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Treleaven J. The Role of the Cervical Spine in Dizziness. J Neurol Phys Ther 2024:01253086-990000000-00074. [PMID: 39146225 DOI: 10.1097/npt.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
The neck can be implicated in dizziness via several, separate, discreet mechanisms. Proprioceptive cervicogenic dizziness (CGD) is the most common and reflects the cervical spine's important role, along with visual and vestibular input, for sensorimotor control. Impaired cervical proprioception can lead to symptoms such as dizziness, unsteadiness, visual disturbances, and altered sensorimotor control, and treatment directed toward cervical musculoskeletal and sensorimotor control is efficacious to improve this in individuals with cervical musculoskeletal disorders. Despite this, CGD is difficult to diagnose. Many people present with both neck pain and dizziness, and often the onset of both follows head and neck trauma, but neither necessarily implicate the neck as the cause of dizziness. Further, people often present with mixed forms of dizziness. Thus, rather than diagnosing CGD, it might be more important to consider the potential for the neck to have no (nil, co-morbid cervical condition) or some (minor, major, or compensatory) role in dizziness. Determining the precise role of the cervical spine role in dizziness requires a skilled interview and examination for cervical musculoskeletal and related sensorimotor impairments and relevant testing of other potential causes. A combination and cluster of test outcomes in addition to comparing responses to specific tests when the cervical afferents are stimulated and not stimulated will be important. Considering the role of the neck in dizziness will allow a balanced approach in assessment and management to allow timely, effective intervention to be provided to the large number of individuals presenting with neck pain and dizziness (Supplemental Digital Content, available at: http://links.lww.com/JNPT/A484).
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Affiliation(s)
- Julia Treleaven
- Neck and Head Research Unit, SHRS, The University of Queensland,Brisbane, Queensland, Australia
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Ebel M, Jahodova A, Jerabek J. Early Manifestation of Benign Paroxysmal Positional Vertigo: A Case Report. Case Rep Neurol 2024; 16:1-5. [PMID: 38179212 PMCID: PMC10764089 DOI: 10.1159/000535550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/25/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder with a heterogeneous etiology, often linked to preceding infections, head injuries, or vestibular neuronitis. While it is commonly observed in the elderly, its occurrence in the pediatric population is rare. To our knowledge, there have been no reported cases of BPPV in patients younger than 5 years. Case Presentation A 4.5-month-old female infant was admitted with episodes of paroxysmal nystagmus. Parents reported fast horizontal eye movements lasting up to 30 s, with one episode accompanied by vomiting. Comprehensive differential diagnosis was considered from epileptic nystagmus to intoxications and both central and peripheral vestibular etiologies. During the observation on ward, connection between the baby's positioning and nystagmus was identified. The diagnostic roll test confirmed a transient positional geotropic nystagmus. The diagnosis aligned with BPPV characteristics, pointing to the right lateral semicircular canal canalolithiasis. A successful Lempert roll maneuver was performed with prompt effect. To further support the diagnosis and research, we introduced a semiautomatic video-oculography method. Conclusion This case highlights a rare instance of BPPV in an infant. The clinical findings combined with the effectiveness of the repositioning maneuvers support the diagnosis of right lateral semicircular canal lithiasis. Despite the rarity of this condition in such a young-age group, the need for thorough diagnostic evaluations is emphasized. In order to document the case, we also present a semiautomatic video analysis pipeline for analyzing abnormal eye movements in a home setting.
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Affiliation(s)
- Matyas Ebel
- Department of Paediatric Neurology, 2nd Faculty of Medicine, University Hospital in Motol, Charles University, Prague, Czech Republic
| | - Alena Jahodova
- Department of Paediatric Neurology, 2nd Faculty of Medicine, University Hospital in Motol, Charles University, Prague, Czech Republic
| | - Jaroslav Jerabek
- Department of Neurology, 2nd Faculty of Medicine, University Hospital in Motol, Charles University, Prague, Czech Republic
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Belhassen S, Mat Q, Ferret C, Clavel R, Renaud B, Cabaraux P. Post-Traumatic Craniocervical Disorders From a Postural Control Perspective: A Narrative Review. BRAIN & NEUROREHABILITATION 2023; 16:e15. [PMID: 37554255 PMCID: PMC10404808 DOI: 10.12786/bn.2023.16.e15] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/10/2023] Open
Abstract
Mild traumatic brain injury (mTBI) and whiplash injury (WI) may lead to long-term disabling consequences known as post-concussive syndrome (PCS) and whiplash-associated disorders (WADs). PCS and WAD patients commonly complain of conditions encompassing dizziness, vertigo, headache, neck pain, visual complaints, anxiety, and neurocognitive dysfunctions. A proper medical work-up is a priority in order to rule out any acute treatable consequences. However investigations may remain poorly conclusive. Gathered in the head and neck structures, the ocular sensorimotor, the vestibular, and the cervical proprioceptive systems, all involved in postural control, may be damaged by mTBI or WI. Their dysfunctions are associated with a wide range of functional disorders including symptoms reported by PCS and WAD patients. In addition, the stomatognathic system needs to be specifically assessed particularly when associated to WI. Evidence for considering the post-traumatic impairment of these systems in PCS and WAD-related symptoms is still lacking but seems promising. Furthermore, few studies have considered the assessment and/or treatment of these widely interconnected systems from a comprehensive perspective. We argue that further research focusing on consequences of mTBI and WI on the systems involved in the postural control are necessary in order to bring new perspective of treatment.
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Affiliation(s)
- Serge Belhassen
- Groupe d'Etudes, de Recherche, d'Information et de Formation sur les Activités Posturo-Cinétiques (Gerifap), Juvignac, France
| | - Quentin Mat
- Department of Otorhinolaryngology, Centre Hospitalier Universitaire (CHU) Charleroi, Charleroi, Belgium
| | - Claude Ferret
- Departments of Oral Health Sciences and Otorhinolaryngology, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier, France
| | - Robert Clavel
- Groupe d'Etudes, de Recherche, d'Information et de Formation sur les Activités Posturo-Cinétiques (Gerifap), Juvignac, France
| | - Bernard Renaud
- Groupe d'Etudes, de Recherche, d'Information et de Formation sur les Activités Posturo-Cinétiques (Gerifap), Juvignac, France
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Astrup J, Gyntelberg F. The Whiplash Disease Reconsidered. Front Neurol 2022; 13:821097. [PMID: 35359634 PMCID: PMC8960646 DOI: 10.3389/fneur.2022.821097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
The natural course of the whiplash disease is reconsidered in relation to the predominant view of its cause. It is assumed that a whiplash-type trauma is causing an acute tissue injury such as a distortion or sprain in the neck followed by neck pain and headache, which then tends to become a chronic pain condition. We conclude that the whiplash disease typically evolves following a minor trauma without any signs of a tissue injury. It presents with central neuromotor dysfunction, such as electromyography (EMG) hyperactivity and abnormal activation patterns associated with dyscoordination of the involved and adjacent muscle groups. This indicates a central neurological rather than a peripheral traumatic pathology. This view places the cause of the whiplash disease within the central nervous system, and, in concordance with the EMG abnormalities and motor dyscoordination, we suggest the term cervical spinal dyssynergia for this pathology. It provides a new paradigm for further investigations of this disease as well as a window for possible specific neuropharmacological therapy directed towards dysfunctional neuromotor control.
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Prabu Raja G, Shyamasunder Bhat N, Cruz A, Prabhu A, Fernandes S, Naaz N. The anatomical myofascial continuum between the neck and eyes. Clin Anat 2022; 35:340-346. [DOI: 10.1002/ca.23835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022]
Affiliation(s)
- G. Prabu Raja
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Science Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
| | - N. Shyamasunder Bhat
- Department of Orthopedics Kasturba Medical College, Manipal Academy of Higher Education Manipal India
| | - Antony Cruz
- School of communication Manipal Academy of Higher Education Manipal Karnataka India
| | - Anupama Prabhu
- Department of Physiotherapy Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
| | - Shifra Fernandes
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Science Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
| | - Nabeela Naaz
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Science Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
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Astrup J, Gyntelberg F, Johansen A, Lei A, Marott JL. Impaired neck motor control in chronic whiplash and tension-type headache. Acta Neurol Scand 2021; 144:394-399. [PMID: 34021596 DOI: 10.1111/ane.13473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study is twofold, first to present a new method based on head laser tracking designed to measure head or hand movements and second to further investigate if patients suffering from chronic whiplash or tension-type headache have impaired motor control of neck muscles. MATERIAL AND METHODS A new laser tracking instrument was designed to measure the ability of a test person to track a reference point moving on the wall by a laser fixed to the forehead or held in the hand. The reference point to be tracked moves in runs of a circle or a square at three different speeds 10, 20, or 30 cm/s. We used a 1 × 1 ×1 m setup geometry to provide head movements well below pain release. Groups of 22 patients diagnosed with chronic whiplash-associated disorder grade 2, 19 patients diagnosed with chronic tension-type headache, and 37 control persons were compared. RESULTS A small but highly significant dyscoordination of head movements was observed in both patient groups and in whiplash also of the hand. CONCLUSIONS Our study presents a new method based on laser tracking for precision quantitative measurements of head or hand movements during standardized conditions. The results confirm that motor control of head movements is impaired in both chronic whiplash and tension-type headache, and in whiplash also of the hand. This suggests involvement of the central nervous system in the pathology of these diseases.
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Affiliation(s)
- Jens Astrup
- Danish Headache Centre Rigshospitalet Glostrup Glostrup Denmark
| | - Finn Gyntelberg
- Danish National Research Centre for Working Environment Copenhagen N Denmark
| | | | | | - Jacob Louis Marott
- Copenhagen City Heart Study Frederiksberg‐Bispebjerg Hospital Copenhagen University Hospital Copenhagen Denmark
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Favaretto N, Lionello M, Boscolo-Berto R, Giacomelli L, Rondinelli R, Marioni G. Video-nystagmographic evidence in more than 700 consecutive cases of road traffic whiplash injury. Am J Otolaryngol 2021; 42:102909. [PMID: 33476974 DOI: 10.1016/j.amjoto.2021.102909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.
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Affiliation(s)
- Niccolò Favaretto
- Department of Neurosciences DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Rafael Boscolo-Berto
- Institute of Human Anatomy, Department of Neuroscience DNS, Padova University, Padova, Italy
| | - Luciano Giacomelli
- Department of Neurosciences DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - Gino Marioni
- Department of Neurosciences DNS, Otolaryngology Section, Padova University, Padova, Italy.
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Inter-Visit Reliability of Smooth Pursuit Neck Torsion Test in Patients with Chronic Neck Pain and Healthy Individuals. Diagnostics (Basel) 2021; 11:diagnostics11050752. [PMID: 33922237 PMCID: PMC8146353 DOI: 10.3390/diagnostics11050752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022] Open
Abstract
Visual disturbances are commonly reported in patients with neck pain. Smooth pursuit neck torsion (SPNT) test performed in neutral position and with trunk rotated under the stationary head has been used to discriminate between those with cervical component and those without. However, no studies investigated the reliability of the SPNT-test in patients with chronic neck pain and healthy controls. The aim of this study was to assess inter-visit reliability of the SPNT-test while applying different amplitudes and velocities of target movement. Thirty-two controls and thirty-one patients were enrolled in the study. The SPNT-test was performed in neutral position and through 45° torsion positions. The test was performed at 20°/s, 30°/s and 40°/s velocities and at 30°, 40° and 50° amplitudes of cyclic sinusoidal target movements. Interclass correlation coefficient and smallest detectable change were calculated for parameters of gain and SPNT-differences. In patients, moderate to good reliability was observed for gain at 40° and 50° amplitudes and for 20°/s and 30°/s velocities, while moderate to excellent reliability for gain was observed in controls. Both groups presented with moderate to good reliability for SPNT-difference. Our findings imply that amplitudes of 40° and 50° and velocities of 20°/s and 30°/s are the most reliable and should be applied in future studies assessing oculomotor functions during the SPNT test.
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Boo M, Matheson G, Lumba-Brown A. Smooth Pursuit Eye-Movement Abnormalities Associated With Cervical Spine Whiplash: A Scientific Review and Case Report. Cureus 2020; 12:e9872. [PMID: 32963912 PMCID: PMC7500708 DOI: 10.7759/cureus.9872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Whiplash injuries may disrupt normal cervical afferent and efferent projections. Oculomotor abnormalities have been reported in chronic whiplash cases, but there is limited knowledge of their presence in acute whiplash and how acute assessment may target early intervention. We present a literature review and case study of a 22-year-old female presenting with an acute concussion and whiplash secondary to a high-speed motor vehicle collision. Smooth pursuit eye-movement abnormalities were observed in relative cervical rotation in the setting of clinical examination of cervicogenic dysfunction. Treatment was focused on cervical manual therapy. While concussive symptoms resolved after seven days, eye-tracking showed a mild improvement and continued to exist in relationship with cervicogenic dysfunction. After completing physical therapy twice weekly for two weeks and in-home exercises, clinical signs and symptoms of whiplash-associated cervicogenic dysfunction and abnormal smooth pursuit eye-movement resolved across all cervical positions. This case highlights the need for ocular-motor impairment assessment following acute whiplash, specifically during cervical rotation. Early intervention should focus on cervical manual therapy and may be important in supporting altered cervical afferents causing oculomotor dysfunctions following acute whiplash.
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Affiliation(s)
- Marie Boo
- Sports Medicine, Stanford University, Stanford, USA
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10
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Worsfold C. Functional rehabilitation of the neck. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1759176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Chris Worsfold
- MSK Research Unit, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. Eur Arch Otorhinolaryngol 2018; 275:2421-2433. [PMID: 30094486 DOI: 10.1007/s00405-018-5088-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other. METHODS This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers' understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links. RESULTS Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm. CONCLUSIONS So far, no single clinical study, either epidemiological or interventional, has incorporated and isolated all the constitute conditions of cervicogenic dizziness. There is a need for such studies in the future to validate either the reliability of a clinical test or the efficacy of an intervention in cervicogenic dizziness.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India.
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Stiebel-Kalish H, Amitai A, Mimouni M, Bach M, Saban T, Cahn M, Gantz L. The Discrepancy between Subjective and Objective Measures of Convergence Insufficiency in Whiplash-Associated Disorder versus Control Participants. Ophthalmology 2018; 125:924-928. [DOI: 10.1016/j.ophtha.2017.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 11/24/2022] Open
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The influence of cervical movement on eye stabilization reflexes: a randomized trial. Exp Brain Res 2017; 236:297-304. [PMID: 29147731 DOI: 10.1007/s00221-017-5127-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/08/2017] [Indexed: 12/20/2022]
Abstract
To investigate the influence of the amount of cervical movement on the cervico-ocular reflex (COR) and vestibulo-ocular reflex (VOR) in healthy individuals. Eye stabilization reflexes, especially the COR, are changed in neck pain patients. In healthy humans, the strength of the VOR and the COR are inversely related. In a cross-over trial the amplitude of the COR and VOR (measured with a rotational chair with eye tracking device) and the active cervical range of motion (CROM) was measured in 20 healthy participants (mean age 24.7). The parameters were tested before and after two different interventions (hyperkinesia: 20 min of extensive active neck movement; and hypokinesia: 60 min of wearing a stiff neck collar). In an additional replication experiment the effect of prolonged (120 min) hypokinesia on the eye reflexes were tested in 11 individuals. The COR did not change after 60 min of hypokinesia, but did increase after prolonged hypokinesia (median change 0.220; IQR 0.168, p = 0.017). The VOR increased after 60 min of hypokinesia (median change 0.155, IQR 0.26, p = 0.003), but this increase was gone after 120 min of hypokinesia. Both reflexes were unaffected by cervical hyperkinesia. Diminished neck movements influences both the COR and VOR, although on a different time scale. However, increased neck movements do not affect the reflexes. These findings suggest that diminished neck movements could cause the increased COR in patients with neck complaints.
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Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother 2017; 7:12. [PMID: 29340206 PMCID: PMC5759906 DOI: 10.1186/s40945-017-0040-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/04/2017] [Indexed: 12/21/2022] Open
Abstract
Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for CGD and therefore CGD is a diagnosis of exclusion. It can be difficult for healthcare professionals to differentiate CGD from other vestibular, medical and vascular disorders that cause dizziness, requiring a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses. Consequently, the purpose of this paper is to provide a systematic diagnostic approach to enable healthcare providers to accurately diagnose CGD. This narrative will outline a stepwise process for evaluating patients who may have CGD and provide steps to exclude diagnoses that can present with symptoms similar to those seen in CGD, including central and peripheral vestibular disorders, vestibular migraine, labyrinthine concussion, cervical arterial dysfunction, and whiplash associated disorder.
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Affiliation(s)
- Alexander S. Reiley
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Frank M. Vickory
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Sarah E. Funderburg
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Rachel A. Cesario
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Richard A. Clendaniel
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
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Ischebeck BK, de Vries J, Janssen M, van Wingerden JP, Kleinrensink GJ, van der Geest JN, Frens MA. Eye stabilization reflexes in traumatic and non-traumatic chronic neck pain patients. Musculoskelet Sci Pract 2017; 29:72-77. [PMID: 28324698 DOI: 10.1016/j.msksp.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/27/2017] [Accepted: 03/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many chronic neck pain patients experience problems with vision. These problems are possibly induced by deviations of the eye stabilization reflexes. It is not known whether these eye reflex alterations occur both in traumatic and non-traumatic neck pain patients. OBJECTIVE To investigate if the cervico-ocular reflex (COR) and the vestibulo-ocular reflex (VOR) are changed in tertiary care patients with prolonged, chronic neck pain with various origin of complaints. DESIGN Cross sectional study. METHODS Ninety-one chronic neck pain patients were subdivided into three groups by origin of complaints, and compared with healthy controls. COR and VOR gains were measured with an infrared eye tracking device with the subject sitting on a rotating chair in a darkened room and with the head fixed. RESULTS Neck pain patients had a higher COR gain (median 0.41, IQR 0.289) compared with healthy controls (median 0.231, IQR 0.179). The mean COR gain did not differ between the three patient groups (Whiplash Associated Disorders 0.444 (SD 0.221); traumatic 0.397 (SD0.205); non-traumatic 0.468 (SD0.236)). There was no difference in VOR gain between the groups. CONCLUSION Chronic neck pain patients, who already received primary care, still have an elevated cervico-ocular reflex. The origin of complaints did not seem to be associated with this deviant oculomotor behavior.
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Affiliation(s)
- Britta K Ischebeck
- Department of Neuroscience, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands; Spine and Joint Centre, Noordsingel 113, 3035 EM, Rotterdam, The Netherlands.
| | - Jurryt de Vries
- Department of Neuroscience, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands; Department of Physical Therapy, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - Malou Janssen
- Department of Neuroscience, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | - Gert-Jan Kleinrensink
- Department of Neuroscience, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jos N van der Geest
- Department of Neuroscience, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maarten A Frens
- Department of Neuroscience, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands; Erasmus University College, Rotterdam, P.O. Box 1738, 3000 BR, Rotterdam, The Netherlands
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