite the
presence of ultrasounds and a need for personalized muscle diagnosis, the complex
muscle group diagnosis remains unsolved [5]. The term “Spasmodic Torticollis” is
referred to the defect. Although, sometimes the defect is not even “Spasmodic” and
not consist “Torticollis”, so it is most of the time referred as “Cervical Dystonia”.
The CD is a common disorder and it is not fully understood or clinically described
completely. The focal dystonia and other movement disorders can be related to each
other in some way. There are certain treatments which are available either in the
forms of injections of certain muscle relaxant chemicals or either there exist brain
stimulation techniques which can reduce the activity of involuntary contracted muscles of neck. The oldest treatment for the relief is injections of Botulinum toxin
types A or B [6]. A brief study of 616 patients with idiopathic cervical dystonia
was done in order to find the efficacy, safety and long-term effect of the injections
of the chemical Botulinum neurotoxin type A. In result, at first the benefits of the
treatment showed itself but with the prolonged usage of the neurotoxin type A, the
antibodies in the body of the patient developed and started acting against the injected
neurotoxin. Soon the body develops immune resistance to injected neurotoxins and
the efficacy of the injections suffers with time. Another type of neurotoxins was used
in the old day which was known as [7] Botulinum neurotoxin (BTX) type A with
higher amount of doses (25 ng protein/100 units). It was used before 1998 but the new
type A neurotoxin of minimal amount of dose (5 ng/100 units) supplanted the former
type A neurotoxin. The latter type A of BTX consisted of low protein load which
reduced the amount of formation of antibodies in the body causing low resistance to
the injected neurotoxin. But with the time the body becomes resistant towards the
injected neurotoxin which is referred to as type A resistant body. So in alternative
solution to the problem, the patients with the type A resistance body were injected
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with another type of Botulinum neurotoxin which is known as [8] Botulinum Neurotoxin Type B (NeuroBloc). The results from the usage of this type of neurotoxin
were safe and efficacious and sustained for a prolonged period of 12–16 weeks.
The treatment of the cervical dystonia is quite complicated. [9] 14% of the patients
do no respond to the injection of Botulinum neurotoxins since the body develops an
immune resistance to the chemicals. So another type of treatment method needed.
This new type of treatment was inclined towards the surgical method. The method
consisted of the stimulation of the globus pallidus internus which is a part of the brain
responsible for the movements. The use of the qurdripolar electrodes is appealing by
placing it bilaterally under the stereotactic guidance to the globus pallidus internus.
The result of this treatment is the gradual improvement in the cervical dystonia within
three months period. But with the prolonged usage of the brain stimulation technique,
the changes were noticed in the globus pallidus internus.
3 Proposed System
The prototype was first designed for the basic support of the neck and head to keep it
still and steady looking only in straightforward direction. As it is shown in the Fig. 1.
Fig. 1 AutoNeck head support system
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Fig. 2 Basic support of the neck and head
The system did not contain any intricate circuitry and was just a wear on the back
device. It only had a basic skeletal structure with a head belt to keep head stuck to
the structure. As it is shown in the Fig. 2.
The device kept his head in straight direction so that he can at least be able to
keep the head straight while working or driving (Table 1).
The circuitry used in system consists of Arduino Uno, Servo Motor, Bluetooth
module, power supply of +5 V and Jumper cables for the connection As it is shown in
the Fig. 3. The Servo Motor is attached to a shaft which rotates from 45° to 135°. The
rotation limit is imposed by the application downloaded on a Smartphone which is to
be operated by the user to rotate it in the desired direction ranging from 45° to 135°.
The connection between the Smartphone and the device is achieved wirelessly via
Bluetooth module which is interconnected with Arduino Uno. The input is received
and stored in the Arduino Uno via Bluetooth module. The input which is received
and stored in Arduino Uno is inserted as input to the code of rotating the Servo Motor
shaft embedded in the Arduino Uno. The input is converted to degree of rotation and
then output is achieved and inserted to the Servo Motor as input. The Servo Motor
responds to the input by producing a degree rotation to the Shaft attached to Servo
Motor. The shafts move the head in the desired direction. Table 2 is shown which
represents all the experimental values.
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Table 1 Devices required for the implementation of the support system
1.1
Arduino Uno
Arduino is a hardware and software company that is open source
which also happens to be a community that designs and manufacture
microcontroller boards and the kits of microcontroller. These
microcontrollers are used to build interactive objects and digital
devices. They can sense and control the objects of the physical world
1.2
Servo motor
It is an actuator which can be linear or rotary which allows the linear
or angular position, velocity and acceleration control precisely. The
position feedback is provided by a sensor that is coupled with a
suitable motor. It requires a sophisticated controller that is a
dedicated module designed to be used with servo motor
1.3
Jumper cables
These are the pairs of electric cables that are used to complete the
connections between various components of circuit. These cables
consist of alligator beak-like connecting ports
1.4
Bluetooth module
It is a standard of wireless technology for data exchange over short
distances (Short wavelength radio waves of UHF ranging in between
2.4 and 2.485 GHz in the ISM band) from mobile and fixed devices,
building PAN (personal area network)
1.5
Circuit box
The circuit box is used to hold and maintain the circuitry and
attached to the main skeletal support structure at the back. The box
has all the devices like servo motor, Bluetooth module, Arduino
Uno, jumper cables
Fig. 3 Connection between different elements of the device
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Table 2 Experimental values
Mobile application input
Static system (Degrees)
Dynamic system (Degrees)
0
0
0
30-R
36
29.8
60-R
64
58.6
90-R
76.4
87
0
0
0
30-L
19.8
26.1
60-L
31
54.8
90-L
42
78
4 Working
The working of Flow chart for proposed system of the device is shown in Fig. 4.
4.1 Android Application
The user will connect Smartphone with AutoNeck device by using a graphical user
interface which allows the user to input the degree of rotation to the device. The
application snap samples are mentioned below.
4.2 Bluetooth Module
The Bluetooth module allows the connection of Smartphone application to Arduino
Uno. The input signals are received at the receiver end of the Bluetooth module. The
Bluetooth module recognizes these input signals and determines the device to which
these signals are to be inserted. The suitable output is produced by the Bluetooth
module and sent to the connected device.
4.3 Arduino Uno
Arduino Uno is connected to the Bluetooth module and a Servo Motor. It receives
input from the Bluetooth module and produces output for Servo Motor in degrees
of rotation. The signals which are transmitted by Bluetooth module are received
at the receiver end of the Arduino Uno. The Arduino Uno is to be programmed
accordingly to support the connection of Bluetooth module and Servo Motor. It
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Fig. 4 Flowchart for proposed system of the device
contains the program that takes the input signal produced by the user and then, it
produces the output for Servo Motor. The Servo Motor receives these rotations at the
receiver end of it connected to transmitter end of Arduino Uno.
4.4 Servo Motor
The Servo Motor is connected to the Arduino Uno and a shaft that rotates with the
shaft of the Servo Motor. The receiver of the Servo Motor recognizes the signal only
in terms of degree of rotations which are actually voltage fluctuations. The input
voltages are applied to the Servo Motor to rotate the shaft of the motor.
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4.5 Gears
The gears are used to provide the transmission of rotation from one body of system
to another body of the system.
The Servo Motor’s shaft has a gear which is attached to it with the diameter of
gear perpendicular to the shaft of the motor. Another gear is attached to the one end
of the other shaft with diameter of gear perpendicular to the length of the shaft. The
gear of motor is tangential to the gear of the other shaft. The rotation is supplied
from the motor gear to the shaft gear.
4.6 Shaft
The main shaft is connected tangentially to the shaft of Servo Motor via gears. The
rotations received at one end of the main shaft via gear rotate the main shaft which
has head belt at the other end.
4.7 Head Belt
It keeps the head still with a Velcro belt which is worn on the forehead of the user.
5 Results
The base angle which is assumed to be the line of sight heading in the straightforward
direction is considered be 0 degrees on goniometer scale.
• The measurements are done with respect to the base angle.
• The affected site for the cervical dystonia is in the right direction of the base angle
which is about 70 degrees right.
• The device is able to rotate to 90° in the right direction from base angle. The effort
produced by the device rotates the head effortlessly as the affected site of the neck
muscles is at 70° right. But the device’s efficacy diminishes as it reaches near the
90° right because the effort of the involuntarily contracted muscles applies a back
torque to rotate the head back to the affected direction of 70°.
System is also able to apply torque effort to rotate the head to the left direction
of the base angle up to 90°. But, here, the effort complexity increases as the effort
produced by the device tries to overcome the involuntarily contracted neck muscle’s
effort and so the workload of the device also increases. As the rotation reaches close
to the 90° left, the back pull of the torque effort of the contracted muscles makes
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harder for the device to rotate further in the left direction and hence, the values of
the recorded observations suffer from the accurate values.
6 Method and Instrument Adopted for the Recorded
Observations
Goniometry: The method of Goniometry is adopted to record the range of motion
of the head by using an instrument known as “Goniometer”. The range of motion is
recorded with respect to an initial line or a pivot.
Goniometer: The device or primitively called as a “Scale” is a two piece scale
lines which are jointed at one end while the counterparts are free to rotate among a
common axis. The scale measurements are minted on the circular part of one scale
line which remains stationary, while the other scale line rotates around it.
The plotting of the graphs is done by assuming that the cervical dystonia’s site
is in the right direction which is keeping the head in in 70° with respect to the line
of sight in the right direction. All the values are plotted by assuming that the initial
position of the head for both the support systems that are static system and dynamic
system is in the straight direction of the head. This direction is named as line of
sight and al the rotations are in with respect to this line of sight. The line of sight
coincides with the degree rotation measurement 0°. The maximum rotation that can
be achieved is 90° right or left which is in line with the shoulder blades. Table 2 is
shown which represents all the experimental values (Figs. 5, 6, 7 and 8).
The discussion of the results obtained under the results obtained title signifies that
the support systems which are mentioned under the related work title are inferior to
the proposed dynamic support system. The plotting of the graphs shows how the
effort produced by the dynamic support system can be coupled with the efforts that
the patient applies in order to rotate the head and surpass the effort produced by the
involuntarily contracted neck muscles. The measurement of the effort that the neck
muscles produces requirement an expensive equipment and so the analysis of the
effort production is done by analysing the degrees of rotation achieved when using
the static support system and dynamic support system. All the initial conditions are
assumed and mentioned under the results obtained title (Fig. 9).
7 Conclusion and Future Work
The recorded observations reflect that the device AutoNeck is a new method for how
technology can help in medical science and proves to be efficacious in providing the
motility to the patients suffering from the defect by working against the involuntarily
nature of the cervical muscles which happens to be the affected site of the cervical
dystonia. The obtained values are selfexplanatory that the device is working hard in
accordance to the voluntarily effort that the patient applies to rotate the head close to
An Improved Technique on Existing Neck and Head Support …
Fig. 5 Picture of smartphone application
Fig. 6 Goniometer
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Fig. 7 Graph of static support system
Fig. 8 Graph of dynamic support system
the desired values. For future enhancements, the input device can be replaced with
a pupil movement tracking sensor which will provide the range of motion as input
to the device which will cause the rotation of the head in the direction of the line of
sight of the pupil.
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Fig. 9 Comparison between the intended input, the static and dynamic support system
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