Abstract:
A cephalic and cervical support apparatus for immobilization and traction of the cervical rachis including a semirigid, flexible unitary shell having a facial opening and upper, middle and lower sections. The upper section substantially conforms to a wearer&#39;s head and has a forehead strap which extends in a substantially horizontal direction across the wearer&#39;s forehead. The middle section substantially conforms to a wearer&#39;s neck area, encircling the neck area, and having a division in the shell in the submandibular region. The lower section substantially conforms to the wearer&#39;s upper shoulder, back and chest area, and has a division connected to the division in the middle section which allows the shell to be opened for installation on a wearer. The division can be releasably closed by a fastening device, and the support apparatus can be held on a wearer by engagement of a pair of arm straps. A structural combination of three curves, the convex curve formed by the joining of the three sections, the downwards facing lower concave curve which conforms to the wearer&#39;s shoulders and the middle concave curve conforming to the wearer&#39;s neck, results in greater rigidity of the shell even with the use of a relatively lightweight structural material.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This patent application is a continuation-in-part of U.S. patent application Ser. No. 461,815, filed on 8 Jan. 1990, now abandoned. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention is directed generally to an improved anatomical support or orthopedic appliance and more particularly to an orthopedic appliance adapted for immobilizing the human cephalic, cervical, and upper thoracic vertebrate. 
     It is often necessary to transport injured individuals to trauma centers. On many occasions it is not known whether these individuals have sustained cephalic or cervical injuries that may be exacerbated should the traumatized individual be moved. Additionally, atlas, axis, or other vertebral fractures of the cervical rachis, often produce jagged edges of bone capable of severing the spinal chord or the cervical vascular supply to the brain. 
     Therefore, a method of quickly and safely immobilizing the cervical rachis of those with potential head and neck injuries has long been an object of those skilled in both transporting and administering emergency medical attention. 
     The saving of even a few seconds in the preparation and transportation of an injured individual can mean the difference between life and death. Since it is often necessary to immobilize the cervical rachis prior to such transportation, orthopedic appliances adapted for such use must be capable of safe and rapid placement on a traumatized individual. 
     There are several prior art devices designed to immobilize the cervical rachis. However, these devices either require that an injured individual be moved unnecessarily, or are difficult and time consuming to position on a traumatized individual. 
     For example, Hale, U.S. Pat. Nos. 2,736,314 and 2,904,040 teach the construction of cervical braces that are difficult and unsafe to install and require movement of the head, neck and shoulders to position the appliance on a traumatized individual. 
     Other multiple piece braces have the same inherent problems: Pujals, U.S. Pat. No. 4,708,129; Calabrese, U.S. Pat. No. 4,677,969; Watt, U.S. Pat. No. 4,194,501; Meyer, U.S. Pat. No. 4,141,368; and Ochs, et al., U.S. Pat. No. 4,043,325. 
     Other prior art devices such as Tucker, et al., U.S. Pat. No. 4,712,540, provide a single point of attachment, but require the traumatized neck to support itself. 
     Likewise, at the discretion of an emergency trauma specialist, it is often necessary to place an individual recovering from a cranial, mandible, or cervical injury in an extended state of traction. Prior art devices are available for such use, however, these devices are heavy, cumbersome, and uncomfortable. 
     Further, it is often desirable to protect convulsion prone patients from head or neck injuries that often occur during seizures. In addition, it is often desirable to maintain the cervical rachis of a comatose patient in a neutral position so as to prevent damage to the rachis and surrounding tissue. 
     Another problem encountered in using prior art devices equipped with forehead straps is that the forehead straps often rest at an upward angle, i.e. the center of the strap rests higher on the forehead than the ends of the strap. This can cause undesirable downward vertical pressure on the spine, thus exacerbating the spinal injury. 
     Yet another problem encountered in using prior art devices is that they tend to be heavy and bulky, using heavy plastics in their construction to supply the necessary degree of rigidity for immobilization of the cervical rachis. This results in discomfort for the wearer, which worsens during extended wearing. Therefore, there is a real need for a relatively lightweight cervical rachis immobilization device. 
     A primary object of the invention is to provide an improved cephalic and cervical support. 
     Another object of the invention is to provide a support that utilizes the thoracic cavity as a foundation to support the head and neck. 
     Another object of the invention is to provide a support that is easy to position on an injured patient. 
     Another object of the invention is to provide a support that is durable and rugged in construction. 
     Another object of the invention is to provide a support that is comfortable to wear. 
     Another object of the invention is to provide a support that may be positioned quickly on an injured individual. 
     Another object of the invention is to provide a support that provides stabilization against flexion, extension, lateral bending, and rotation of the cervical rachis. 
     Another object of the invention is to provide a support that allows a health care provider access to an injured individual&#39;s ears for diagnostic evaluation and potential treatment. 
     Another object of the invention is to provide a support that allows a health care provider access to an injured individual&#39;s anterior neck region. 
     Another object of the invention is to provide a support that allows a health care provider to artificially ventilate an injured individual. 
     Another object of the invention is to provide a support that has a forehead securement strap which extends in a substantially horizontal direction across a wearer&#39;s forehead thereby substantially eliminating downwards vertical pressure on the spinal column. 
     Another object of the invention is to provide a support that is relatively lightweight and comfortable to wear for extended periods, yet retains sufficient rigidity to immobilize the cervical rachis. 
     Finally, another object of the invention is to provide a support that is safe in use and durable in construction. 
     SUMMARY OF THE INVENTION 
     The present invention includes a firm yet pliable shell for immobilization and traction of the cervical rachis. The shell opens at the front and includes a back portion formed to be supported on the upper back and extend upwardly past the neck to at least the lambda region of the skull in order to secure the head against rearward movement. The shell also has right and left side portions extending forwardly from opposite sides of the shell back portion to generally conform to the tops of a wearer&#39;s shoulders and sides of the wearer&#39;s head. The right and left front portions extend forwardly from the right and left side portions for conforming the shell to the anterior upper chest of a wearer. 
     The appliance is secured to a wearer by a pair of arm straps extending from the left and right sides of the back portion and under the axilla to the left and right sides of the front portion respectively. 
     The left and right sides of the front portions are releasably and adjustably secured together by straps in order to draw the back and side portions into engagement against the head of a wearer. An additional strap is provided to releasably and adjustably secure the neck stabilizer to opposite front portions so that the appliance conforms to the full circumference of the wearer&#39;s head to substantially fix the position of the wearer&#39;s head against movement. 
     In reference to FIGS. 16-25, the following summary describes the present invention as including a semirigid, flexible unitary shell for immobilization and traction of the cervical rachis. The shell opens at the front and includes a facial opening and upper, middle, and lower sections. 
     The upper section is formed to substantially conform to a wearer&#39;s head, extending upwards along the rear of the head to a point above the base of the wearer&#39;s occipital bone. The front top edges of the upper section are adjacent the upper portion of the wearer&#39;s forehead and substantially conform to the sides of a wearer&#39;s head. 
     The middle section is formed to substantially conform to a wearer&#39;s neck area, encircling the wearer&#39;s neck and having a division in front to allow the shell to be placed on a wearer. The division extends downwards from the jaw area to the lower section. 
     The lower section is formed to substantially conform to a wearer&#39;s upper chest and shoulder and to rest thereon. A division is formed in the front face of the lower section, extended horizontally, then vertically downwards substantially parallel to the division in the middle section, thus forming a Z-shaped division to allow the shell to open. 
     The upper, middle, and lower sections join to form a substantially concave joining curve along the sides and rear of the shell. 
     To secure the support apparatus to a wearer a pair of arm straps are connected to and extend between front and back portions of the lower section, one strap on each side of said lower section, and adjustable and releasable to secure the support on a wearer. The arm straps pass underneath the arms and are reattached to the opposite portion of the lower section. 
     A forehead strap further secures the support apparatus on a wearer. The forehead strap is releasably and adjustably mounted on the upper section and extending between the upper opposite sides. The forehead strap may be placed across the forehead of a support wearer and secured to further prevent movement of the spinal area. Importantly, the forehead strap is designed to fit on and across the wearer&#39;s forehead in a substantially horizontal holding position, thus substantially eliminating downward vertical pressure on the spine of the support apparatus wearer, pressure which could possibly cause additional injury to the spine. 
     Lastly, the front division can be releasably and adjustably closed and secured by a fastening means such as a hook and loop fastener, so that a range of differently sized wearers may be accommodated. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a front view of a preferred embodiment of the Cephalic and Cervical Support Appliance 10 showing the axillary straps in an engaged position; 
     FIG. 2 is a front elevational view of a second embodiment having axillary straps being attached to the center back portion of the appliance 11 and showing the securement straps in a disengaged position; 
     FIG. 3 is a side elevational view of the FIG. 1 embodiment showing the right ear portal and the anterior cervical flap retainer hook fastener for locking the flap in an open position; 
     FIG. 4 is a rear elevational view of the FIG. 1 embodiment showing the left and right arm straps and their attachment points; 
     FIG. 5 is a top elevational view showing the head and face openings of the appliance; 
     FIG. 6 is a bottom elevational view illustrating the outline of the upper thoracic cavity formed by the appliance; 
     FIG. 7 is a side cross-sectional view showing the right ear portal of the appliance; 
     FIG. 8 is a front elevational view of the FIG. 2 embodiment positioned for placement on an accident victim; 
     FIG. 9 is a front elevational view of the FIG. 2 embodiment positioned above and ready to be placed from the posterior to the anterior onto an accident victim; 
     FIG. 10 is a front elevational view of the FIG. 2 embodiment positioned on an accident victim and showing the draw strap securing the front portions of the appliance; 
     FIG. 11 is a front elevational view of the FIG. 2 embodiment positioned on an accident victim and showing the arm straps attached beneath the left and right armpits; 
     FIG. 12 is a front elevational view of the FIG. 2 embodiment positioned on an accident victim and showing the anterior cervical flap secured by the anterior cervical strap; 
     FIG. 13 is a front elevational view of the FIG. 2 embodiment positioned on an accident victim and showing the frontal region strap secured to its attachment point; 
     FIG. 14 is a cross-sectional side view of a preferred embodiment positioned on an accident victim and showing an abbreviated internal anatomy of the cephalic and cervical regions; and 
     FIG. 15 is a partial sectional side view showing the right ear through the portal of a preferred embodiment. 
     FIG. 16 is a perspective view of an alternative embodiment of the invention showing the facial opening, arm straps and other features of the invention. 
     FIG. 17 is a top plan view of the invention of FIG. 16 showing the head opening and the middle concave curve conforming to the neck area. 
     FIG. 18 is a front elevational view of the invention of FIG. 16 showing the division in the front of the shell and the hook and loop fasteners for securing and closing the division and the concave side curves of the shell. 
     FIG. 19 is a side elevational view of the invention of FIG. 16 showing the rear joining concave curve. 
     FIG. 20 is a bottom plan view of the invention of FIG. 16. 
     FIG. 21 is a top sectional view of the invention of FIG. 16 taken along line 21--21 in FIG. 18 showing the lower part of the middle section and the lower section. 
     FIG. 22 is a front sectional view of the invention of FIG. 16 taken along line 23--23 in FIG. 19 showing the substantially form-fitting back and the concave joining curve extending along the upper, middle and lower sections of the invention. 
     FIG. 23 is a side sectional view of the invention of the FIG. 16 taken along line 22--22 in FIG. 18 showing the side cutaway of the shell and the ear opening. 
     FIG. 24 is a front view of the support of FIG. 16 on a wearer showing how the joining curves conform to a wearer&#39;s neck, head, shoulders and chest and how the arm straps secure the device on the wearer. 
     FIG. 25 is a side view of the support of FIG. 16 on a wearer showing the horizontal forehead strap and the chin and lower jaw support position. 
     FIG. 26 is a perspective view of the support of FIG. 16 showing the shell liner installed in the shell. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     The Cephalic and Cervical Support Appliance of the present invention is illustrated in two embodiments 10 and 11. The embodiment of FIG. 1 is further depicted in FIGS. 3, 4, 5, 6, 10, 11, 12, and 13 and is designated by the numeral 10. The second embodiment is shown in FIGS. 2, 8, and 9. FIGS. 7, 14, and 15 are generic to both embodiments and illustrate the appliance in cross-sectional views. 
     The two embodiments (10 and 11) differ in the placement of the back portion 14 attachment points 38 and 40 (FIGS. 2 and 4) of the axillary straps 34 and 36. The appliance 10 has the axillary straps 34 and 36 fixed at the lower center 15 of the back portion 14, while the appliance 11 has the axillary straps 34 and 36 fixed on the back left and right shoulder portions 16 and 18. 
     The appliance of both embodiment 10 and 11 includes a firm yet pliable bilayer shell of a polyurethane closed cell foam 126 covered by an easy to clean pliable synthetic polymer 128 (FIG. 7). As shown in FIGS. 2 and 6 the shell opens at the front (left and right front portions 12 and 13), and includes an opening 74 (FIG. 8) adapted so as to leave the facial area unobstructed by the installed appliance 10 or 11. 
     Included in the preferred embodiments is a back portion 14 formed to be supported on the upper posterior of the thoracic cavity. The back portion 14 extends upwardly past the neck to the lambda 118 region of the skull (FIG. 14). The thickness of the back portion increases from about 2.0 centimeter at or near point 15 to about 3.0 centimeters so that the thickness of the shell is greatest from the base of the neck to the upper extent of the back portion 14. 
     The shell also includes left and right side portions extending forward from opposite sides of the back portion 14. The left and right side portions include left and right side shoulder portions 16 and 18, left and right side neck portions 20 and 22, and left and right side head portions 26 and 28 (FIG. 4). 
     The left and right side head portions 26 and 38 of the shell extend upwardly to approximately 5.5 centimeters above the helix 120 of each ear 84 (FIG. 14). The left and right side head portions 26 and 28 of the shell have ear portals 30 and 32 respectively. The ear portals 30 and 32 are of a sufficient dimension to allow a health care provider access to an accident victim&#39;s ears 84. 
     The left and right side head portions 26 and 28 extend forward from the back portion 14 to the sides of a wearer&#39;s face so as to sheath and support a wearer&#39;s cervical rachis 125 and prevent movement of the head. 
     The back portion 14 extends upwardly and forwardly to the left and right front portions 12 and 13 to form left and right shoulder portions 16 and 18. So that the shell forms a cavity adapted to be fitted over the upper thoracic cavity 102 of an accident victim 80, the left and right shoulder portions extend at the left and right back from point 15 to the medial border of the scapula 101, and along the left and right front portions from approximately 5.0 centimeters below the jugular notch 112 along the clavicle 108 to the anterior angle of the axial 109. 
     The left and right front edges 140 and 142 of the left and right front portions 12 and 13 are drawn and held together by a draw strap 50 (FIGS. 9 and 10). The draw strap 50 is preferably made from a woven nylon strapping material, and is permanently attached on the left front portion 12 at point 52 (FIG. 8). Sewn or glued to the opposing end of the strap 50 is a portion of loop fastener 56 adapted to be removably secured by a portion of hook fastener 54 attached to the front right portion 13. 
     So as to draw the left and right front 144 and 146 and left and right back 148 and 150 shoulder portions together a pair of axillary straps 34 and 36 are provided (FIG. 4). 
     As shown by FIGS. 1 and 2 the axillary straps 34 and 36 may be permanently attached at either point 15 of the back portion 14, or on the left and right sides of the back portion 38 and 40 respectively. 
     Sewn or glued to the opposing ends of the axillary straps 34 and 36 are portions of loop fasteners 46 and 48. Sewn or glued to the front left and right shoulder portions 144 and 146 are hook fastener portions 42 and 44. The straps 34 and 36 are passed beneath the left and right arms 92 and 94 and are secured by the hook and loop fasteners so as to draw the left and right front (12 and 13) and back 14 portions together. Thus, secured by the axillary straps 34 and 36 a rigid foundation is formed by the shell about a wearer&#39;s thoracic cavity 102. 
     The right front portion 13 forms an anterior cervical flap 64 positioned above the right draw strap hook fastener 54 attachment point. The flap 64 extends to overlap the left front edge 140 so as to cover the anterior cervical region 104 from the mandible 96 to the jugular notch 112. 
     Permanently attached to the flap 64 at point 68 is a woven nylon strap 66. Sewn or glued to the opposing end of the strap 66 is a portion of loop fastener 72 adapted to be removably secured by a portion of hook fastener 70 attached to the left front portion 12 of the shell. In this way the anterior cervical strap 66 may be used to secure the anterior cervical region 104 and adding further rigidity to the left and right neck portions 20 and 22 of the appliance (10 or 11). 
     Likewise, the anterior cervical region 104 may be exposed while the appliance (10 or 11) is positioned on an accident victim 80 by drawing the flap 64 to the right so that the strap 66 loop fastener portion 72 may be removably secured by the hook fastener portion 132 (FIG. 3) permanently attached to the right cervical side of the shell 22. Thus, with the flap 64 secured in this position, health care providers may perform tracheotomies or the like. 
     In order to cause the shell material of the left and right side head portions 26 and 28 to conform to the shape of a wearer&#39;s head, and to further secure and immobilize the cervical rachis, a frontal region strap 134 of woven nylon is provided. 
     The frontal region strap 134 is permanently attached at point 135 on the left head side portion 26. Sewn or glued to the opposing end of the strap 134 is portion of loop fastener 138 for attachment to a portion of hook fastener 136 permanently attached to the right head side portion at point 137. The strap may be drawn across an accident victim&#39;s forehead 98 and secured by the strap hook and loop fastener means (FIG. 13). 
     So that a wearer of the appliance may be ventilated with an oxygen mask or the like, the facial area of a wearer is left unobstructed by the appliance (FIG. 13). 
     Whereas, not all individuals have the same body size, the embodiments 10 and 11 of the appliance may be of varying dimensions so as to allow for the safe and comfortable fit of any sized individual. Additionally, so that a health care provider may quickly locate the correct sized appliance each size may be formed of a different colored material. 
     In operation, one can readily and safely place the appliance 10 or 11 onto an accident victim 80 as shown by FIGS. 8, 9, 10, 11, 12, and 13. 
     FIG. 8 illustrates the appliance 11 having the draw strap 50, anterior cervical strap 66, axillary straps 34 and 36, and the frontal region strap 134 disengaged for positioning of the appliance 11 onto an accident victim 80. 
     FIG. 9 illustrates how the appliance 11 is brought from above and behind for positioning onto an accident victim 80. 
     FIG. 10 illustrates how the draw strap 50 is secured first in order to immobilize the cervical rachis 125 (FIG. 14). The next step in positioning the appliance 11 onto an accident victim 80 is illustrated by FIG. 11 where the axillary straps 34 and 36 are utilized to draw the front and back portions together in order to add further shell rigidity. FIG. 12 illustrates the closed position of the anterior cervical flap 64. 
     FIG. 13 illustrates the final step in positioning the appliance 11 onto an accident victim 80, wherein the frontal region strap 134 is secured so as to completely immobilize the cervical rachis 125 of an accident victim. 
     An alternative preferred embodiment of the Cephalic and Cervical Support Apparatus 210 is shown in FIGS. 16-25 as including a semirigid, flexible unitary shell 212 having a facial opening 214 and upper, middle and lower sections 216, 218 and 220. 
     The upper section 216 is preferably formed to substantially conform to a wearer&#39;s head and encompasses the apparatus from the top of the chin and lower jaw support 234 to the top of the support apparatus 210. The upper section 216 contains the facial opening 214, which is adapted so as to leave the facial area unobstructed by the installed support appliance 210. The upper section 216 also includes a pair of ear openings 222a and 222b cut into and through opposite sides of the upper section 216 so that health care providers may obtain access to the ears of a wearer. The upper section 216 also includes a forehead strap 224 preferably releasably and adjustably mounted to the top forward portion 226a and 226b of the upper section 216. The forehead strap mounting means is preferably a hook and loop fastener mounted on each end of the strap 224, and on the outer face of the apparatus at the top forward portion 226a and 226b such that the strap 224 may be placed across an apparatus wearer&#39;s forehead and secured, thus further immobilizing the wearer&#39;s neck area. Importantly, the forehead strap 224 is designed to fit on and across the apparatus wearer&#39;s forehead in a substantially horizontal holding position, thus substantially eliminating downwards vertical pressure on the spine of the support apparatus wearer, which can be caused by angled forehead straps. The forehead strap 224 may also be constructed of the same material and attached the same way as disclosed in the previously submitted specification as reference numeral 134. 
     The middle section 218 is preferably formed to substantially conform to the wearer&#39;s neck area, encircling the neck area and having a division 230 formed in the front face of the middle section 218. The division 230 is one part of the shell division 229, which includes the divisions in the lower section 220 also. The division 230 is substantially vertical and extends downwards from the left bottom of a wearer&#39;s jaw area, towards and into the lower section 220. Underneath the chin of the apparatus wearer is preferably a chin and lower jaw support 234, consisting of an outward shell extension approximately 3/4&#34; in extension and between 31/2&#34; and 41/2&#34; in width across the facial opening 214, in the preferred adult-sized embodiment of the present invention. This chin support 234 assists in further immobilizing the wearer&#39;s head, and in addition makes the apparatus more comfortable to wear. 
     On all sides of the middle section 218, except for the front face 232, a convex joining curve 236 is formed by the joining of the upper, middle and lower sections 216, 218 and 220. This joining curve 236 is best shown in FIG. 22 as a cutaway side of the shell 212, as extending downwards from just below the ear openings 222a and 222b to the outer edges of lower section 220. 
     This curve 236 adds stability to the shell 212 and helps the shell 212 conform to the head, neck and shoulder contours better. Furthermore, the convex joining curve 236 allows for a more comfortable wearing of the apparatus 210, which is important for situations in which the apparatus 210 may be worn for extended periods. 
     Beginning between 1&#34; and 3&#34;, preferably 2&#34;, below the lowest part of the chin and lower jaw support 234 is the lower section 220 of the apparatus 210, which is formed to substantially conform to an apparatus wearer&#39;s upper shoulder back and chest area and to rest thereon. The lower section 220 is between 10&#34; and 13&#34;, and preferably 11&#34;, in width at the widest point in the transverse dimension shown by line 21--21 in FIG. 18. 
     The lower section 220 contains a division 238 which is a continuation of the division 230 in the middle section 218. The lower section division 238 preferably has two components, a horizontal one 240 and a vertical one 242. The horizontal division 240 extends rightwardly from the end of the vertical division 230 in the middle section 218, extending beneath the chin and lower jaw support 234, between 2&#34; and 4&#34;, and preferably 3&#34;, below that support 234. The horizontal division 240 extends approximately 3&#34; to 5&#34; across the front face 246 of the lower section 220, approximately the same width as the chin and lower jaw support 234. The horizontal division 240 then intersects the vertical division 242 in the lower section 220, which extends downwards to the base of the lower section 220. The Z-shaped shell division 229 thus formed results in two flaps being formed, an upper neck flap 250 and a lower chest flap 252. In this manner, the shell 212 can be opened to allow the support apparatus 210 to be installed on a wearer. 
     Also mounted on the lower section 220 are a pair of arm straps 248a and 248b preferably made of an elastic material. The arm straps 248a and 248b are mounted on opposite sides of the lower section 220, as shown in FIG. 17, the strap ends removably and adjustably attached to the base of the apparatus 210, thus forming loops. The arm straps 248a and 248b are preferably mounted and installed on a wearer as disclosed in the previously submitted specification as reference numerals 34 and 36. 
     Finally, a tracheotomy opening 244 may be formed in the front face 246 of the lower section 220 approximately centered both vertically and horizontally on the horizontal division 240. The tracheotomy opening 244 is preferably between 11/4&#34; and 21/4&#34; in diameter to allow access for health care workers to the neck area to perform tracheotomies and the like. 
     To close and secure the shell division 229, a pair of securement straps 254 and 256 have their ends permanently mounted on the flaps 250 and 252, the upper securement strap 254 on the upper neck flap 250, the lower securement strap 256 on the lower chest flap 252. Mounted on the shell 212 at points 258 and 260 are portions of loop fastener which may be engaged by hook fasteners mounted on the nonmounted ends of the securement straps 254 and 256, such that the shell division 229 may be closed and secured in various positions to accommodate variously sized wearers. 
     The lower section 220 also has a downwards facing lower concave curve shape 262 such that the shoulders and trapezius muscle area of a wearer may fit therein. 
     The middle section 218, furthermore, has a middle concave curve 264 extending rearwardly in a substantially horizontal plane from a side of the front face of the middle section 218, curving around the side and rear neck area of a wearer, and ending in the opposite side of the front face. 
     The three curves previously mentioned, the convex joining curve 236, the downwards facing lower concave curve shape 262 and the middle concave curve 264, as a group work to greatly increase the stability of the support apparatus 210 in the following manner. As shown best in FIG. 25, the three curves 236, 262, 264 are in substantially orthogonal planes therefore providing tensioning strength in all directions. It is this unique combination of three curves 236, 262, 264 which further strengthens and reinforces the support apparatus 210. 
     The preferred construction material for the shell 212 is a pliable closed cell foam, which is a synthetic polymer. The synthetic polymer is preferably a polyurethane foam, and the shell 212 can be formed by layering the polyurethane foam one wearer-shaped mold. The layering of the foam results in increased rigidity of the shell 212. Preferably, the shell 212 is of a thickness between 1/32&#34; and 1/4&#34;, to keep the shell 212 semirigid but allow it to remain flexible. 
     A further preferred element of the present invention is a shell liner 266 as shown in FIG. 26. The shell liner 266 may be formed from a variety of cushioning materials, among which may be a cotton-like fabric such as that used in cloth diapers or a closed-cell polymer sponge material such as any of a number of commercially available foam sponge materials. The shell liner 266 is designed to conform to the inner surface 268 of the shell 212 and to substantially cover the inner surface 268 of the shell 212. The shell liner 266 may be removably secured to the inner surface 268 by double-sided adhesive tape or any other suitable means. The shell liner 266 serves several important purposes, one of which is to provide a cushioning substance so that the shell 212 may fit more comfortably and snugly on the wearer, thus providing better cephalic and cervical support. Most importantly, the shell liner 266 can be replaceable and disposable, thus allowing sanitary conditions to be better maintained. With today&#39;s increased concerns over blood-transmitted diseases, this disposable liner 266 addresses the present needs of health care providers in helping to prevent the spread of disease, a need unaddressed by previously disclosed devices. 
     Whereas, the invention has been disclosed in connection with a preferred embodiment thereof, it is apparent that many modifications, substitutions, and additions may be made thereto which are within the intended broad scope of the appended claims. 
     Thus, there has been described and shown a cephalic and cervical support apparatus which accomplishes at least all of the stated objects.