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Yilmaz K, Yazicioglu FG, Akkoyun Sert O, Ozturk B, Armutlu K, Yuce H. The effects of basic body awareness therapy on balance in patients with chronic neck pain: a randomised crossover trial. Somatosens Mot Res 2023; 40:147-155. [PMID: 36815247 DOI: 10.1080/08990220.2023.2181327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE This study aimed to compare the effects of basic body awareness therapy (BBAT) and conventional treatments (CT) on balance in patients with chronic neck pain. METHODS Thirty-five patients with neck pain participated in this randomised two-period crossover trial. Patients were divided into A (BBAT/CT) (n = 17) and B (CT/BBAT) (n = 18) groups. Group A received BBAT twice a week for 6 weeks, whereas Group B received CT within the same parameters. After a 5-week washout period, the treatments received by the groups were changed. The primary outcome was balance, assessed via the sensory organisation test (SOT) using the computerised dynamic posturography device. The secondary outcome was pain assessed by the visual analogue scale. Assessments were performed before and after primary and secondary treatments. RESULTS In Group A, the SOT conditions 4, 5, 6; composites score; and visual and vestibular system scores increased after BBAT; however, only condition five scores and vestibular system scores increased (p < .05) in Group B, which started with CT. Within the groups, both treatments were effective for easing pain (p < .05). CONCLUSIONS Although patients who started the therapy with BBAT showed more improvement in balance, no differences were observed between the therapies.
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Affiliation(s)
- Kamil Yilmaz
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, KTO Karatay University, Konya, Turkey
| | - Fatma Gul Yazicioglu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ozlem Akkoyun Sert
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, KTO Karatay University, Konya, Turkey
| | - Burak Ozturk
- Department of Audiology, Faculty of Health Sciences, Izmir Bakircay University, İzmir, Turkey
| | - Kadriye Armutlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hamiyet Yuce
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balıkesir, Turkey
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Moen U, Knapstad MK, Wilhelmsen KT, Goplen FK, Nordahl SHG, Berge JE, Natvig B, Meldrum D, Magnussen LH. Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study. BMC Musculoskelet Disord 2023; 24:173. [PMID: 36882720 PMCID: PMC9992911 DOI: 10.1186/s12891-023-06279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain. METHODS This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression. RESULTS Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups. CONCLUSION Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.
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Affiliation(s)
- Unni Moen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Mari Kalland Knapstad
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Norwegian National Advisory Unit On Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
| | | | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit On Vestibular Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Erik Berge
- Norwegian National Advisory Unit On Vestibular Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bård Natvig
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Dara Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Liv Heide Magnussen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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3
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Gill-Lussier J, Saliba I, Barthélemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med 2023; 12:jcm12051884. [PMID: 36902670 PMCID: PMC10003866 DOI: 10.3390/jcm12051884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Proprioceptive cervicogenic dizziness (PCGD) is the most prevalent subcategory of cervicogenic dizziness. There is considerable confusion regarding this clinical syndrome's differential diagnosis, evaluation, and treatment strategy. Our objectives were to conduct a systematic search to map out characteristics of the literature and of potential subpopulations of PCGD, and to classify accordingly the knowledge contained in the literature regarding interventions, outcomes and diagnosis. A Joanna Briggs Institute methodology-informed scoping review of the French, English, Spanish, Portuguese and Italian literature from January 2000 to June 2021 was undertaken on PsycInfo, Medline (Ovid), Embase (Ovid), All EBM Reviews (Ovid), CINAHL (Ebsco), Web of Science and Scopus databases. All pertinent randomized control trials, case studies, literature reviews, meta-analyses, and observational studies were retrieved. Evidence-charting methods were executed by two independent researchers at each stage of the scoping review. The search yielded 156 articles. Based on the potential etiology of the clinical syndrome, the analysis identified four main subpopulations of PCGD: chronic cervicalgia, traumatic, degenerative cervical disease, and occupational. The three most commonly occurring differential diagnosis categories are central causes, benign paroxysmal positional vertigo and otologic pathologies. The four most cited measures of change were the dizziness handicap inventory, visual analog scale for neck pain, cervical range of motion, and posturography. Across subpopulations, exercise therapy and manual therapy are the most commonly encountered interventions in the literature. PCGD patients have heterogeneous etiologies which can impact their care trajectory. Adapted care trajectories should be used for the different subpopulations by optimizing differential diagnosis, treatment, and evaluation of outcomes.
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Affiliation(s)
- Joseph Gill-Lussier
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
- Collège d’Études Ostéopathique de Montréal (CEOM), Montréal, QC H3G 1W7, Canada
| | - Issam Saliba
- Division of Otolaryngology, Head and Neck Surgery—Otology and Neurotology, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC H2X 3E4, Canada
- Correspondence:
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
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4
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Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. J Clin Med 2022; 11:jcm11216293. [DOI: 10.3390/jcm11216293] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 01/17/2023] Open
Abstract
Basic science and clinical evidence suggest that cervical spine disorders can lead to dizziness. The cervical spine has highly developed proprioceptive receptors, whose input information is integrated with the visual and vestibular systems in the central nervous system, acting on the neck and eye muscles to maintain the coordinative motion of the head, eyes, neck, and body through various reflex activities. When the cervical proprioceptive input changes due to the mismatch or conflict between vestibular, visual, and proprioceptive inputs, cervicogenic dizziness may occur. The diagnosis of cervicogenic dizziness can be determined based on clinical features, diagnostic tests, and the exclusion of other possible sources of dizziness. The cervical torsion test appears to be the best diagnostic method for cervicogenic dizziness. Based on the available evidence, we first developed the diagnostic criteria for cervicogenic dizziness. Treatment for cervicogenic dizziness is similar to that for neck pain, and manual therapy is most widely recommended.
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Koukoulithras I, Drousia G, Kolokotsios S, Plexousakis M, Stamouli A, Roussos C, Xanthi E. A Holistic Approach to a Dizzy Patient: A Practical Update. Cureus 2022; 14:e27681. [PMID: 36106247 PMCID: PMC9447938 DOI: 10.7759/cureus.27681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/07/2022] Open
Abstract
Dizziness is one of the most common symptoms encountered by physicians daily. It is divided into four categories: vertigo, disequilibrium, presyncope, and psychogenic dizziness. It is essential to distinguish these four symptoms because the causes, prognosis, and treatment differ. Vertigo constitutes a disease of the central or peripheral nervous system. Central origin vertigo may be a life-threatening situation and must be detected as soon as possible because it includes diseases such as stroke, hemorrhage, tumors, and multiple sclerosis. Peripheral origin vertigo includes benign diseases, which may be fully treatable such as vestibular migraine, benign paroxysmal positional vertigo, vestibular neuritis, Ménière’s disease, and cervical vertigo. The HINTS (head impulse, nystagmus, test of skew) examination is essential to distinguish central from peripheral causes. A detailed history including the duration of vertigo (episodic or continuous), its trigger, and a clinical examination step by step following the appropriate protocol could help to make a definite and accurate diagnosis and treatment. Due to a lack of expertise in dizziness and inappropriate treatment, many patients are admitted to dizziness clinics with long-standing dizziness. A holistic treatment combining medications, vestibular rehabilitation, physiotherapy, and psychotherapy should be initiated to improve the quality of life of these patients. So, this review aims to recommend a clinical protocol for approaching a dizzy patient with vertigo and to present in detail the epidemiology, pathophysiology, symptoms, diagnosis, and contemporary treatments of all causes of vertigo.
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Combination of Two Manipulative Techniques for the Treatment of Cervicogenic Dizziness: A Randomized Controlled Trial. Life (Basel) 2022; 12:life12071023. [PMID: 35888111 PMCID: PMC9318906 DOI: 10.3390/life12071023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022] Open
Abstract
Cervicogenic dizziness is clinically associated with upper cervical spine dysfunctions. It seems that manual therapy decreases the intensity of dizziness in these subjects, but what happens to pain measured by pressure pain threshold (PPT) has not been studied. Purpose: analyze the short-term effects of combination two manipulation techniques protocol in worst dizziness intensity (wVAS), dizziness and cervical disability, upper cervical spine mobility and mechanosensivity of cervical tissue. Methods: Assessor-blinded randomized controlled trial was developed. A total of 40 patients with cervicogenic dizziness were randomly divided into two groups. The experimental group received three treatments consisting of a functional massage and a manipulation technique, and compared with a control group. The wVAS, dizziness handicap inventory (DHI), neck disability index (NDI), UCS mobility, and PPTs were measured. Measurements were made at the baseline, first follow-up 48 h after intervention and second follow-up 1 month after the intervention. Results: at second follow-up wVAS (p < 0.001), NDI (p < 0.001), DHI (p < 0.001), and upper right trapezius (p < 0.022) and right suboccipital (p < 0.043) PPTs showed a difference between groups in favor of the experimental group. Conclusions: apparently, the proposed intervention protocol decreases the intensity of dizziness and the mechanosensitivity of the cervical tissue and improves the feeling of disability due to neck pain and dizziness.
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7
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Moen U, Magnussen LH, Wilhelmsen KT, Goplen FK, Nordahl SHG, Meldrum D, Knapstad MK. Prevalence and distribution of musculoskeletal pain in patients with dizziness—A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1941. [PMID: 35191148 PMCID: PMC9286866 DOI: 10.1002/pri.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/28/2021] [Accepted: 01/29/2022] [Indexed: 12/04/2022]
Abstract
Background and purpose Musculoskeletal disorders are among the leading causes of disability globally, but their role in patients with dizziness and imbalance is not well understood or explored. Such knowledge may be important as musculoskeletal pain and dizziness can mutually influence each other, leading to a complex condition requiring more comprehensive approaches to promote successful recovery. We conducted a systematic review to examine the extent and characteristic of reported musculoskeletal pain in patients with dizziness. Methods A comprehensive literature search in Medline, Embase, Cochrane, Scopus, Amed, Google Scholar, SveMed+, and Web of Science was conducted in March 2021. Inclusion criteria were studies examining patients with a vestibular diagnosis, patients with cervicogenic dizziness and patients included based on having dizziness as a symptom; and reported musculoskeletal pain. Data regarding age, sex, sample size, diagnosis and musculoskeletal pain was extracted. The Crowe Critical Appraisal Tool was used for assessing methodical quality of the included studies. Results Out of 1507 screened studies, 16 studies met the inclusion criteria. The total sample consisted of 1144 individuals with dizziness. The frequency of patients reporting pain ranged between 43% and 100% in the included studies. Pain intensity were scored between 5 and 7 on a 0–10 scale. Pain in the neck and shoulder girdle was most often reported, but musculoskeletal pain in other parts of the body was also evident. Discussion In the included studies, musculoskeletal pain was highly prevalent in patients with dizziness, with pain intensity that may have a moderate to severe interference with daily functioning. Pain in the neck and shoulder is well documented, but there are few studies addressing musculoskeletal pain in additional parts of the body. More research is needed to understand the relations between dizziness and musculoskeletal pain.
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Affiliation(s)
- Unni Moen
- Western Norway University of Applied Sciences Bergen Norway
| | | | | | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders Haukeland University Hospital Bergen Norway
- Department of Otorhinolaryngology & Head and Neck Surgery Haukeland University Hospital Bergen Norway
| | - Stein Helge Glad Nordahl
- Department of Otorhinolaryngology & Head and Neck Surgery Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Dara Meldrum
- The School of Medicine Trinity College Dublin The University of Dublin Dublin Ireland
| | - Mari Kalland Knapstad
- Western Norway University of Applied Sciences Bergen Norway
- Norwegian National Advisory Unit on Vestibular Disorders Haukeland University Hospital Bergen Norway
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8
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Seemungal BM, Agrawal Y, Bisdorff A, Bronstein A, Cullen KE, Goadsby PJ, Lempert T, Kothari S, Lim PB, Magnusson M, Marcus HJ, Strupp M, Whitney SL. The Bárány Society position on 'Cervical Dizziness'. J Vestib Res 2022; 32:487-499. [PMID: 36404562 PMCID: PMC9837683 DOI: 10.3233/ves-220202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper describes the Bárány Society Classification OverSight Committee (COSC) position on Cervical Dizziness, sometimes referred to as Cervical Vertigo. This involved an initial review by a group of experts across a broad range of fields, and then subsequent review by the Bárány Society COSC. Based upon the so far published literature, the Bárány Society COSC takes the view that the evidence supporting a mechanistic link between an illusory sensation of self-motion (i.e. vertigo - spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebrae, soft tissue structures or cervical nerve roots - is lacking. When a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions (e.g. a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome). The Committee notes, that migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms. The committee also notes that since head movement aggravates symptoms in almost any vestibular condition, the common finding of increased neck muscle tension in vestibular patients, may be linked as both cause and effect, to reduced head movements. Additionally, there are theoretical mechanisms, which have not been explored, whereby cervical pain may promote vaso-vagal, cardio-inhibitory reflexes and hence by presyncopal mechanisms, elicit transient disorientation and/or imbalance. The committee accepts that further research is required to answer the question as to whether those rare cases in which neck muscle spasm is associated with a vague sense of spatial disorientation and/or imbalance, is indeed linked to impaired neck proprioception. Future studies should ideally be placebo controlled and double-blinded where possible, with strict inclusion and exclusion criteria that aim for high specificity at the cost of sensitivity. To facilitate further studies in "cervical dizziness/vertigo", we provide a narrative view of the important confounds investigators should consider when designing controlled mechanistic and therapeutic studies. Hence, currently, the Bárány COSC refrains from proposing any preliminary diagnostic criteria for clinical use outside a research study. This position may change as new research evidence is provided.
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Affiliation(s)
- Barry M. Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alexander Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Adolfo Bronstein
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Kathleen E. Cullen
- Departments of Biomedical Engineering, Neuroscience, and Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, USA
| | - Peter J. Goadsby
- King’s College London, UK & University of California, Los Angeles, USA
| | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | - Sudhir Kothari
- Department of Neurology, Poona Hospital and Research Centre, Pune, India
| | - Phang Boon Lim
- Cardiology Department, Hammersmith Hospital, Imperial College London, UK
| | - Måns Magnusson
- Department of Otorhinolaryngology and Clinical Sciences, Lund University & Skane University Hospital, Sweden
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Susan L. Whitney
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, USA
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Rehman Y, Kirsch J, Bhatia S, Johnston R, Bingham J, Senger B, Swogger S, Snider KT. Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: Protocol for systematic review and meta-analysis. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Gustavsen IØ, Wilhelmsen K, Goode AP, Nordahl SHG, Goplen FK, Nilsen RM, Magnussen LH. Dizziness and physical health are associated with pain in dizzy patients-A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1923. [PMID: 34585499 DOI: 10.1002/pri.1923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders. Such knowledge may be important for choice of treatments. The study objectives were to examine the extent and localization of musculoskeletal pain and explore whether pain was associated with dizziness and health-related quality of life. METHODS The cross-sectional study investigated anonymized data from an earlier survey on patients with long-lasting dizziness (>3 months) examined in an oto-rhino-laryngological department. The sample includes patient between 18 and 70 years with Ménière's disease, vestibular schwannoma, benign positional paroxysmal vertigo, vestibular neuritis, non-otogenic dizziness, and cervicogenic dizziness. General musculoskeletal, that is, pain in muscles, tendons, and joints was registered by a yes/no question. A pain drawing registered localization of pain. Multiple binary logistic regression models were used to determine the association between pain and vertigo-balance and autonomic-anxiety related dizziness by the short Vertigo Symptom Scale (VSS) and sub-scales (VSS-V, VSS-A), and between pain and health-related quality of life by the SF-36, mental and physical component summary scale (SF-36 MCS, SF-36 PCS). RESULTS The sample consisted of 503 patients, 60.2% were women, the median age was 50 years. General musculoskeletal pain was reported by 72.8% of patients, neck pain by 59.2% and widespread pain by 21.9%. Multiple binary logistic regression models demonstrated that all the pain measures were significantly associated with VSS-V and VSS-A and SF-36 PCS, but not SF-36 MCS. DISCUSSIONS Musculoskeletal pain is prevalent in patients with long-lasting dizziness. The strong associations between pain, VSS, and SF-36 PCS could result in a self-sustaining complex condition. The findings imply that in addition to assessing and treating the vestibular symptoms, musculoskeletal symptoms and physical health should be addressed.
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Affiliation(s)
- Ingvild Ølfarnes Gustavsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kjersti Wilhelmsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Adam P Goode
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv Heide Magnussen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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11
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Carrasco-Uribarren A, Rodríguez-Sanz J, Malo-Urriés M, Hidalgo-García C, Tricás-Moreno JM, Balboa-López D, Cabanillas-Barea S. Short-term effects of an upper cervical spine traction-manipulation program in patients with cervicogenic dizziness: A case series study. J Back Musculoskelet Rehabil 2021; 33:961-967. [PMID: 32144976 DOI: 10.3233/bmr-181479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Damage on the somatosensory system could cause sensation of dizziness, a condition known as cervicogenic dizziness (CD). Manual physical therapy has shown beneficial effects, relieving the symptoms of cervicogenic dizziness. However, the effect of upper cervical spine manipulation is unknown, as this is a technique that respects the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) safety criteria. OBJECTIVE To assess the effects of upper cervical spine traction-manipulation in subjects with cervicogenic dizziness. METHODS This was a descriptive case series study. Treatment focused on the upper cervical spine manipulation procedure. Evaluation was performed before and after the treatment. Variables recorded include upper and lower cervical range of motion, Cervical Flexion-Rotation Test (CFRT), dizziness intensity and cervical pain (VAS), self-perceived dizziness measured with Dizziness Handicap Inventory (DHI) and subjective perception of outcome (GROC-scale). RESULTS Ten subjects were recruited. After the treatment protocol, there was an increased range of movement towards the most restricted side, as measured by the CFRT (p< 0.001), decreased intensity of dizziness (p< 0.001) and intensity of pain (p< 0.001). Functional capacity also improved after the intervention (p< 0.011). CONCLUSION Upper cervical spine manipulation may decrease dizziness intensity and cervical pain and improve functional ability and upper cervical spine mobility in patients with cervicogenic dizziness.
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Affiliation(s)
| | | | - Miguel Malo-Urriés
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza, Spain.,Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - César Hidalgo-García
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza, Spain.,Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - José Miguel Tricás-Moreno
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza, Spain.,Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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12
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Micarelli A, Viziano A, Granito I, Carlino P, Micarelli RX, Augimeri I, Alessandrini M. Postural and clinical outcomes of sustained natural apophyseal glides treatment in cervicogenic dizziness patients: A randomised controlled trial. Clin Rehabil 2021; 35:1566-1576. [PMID: 33896213 DOI: 10.1177/02692155211012413] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate how self-report and posturographic measures could be affected in patients with cervicogenic dizziness undergoing sustained natural apophyseal glides. DESIGN Randomised controlled single-blind study. SETTING Tertiary rehabilitation centre. SUBJECTS Patients affected by cervicogenic dizziness, diagnosed by applying accepted criteria. Forty-one patients (19 male, 22 female: mean age 44.3 ± 14.8 years) receiving treatment, and 39 patients (18 male, 21 female: mean age 43.8 ± 13.9 years) receiving placebo were included in the study. INTERVENTIONS The treatment group underwent sustained natural apophyseal glides, while the placebo was constituted by a detuned laser. Both groups received their interventions six times over 4 weeks. MAIN MEASURES Outcomes were tested by means of self-report measures such as perceived dizziness, neck disability, anxiety and depression. Also, cervical range of motion and posturography testing with power spectra frequency were analysed. RESULTS When compared to placebo, treated patients demonstrated a significant decrease in perceived dizziness (post-treatment total Dizziness Handicap Inventory score 20.5 ± 5.3 as compared to 26.2 ± 6 baseline), neck disability and pain (Neck Disability Index and Neck Pain Index post-treatment scores 12.5 ± 4.3 and 45.6 ± 15.1, respectively, as compared to baseline scores of 15.1 ± 4.8 and 62.5 ± 14.3), as well as significant improvement in cervical range of motion and some posturographic parameters. CONCLUSION Sustained natural apophyseal glides may represent a useful intervention in reaching short-term beneficial effects in patients with cervicogenic dizziness, with respect to self-perceived symptoms, proprioceptive integration and cervical range of motion improvement.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Ivan Granito
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Pasquale Carlino
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | | | - Ivan Augimeri
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome, Italy
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13
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Micarelli A, Viziano A, Micarelli B, Giulia DF, Alessandrini M. Usefulness of postural sway spectral analysis in the diagnostic route and clinical integration of cervicogenic and vestibular sources of dizziness: A cross-sectional preliminary study. J Vestib Res 2021; 31:353-364. [PMID: 33843709 DOI: 10.3233/ves-190729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin. OBJECTIVE To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients -93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) -with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON). METHODS All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires. RESULTS UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients. CONCLUSIONS PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Di Fulvio Giulia
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
| | - Marco Alessandrini
- University of Rome Tor Vergata -Department of Clinical Sciences and Translational Medicine -Italy
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14
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Carrasco-Uribarren A, Rodriguez-Sanz J, López-de-Celis C, Pérez-Guillen S, Tricás-Moreno JM, Cabanillas-Barea S. Short-term effects of the traction-manipulation protocol in dizziness intensity and disability in cervicogenic dizziness: a randomized controlled trial. Disabil Rehabil 2021; 44:3601-3609. [PMID: 33470861 DOI: 10.1080/09638288.2021.1872719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Analyse the short-term effects of traction-manipulation protocol in dizziness and pain intensity and disability, cervical mobility and postural instability. MATERIALS AND METHODS Randomized controlled assessor-blind clinical trial. The traction-manipulation protocol was carried out in the intervention group and compared with a control group where the subjects were kept supine. The intervention protocol follows the IFOMPT safety recommendations. Dizziness and pain intensity, Dizziness Handicap Inventory (DHI), cervical mobility and balance were measured after 48 h and a one-month follow-up. RESULTS Forty subjects with cervicogenic dizziness were randomly assigned to an intervention or control group. Significant differences were found in favour of the intervention protocol group in: dizziness intensity (p < 0.001; d = 1.31), DHI (p < 0.001; d = 0.76) pain intensity (p < 0.007; d = 0.92), upper cervical flexion (p < 0.032; d = 0.30) and extension (p < 0.012; d = 0.80) at 48 h follow up. At one-month follow up there were significant differences in favour of the intervention group in: dizziness intensity (p < 0.001; d = 0.95), DHI (p < 0.001; d = 0.0.92) pain intensity (p < 0.001; d = 1.38) and upper cervical extension (p < 0.005; d = 0.92). Postural instability improved in mediolateral displacement static with eyes closed (p < 0.032; d = 0.79) and in dynamic with eyes open (p = 0.003; d = 0.55) at one-month follow-up in the intervention group. CONCLUSION The traction-manipulation protocol reduces the dizziness and pain intensity, ameliorates disability and improves upper cervical mobility and postural instability.IMPLICATIONS FOR REHABILITATIONThe intervention protocol reduces the dizziness and pain intensity, and improves self-perceived disability in patients with cervicogenic dizziness.Manual therapy improves the cervical range of motion and the postural instability in the cervicogenic dizziness.The intervention protocol follows the safety recommendations of the International Federation of Orthopaedic Manipulative Physical Therapists.
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Affiliation(s)
| | - Jacobo Rodriguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - Carles López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain.,Fundació Institut Universitari per a La Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Silvia Pérez-Guillen
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | | | - Sara Cabanillas-Barea
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
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15
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Sung YH. Upper cervical spine dysfunction and dizziness. J Exerc Rehabil 2020; 16:385-391. [PMID: 33178639 PMCID: PMC7609854 DOI: 10.12965/jer.2040612.306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Although various causes of dizziness have been identified, many patients suffer from dizziness of unknown etiology and continue to visit hospitals to resolve their symptoms. Problems that occur in the ligaments or muscles of the upper cervical spine can cause confusion in proprioception. These changes can convey misinformation to the vestibular nucleus, resulting in abnormal reactions that can lead to cervicogenic dizziness (CGD). Though CGD remains controversial, it should be considered while diagnosing patients with dizziness. Understanding CGD can help create treatment strategies for them. This article suggested a relationship between the structure and function of the upper cervical spine and dizziness, and presented evaluations and treatments for the same.
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Affiliation(s)
- Yun-Hee Sung
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon, Korea
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16
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Viziano A, Micarelli A, Carlino P, Granito I, Alessandrini M. Bridging the gap between temporomandibular disorders, static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes. J Electromyogr Kinesiol 2020; 54:102455. [PMID: 32795906 DOI: 10.1016/j.jelekin.2020.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/22/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022] Open
Abstract
Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.
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Affiliation(s)
- Andrea Viziano
- University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy.
| | - Alessandro Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy; Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Pasquale Carlino
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Ivan Granito
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- University of Rome Tor Vergata, Department of Clinical Sciences and Translational Medicine, Italy
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17
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Micarelli A, Viziano A, Granito I, Micarelli RX, Augimeri I, Alessandrini M. Temporomandibular disorders and cervicogenic dizziness: Relations between cervical range of motion and clinical parameters. Cranio 2020; 40:348-357. [PMID: 32544368 DOI: 10.1080/08869634.2020.1780772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS). METHODS CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS. RESULTS TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension. DISCUSSION Present findings demonstrated a relation between spine movement impairment and TMD.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,Dental and Rehabilitation Department, ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ivan Granito
- Dental and Rehabilitation Department, ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Riccardo Xavier Micarelli
- Dental and Rehabilitation Department, ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Ivan Augimeri
- Dental and Rehabilitation Department, ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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18
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Hoppes CW, Romanello AJ, Gaudette KE, Herron WK, McCarthy AE, McHale CJ, Bares J, Turner R, Whitney SL. Physical therapy interventions for cervicogenic dizziness in a military-aged population: protocol for a systematic review. Syst Rev 2020; 9:62. [PMID: 32293544 PMCID: PMC7087372 DOI: 10.1186/s13643-020-01335-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic cervicogenic dizziness is dizziness that is temporally associated with neck pain and injury after other causes of dizziness have been excluded. It can lead to activity limitations and participation restrictions that may include lost duty or work days. The objective of this systematic review is to determine which interventions are most effective in decreasing dizziness or vertigo and neck pain in military-aged adults with traumatic cervicogenic dizziness. METHODS The literature will be systematically searched using the following online databases: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, CENTRAL, Cochrane Methodology Register), CINAHL, SCOPUS, Web of Science, and J-STAGE. The review will include randomized controlled trials (RCTs), including cluster RCTs and controlled (non-randomized) clinical trials or cluster trials, and observational studies (including prospective and retrospective comparative cohort and case-control or nested case-control studies) and determine the effectiveness of physical therapy interventions for the treatment of traumatic cervicogenic dizziness in military-aged adults. Assessment of methodological quality will be performed by two independent, blinded reviewers using the PEDro scale. The level of evidence will be determined using the GRADE scale. The primary outcome measures will be change in dizziness and neck pain and disability from baseline to the last available follow-up, measured using the Dizziness Handicap Inventory and Neck Disability Index. Other relevant outcome measures will include self-reported change in symptoms, time to return to duty or work, and quality of life. DISCUSSION This systematic review will identify, evaluate, and integrate the evidence on the effectiveness of physical therapy interventions for cervicogenic dizziness in a military-aged population. We anticipate our findings may inform individual treatment and future research. Clinical recommendations generated from this systematic review may inform military physical therapy treatment of individuals with cervicogenic dizziness. SYSTEMATIC REVIEW REGISTRATION In accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 21 January 2020 (registration number CRD42020150853). In the event of protocol amendments, the date of each amendment will be accompanied by a description of the change and the rationale.
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Affiliation(s)
- Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA.
| | - Anthony J Romanello
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Kathryn E Gaudette
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - William K Herron
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Anne E McCarthy
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Catherine J McHale
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX, 78234, USA
| | - Joan Bares
- Stimson Library, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Rose Turner
- Falk Library, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Micarelli A, Viziano A, Augimeri I, Micarelli B, Capoccia D, Alessandrini M. Diagnostic route of cervicogenic dizziness: usefulness of posturography, objective and subjective testing implementation and their correlation. Disabil Rehabil 2019; 43:1730-1737. [PMID: 31656108 DOI: 10.1080/09638288.2019.1680747] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects. MATERIALS AND METHODS Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale. RESULTS Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures - highlighting significant complaints of subjective feeling of dizziness - were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients. CONCLUSIONS The implementation of posturography - including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements.Implications for rehabilitationUncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation.Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations.Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up.
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Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ivan Augimeri
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | | | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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20
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Aydin T, Dernek B, Sentürk Ege T, Karan A, Aksoy C. The Effectiveness of Dry Needling and Exercise Therapy in Patients with Dizziness Caused By Cervical Myofascial Pain Syndrome; Prospective Randomized Clinical Study. PAIN MEDICINE 2019; 20:153-160. [PMID: 29718418 DOI: 10.1093/pm/pny072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective The aim of this study is to compare the effectiveness of dry needling therapy combined with exercise and exercise treatment alone for alleviating the dizziness caused by cervical myofascial pain syndrome. Design This was a prospective randomized clinical study that included 61 women who had dizziness and myofascial trigger points on the neck muscles. The patients were randomized into a dry needling + exercise group (N = 31) and an exercise only group (N = 30). Results The mean age of the patients (±SD) was 38.4 ± 8.3 years. The intragroup comparisons of the severity of neck pain, algometric measurement, number of dizziness attacks per week, severity of the dizziness, fall index, and the Dizziness Handicap Inventory were improved in both groups at the first and fourth months (P < 0.05). The intergroup comparisons of the severity of neck pain, algometric measurement, number of dizziness attacks per week, the severity of the dizziness, and the Dizziness Handicap Inventory were more improved in the dry needling + exercise group at the first or fourth month compared with their inital assessments (P < 0.05). There was no diffence in fall index scores between the groups (P > 0.05). Conclusions Both dry needling + exercise therapy and exercise therapy alone were effective in treating dizziness caused by cervical myofascial pain syndrome. However, dry needling + exercise treatment was superior to exercise treatment alone.
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Affiliation(s)
- Tugba Aydin
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
| | - Bahar Dernek
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
| | - Tülin Sentürk Ege
- Department of Otolaryngology, Bagcilar Education and Research Hospital, Istanbul, Turkey
| | - Ayse Karan
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
| | - Cihan Aksoy
- Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul, Turkey
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Abstract
A complex diagnosis such as concussion requires a multidisciplinary patient-centered approach to maximize health outcomes. There is growing evidence to support the role of the Physical Therapist as a key member of the team of healthcare professionals managing children and adolescents with a protracted recovery following concussion. Symptoms such as headache, dizziness, neck pain, gaze instability, balance dysfunction, and fatigue can be addressed through a multimodel approach. This article provides an overview of the targeted pathways of examination and treatment of individuals with a concussion through vestibular rehabilitation, cervicogenic rehabilitation, exertional training, and patient education.
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22
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Hermansen A, Peolsson A, Hedlund R, Kammerlind AS. Balance problems and dizziness after neck surgery - associations with pain and health-related quality of life. Physiother Theory Pract 2019; 36:1145-1152. [PMID: 30686102 DOI: 10.1080/09593985.2019.1571137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10-13 years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness. Material and methods: Sixty-eight individuals, 10 years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life. Results: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory. Conclusions: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients' descriptions of these problems are in line with common symptoms of cervicogenic dizziness.
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Affiliation(s)
- Anna Hermansen
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University , Linköping, Sweden
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University , Linköping, Sweden
| | - Rune Hedlund
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Göteborg, Sweden
| | - Ann-Sofi Kammerlind
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University , Linköping, Sweden.,Futurum, Region Jönköping County , Jönköping, Sweden
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23
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Kendall JC, French SD, Hartvigsen J, Azari MF. Chiropractic treatment including instrument-assisted manipulation for non-specific dizziness and neck pain in community-dwelling older people: a feasibility randomised sham-controlled trial. Chiropr Man Therap 2018; 26:14. [PMID: 29760878 PMCID: PMC5943997 DOI: 10.1186/s12998-018-0183-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/23/2018] [Indexed: 12/18/2022] Open
Abstract
Background Dizziness in older people is a risk factor for falls. Neck pain is associated with dizziness and responds favourably to neck manipulation. However, it is unknown if chiropractic intervention including instrument-assisted manipulation of the neck in older people with neck pain can also improve dizziness. Methods This parallel two-arm pilot trial was conducted in Melbourne, Australia over nine months (October 2015 to June 2016). Participants aged 65–85 years, with self-reported chronic neck pain and dizziness, were recruited from the general public through advertisements in local community newspapers and via Facebook. Participants were randomised using a permuted block method to one of two groups: 1) Activator II™-instrument-assisted cervical and thoracic spine manipulation plus a combination of: light massage; mobilisation; range of motion exercises; and home advice about the application of heat, or 2) Sham-Activator II™-instrument-assisted manipulation (set to zero impulse) plus gentle touch of cervical and thoracic spinal regions. Participants were blinded to group allocation. The interventions were delivered weekly for four weeks. Assessments were conducted one week pre- and post-intervention. Clinical outcomes were assessed blindly and included: dizziness (dizziness handicap inventory [DHI]); neck pain (neck disability index [NDI]); self-reported concerns of falling; mood; physical function; and treatment satisfaction. Feasibility outcomes included recruitment rates, compliance with intervention and outcome assessment, study location, success of blinding, costs and harms. Results Out of 162 enquiries, 24 participants were screened as eligible and randomised to either the chiropractic (n = 13) or sham (n = 11) intervention group. Compliance was satisfactory with only two participants lost to follow up; thus, post-intervention data for 12 chiropractic intervention and 10 sham intervention participants were analysed. Blinding was similar between groups. Mild harms of increased spinal pain or headaches were reported by 6 participants. Costs amounted to AUD$2635 per participant. The data showed a trend favouring the chiropractic group in terms of clinically-significant improvements in both NDI and DHI scores. Sample sizes of n = 150 or n = 222 for dizziness or neck pain disability as the primary outcome measure, respectively, would be needed for a fully powered trial. Conclusions Recruitment of participants in this setting was difficult and expensive. However, a larger trial may be feasible at a specialised dizziness clinic within a rehabilitation setting. Compliance was acceptable and the outcome measures used were well accepted and responsive. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000653763. Registered 13 June 2013. Trial funding: Foundation for Chiropractic Research and Postgraduate Education (Denmark).
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Affiliation(s)
- Julie C Kendall
- 1School of Health and Biomedical Sciences, RMIT University, PO Box 71 Bundoora, Melbourne, VIC 3083 Australia
| | - Simon D French
- 2School of Rehabilitation Therapy, Queens University, Kingston, Canada.,3Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Jan Hartvigsen
- 4Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,5Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Michael F Azari
- 1School of Health and Biomedical Sciences, RMIT University, PO Box 71 Bundoora, Melbourne, VIC 3083 Australia
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Reneker JC, Cheruvu VK, Yang J, James MA, Cook CE. Physical examination of dizziness in athletes after a concussion: A descriptive study. Musculoskelet Sci Pract 2018; 34:8-13. [PMID: 29197811 DOI: 10.1016/j.msksp.2017.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dizziness is commonly reported after concussion. With the forces experienced at the time of the injury, several anatomical locations may have been altered, causing dizziness. OBJECTIVE Describe an objective examination and the types of impairment/dysfunction implicated by the results of clinical examination tests in subjects with dizziness after a concussion. DESIGN Cross-Sectional. METHODS Athletes between ages 10-23 were enrolled with a diagnosis of concussion. An examination was completed to identify areas potentially contributing to dizziness, including tests of oculomotor control, the vestibular system, neuromotor control, and musculoskeletal components of the cervical spine. Descriptive analyses were completed to define the anatomical areas/types of dysfunction identified by positive findings of the examination tests. RESULTS All (n = 41; 100%) subjects had examination findings consistent with central dysfunction. Of these, 36 (97.8%) had oculomotor control deficits; 29 (70.7%) demonstrated motion sensitivity; and 6 (15%) had central vestibular deficits. Nineteen (46.3%) had peripheral dysfunction, including 18 (43.9%) with unilateral hypofunction, and 2 (4.9%) with Benign Paroxysmal Positional Vertigo. Thirty-four (82.9%) had cervical dysfunction, with 11 (26.8%) presenting with cervicogenic dizziness, and 31 (75.6%) with altered neuromotor control. CONCLUSIONS Functional injury to centrally-mediated pathways, specifically oculomotor control, and afferent and efferent pathways in the cervical spine are commonly identified through clinical examination tests in individuals with a complaint of dizziness post-concussion. According to results presented here, a high majority (90%) of the participants demonstrated dizziness that appeared to be multifactorial in nature and was not attributable to one main type of dysfunction. The common pathways between the systems make it difficult to isolate only one anatomical area as a contributor to dizziness.
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Affiliation(s)
- Jennifer C Reneker
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States; Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, United States; Department of Neurosurgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Vinay K Cheruvu
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Dept. of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Mark A James
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States
| | - Chad E Cook
- Division of Physical Therapy, Department of Orthopaedics, Duke University, Durham, NC, United States
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Grande-Alonso M, Moral Saiz B, Mínguez Zuazo A, Lerma Lara S, La Touche R. Biobehavioural analysis of the vestibular system and posture control in patients with cervicogenic dizziness. A cross-sectional study. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Yaseen K, Hendrick P, Ismail A, Felemban M, Alshehri MA. The effectiveness of manual therapy in treating cervicogenic dizziness: a systematic review. J Phys Ther Sci 2018; 30:96-102. [PMID: 29410575 PMCID: PMC5788784 DOI: 10.1589/jpts.30.96] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/12/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This review provides an evaluation of the evidence for the effectiveness of
using manual therapy to treat cervicogenic dizziness. [Subjects and Methods] The
literature was systematically searched on the May 2, 2016 using the following online
databases: Medline, EMBASE, CINAHL and PEDro. This review included randomised controlled
trials and compared the efficacy of manual therapy for the treatment of cervicogenic
dizziness, compared to other types of intervention. This study measured changes based on
dizziness intensity and frequency. [Results] The primary search found 30 articles, but
only four articles met the inclusion criteria. Assessment of methodological quality was
performed by two researchers using the PEDro scale. The level of evidence was determined
using a recognised grading scale. Three out of the four articles were deemed to have high
methodological quality, while the fourth was rated as moderate quality. The attributed
level of evidence was moderate (level 2). [Conclusion] Manual therapy is potentially
effective for managing cervicogenic dizziness. However, due to the heterogeneity of the
results and techniques and the low number of studies, further research is recommended to
provide conclusive evidence.
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Affiliation(s)
- Khalid Yaseen
- Department of Physical Therapy, Faculty of Physical Therapy, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Paul Hendrick
- Physiotherapy Division, School of Health Sciences, University of Nottingham, UK
| | - Ayah Ismail
- Department of Physical Therapy, Faculty of Physical Therapy, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Mohannad Felemban
- Department of Physical Therapy, Faculty of Physical Therapy, King Abdul Aziz University: Jeddah, Saudi Arabia
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Papa L, Amodio A, Biffi F, Mandara A. Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness. J Bodyw Mov Ther 2017; 21:866-872. [PMID: 29037641 DOI: 10.1016/j.jbmt.2017.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/30/2017] [Accepted: 02/26/2017] [Indexed: 11/30/2022]
Abstract
The aim of the study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) in patients with Benign-Paroxysmal-Positional Vertigo (BPPV). Thirty-one patients with BPPV were randomly assigned into two groups: 19 patients received osteopathic treatments (TG) and 12 patients received sham therapy (SG), both in four weekly sessions. Before the first and the last treatment, those patients were evaluated using Dizziness Handicap Inventory (DHI) and stabilometric platform to assess lifestyle modification and balance functions. After the treatment session, TG compared to SG showed an improvement in DHI global (p = 0.02), functional (p = 0.03) and physical (p = 0.03) components, as well as a reduction of swinging area (p = 0.02). An association between swinging area and lifestyle measures (global [r = 0.53; p = 0.02]; functional [r = 0.50; p = 0.03]; physical [r = 0.60; p = 0.01]) changes were found in TG. These findings suggest that OMT could be a useful approach to reduce imbalance symptoms and to improve the quality of life in patients suffering from dizziness.
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Affiliation(s)
- L Papa
- European Research Centre for Osteopathic Medicine, Italy; International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy.
| | - A Amodio
- International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
| | - F Biffi
- International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
| | - A Mandara
- European Research Centre for Osteopathic Medicine, Italy; International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
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Utility of a brief assessment tool developed from the Dizziness Handicap Inventory to screen for Cervicogenic dizziness: A case control study. Musculoskelet Sci Pract 2017; 30:42-48. [PMID: 28521181 DOI: 10.1016/j.msksp.2017.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/10/2017] [Accepted: 03/18/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cervicogenic dizziness (CGD) is hard to diagnose as there is no objective test. OBJECTIVE Can a brief assessment tool be derived from the Dizziness Handicap Inventory (DHI) to assist in screening for CGD? DESIGN Case-control study with split-sample analysis. METHOD 86 people with CGD and 86 people with general dizziness completed the DHI as part of the assessment of their dizziness. Descriptive statistics were used to assess how frequently each question on the DHI was answered 'yes' or 'sometimes' by participants with CGD and by participants with general dizziness. The questions that best discriminated between GCD and general dizziness were compiled into a brief assessment tool for CGD. Data from 80 participants (40 from each group) were used to generate a receiver operating characteristic (ROC) curve to establish a cut-off score for that brief assessment tool. Then, data from the remaining 92 participants were used to try to validate the diagnostic ability of the brief assessment tool using that cut-off score. RESULTS Questions 1, 9 and 11 were the most discriminatory and were combined to form the brief assessment tool. The ROC curve indicated an optimal threshold of 9. The diagnostic ability of the brief assessment tool among the remaining 46 participants from each group was: sensitivity 77% (95% CI: 67 to 84), specificity 66% (56-75), positive likelihood ratio 2.28 (1.66-3.13), and negative likelihood ratio 0.35 (0.23-0.53). CONCLUSION A brief assessment tool of three questions appears to be helpful in screening for CGD.
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Malmström EM, Fransson PA, Jaxmar Bruinen T, Facic S, Tjernström F. Disturbed cervical proprioception affects perception of spatial orientation while in motion. Exp Brain Res 2017. [PMID: 28623390 PMCID: PMC5550524 DOI: 10.1007/s00221-017-4993-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The proprioceptive, visual and vestibular sensory systems interact to maintain dynamic stability during movement. The relative importance and interplay between these sensory systems is still not fully understood. Increased knowledge about spatial perception and postural orientation would provide better understanding of balance disorders, and their rehabilitation. Displacement of the body in space was recorded in 16 healthy subjects performing a sequence of stepping-in-place tests without any visual or auditory cues. Spatial displacement and orientation in space were determined by calculating two parameters, “Moved distance (sagittal + lateral displacement)” and “Rotation”. During the stepping-in-place tests vibration were applied in a randomized order on four different cervical muscles, and the effects were compared between muscles and to a non-vibration baseline condition. During the tests a forward displacement (“Moved distance”) was found to be the normal behavior, with various degrees of longitudinal rotation (“Rotation”). The moved distance was significantly larger when the vibration was applied on the dorsal muscles (916 mm) relative to on ventral muscles (715 mm) (p = 0.003) and the rate of displacement was significantly larger for dorsal muscles (36.5 mm/s) relative to ventral (28.7 mm/s) vs (p = 0.002). When vibration was applied on the left-sided muscles, 16° rotation to the right was induced (p = 0.005), whereas no significant rotation direction was induced with right-sided vibration (3°). The rate of rotation was significantly larger for vibration applied on ventral muscles (0.44°/s) relative to on dorsal (0.33°/s) (p = 0.019). The results highlight the influence of cervical proprioception on the internal spatial orientation, and subsequent for postural control.
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Affiliation(s)
- Eva-Maj Malmström
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden. .,Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden.
| | - Per-Anders Fransson
- Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden
| | | | - Semir Facic
- Medpro Clinic Rehab AB, Torpavägen 23, Vänersborg, Sweden
| | - Fredrik Tjernström
- Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden
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De Hertogh W, Castien R, De Pauw J, Michiels S. Letter to the Editor concerning: Dizziness and neck pain: a correct diagnosis is required before consulting a physiotherapist, by Van Leeuwen and Van der Zaag-Loonen 2016. Acta Neurol Belg 2017; 117:573-574. [PMID: 28299596 DOI: 10.1007/s13760-017-0770-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Affiliation(s)
- W De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, CDE, D.S.022, Universiteitsplein 1, Wilrijk, 2610, Antwerp, Belgium.
| | - R Castien
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Healthcare Center Haarlemmermeer, Hoofddorp, The Netherlands
| | - J De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, CDE, D.S.022, Universiteitsplein 1, Wilrijk, 2610, Antwerp, Belgium
| | - S Michiels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, CDE, D.S.022, Universiteitsplein 1, Wilrijk, 2610, Antwerp, Belgium
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
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Kennedy E, Quinn D, Tumilty S, Chapple CM. Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: A retrospective analysis. Musculoskelet Sci Pract 2017; 29:91-98. [PMID: 28347935 DOI: 10.1016/j.msksp.2017.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/02/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Concussion is typically defined as a mild brain injury, and yet the brain is unlikely to be the only source of persistent post-concussion symptoms. Concurrent injury to the cervical spine in particular is acknowledged as a potential source of common persistent symptoms such as headache, dizziness and neck pain. OBJECTIVES To describe the cervical spine findings and outcomes of treatment in a series of patients with persistent post-concussion symptoms, and describe the clinical characteristics of a cervicogenic component when it is present. DESIGN Retrospective chart review of a consecutive series of patients with concussion referred to a physiotherapist for cervical spine assessment. METHOD Patient charts for all patients over a calendar year referred by a concussion service provider to a physiotherapist for cervical spine assessment were de-identified and transferred to the research team. Clinical data were independently extracted by two research assistants and analysed using descriptive statistics. RESULTS/FINDINGS Data were analysed from 46 patient charts. Those with a cervicogenic component (n = 32) were distinguished from those without a cervicogenic component (n = 14) by physical examination findings, particularly pain on manual segmental examination. Physiotherapy treatment of the cervicogenic component (n = 21) achieved improvements in function (mean increase of 3.8 in the patient-specific functional scale), and pain (mean decrease of 4.6 in the numeric pain-rating scale). CONCLUSIONS The clinical characteristics described give preliminary support to the idea that the cervical spine may contribute to persistent post-concussion symptoms, and highlight the value of physiotherapy assessment and treatment of the cervical spine following a concussive injury.
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Affiliation(s)
- Ewan Kennedy
- School of Physiotherapy, 325 Great King Street, University of Otago, Dunedin, 9054, New Zealand.
| | - Dusty Quinn
- Back in Motion Ltd, 27-29 Albany Street, Dunedin, 9016, New Zealand
| | - Steve Tumilty
- School of Physiotherapy, 325 Great King Street, University of Otago, Dunedin, 9054, New Zealand
| | - Cathy M Chapple
- School of Physiotherapy, 325 Great King Street, University of Otago, Dunedin, 9054, New Zealand
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32
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Reneker JC, Hassen A, Phillips RS, Moughiman MC, Donaldson M, Moughiman J. Feasibility of early physical therapy for dizziness after a sports-related concussion: A randomized clinical trial. Scand J Med Sci Sports 2017; 27:2009-2018. [PMID: 28211600 DOI: 10.1111/sms.12827] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 12/30/2022]
Abstract
The purpose of this study was to (a) assess the feasibility of recruitment/retention of participants, protocol/resource management, and participant safety, and (b) estimate the size of the effect between the experimental and control groups. This was a feasibility study conducted as a prospective pilot double-blind randomized clinical trial. Subjects aged 10-23 years old with acute concussion and dizziness were enrolled from sports medicine centers. Forty-one participants were randomized into treatment and were seen for physical therapy beginning at 10 days post-concussion. Subjects in the experimental group received individually tailored, pragmatically delivered progressive interventions. Subjects in the control received prescriptive sham to minimally progressive interventions. The two primary outcomes were medical clearance for return-to-play and symptomatic recovery. The median number of days to medical clearance for the experimental group was 15.5 and for the control was 26. The median number of days to symptomatic recovery was 13.5 for the experimental group and was 17 for the control. According to Cox proportional hazards regression for time to medical release for return-to-play, the experimental group demonstrated a hazard ratio of 2.91 (95% CI: 1.01, 8.43) compared to the control. For time-to-symptomatic recovery, those in the experimental group demonstrated a hazard ratio of 1.99 (95% CI: 0.95, 4.15) compared to the control. The results indicate that it is feasible and safe to complete this type of intervention study. The results provide strong support for the allocation of resources to conduct well-powered randomized clinical trials of this intervention.
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Affiliation(s)
- J C Reneker
- Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, USA
| | - A Hassen
- Walsh University, North Canton, OH, USA
| | | | - M C Moughiman
- Louis Stokes Cleveland Veterans Administration Medical Center, Akron, OH, USA
| | | | - J Moughiman
- Louis Stokes Cleveland Veterans Administration Medical Center, Akron, OH, USA
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Burke S, Lynch K, Moghul Z, Young C, Saviola K, Schenk R. The reliability of the cervical relocation test on people with and without a history of neck pain. J Man Manip Ther 2016; 24:210-4. [PMID: 27582620 DOI: 10.1179/2042618615y.0000000016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Physical therapy intervention is often sought to treat cervical spine conditions and a comprehensive physical therapy examination has been associated with more favourable outcomes. The cervical relocation test (CRT) is one method used to assess joint position sense (PS) integrity of the cervical spine. Previous research has found significant differences in the CRT between symptomatic and asymptomatic subjects. Impaired kinaesthetic awareness in the cervical spine may be associated with degenerative joint disease, chronicity of the complaint and increased susceptibility to re-injury. PURPOSE The purpose of this study was to determine the intertester and intratester reliability of cervical relocation using the cervical range of motion instrument (CROM) and an affixed laser (AL) device among subjects with and without a history of neck pain. In addition, it was hypothesised that those individuals with a history of neck pain would have greater difficulty on the CRT. METHODS A total of 50 asymptomatic subjects (n = 50) were assigned to two researchers. The CRT was performed for each tester by the subject rotating the cervical spine for three trials to the right and left for the CROM and AL. RESULTS The results indicate a significant intertester reliability of the CROM (interclass correlation coefficient (ICC) = 0.717[0.502-0.839]; 0.773[0.595-0.873]) for the subjects in this sample. CONCLUSION This study demonstrated that the CROM is a reliable device for measuring cervical relocation between different testers. Future research should investigate if the CRT is predictive of prognosis in patients with cervical pathology.
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Affiliation(s)
- Sarah Burke
- Daemen College Department of Physical Therapy, Daemen College, Amhesrt, NY, USA
| | - Kristina Lynch
- Daemen College Department of Physical Therapy, Daemen College, Amhesrt, NY, USA
| | - Zakkee Moghul
- Daemen College Department of Physical Therapy, Daemen College, Amhesrt, NY, USA
| | - Craig Young
- Daemen College Department of Physical Therapy, Daemen College, Amhesrt, NY, USA
| | | | - Ron Schenk
- Daemen College Department of Physical Therapy, Daemen College, Amhesrt, NY, USA
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Grande-Alonso M, Moral Saiz B, Mínguez Zuazo A, Lerma Lara S, La Touche R. Biobehavioural analysis of the vestibular system and posture control in patients with cervicogenic dizziness. A cross-sectional study. Neurologia 2016; 33:98-106. [PMID: 27452617 DOI: 10.1016/j.nrl.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 05/22/2016] [Accepted: 06/03/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cervicogenic dizziness is a musculoskeletal disorder mainly characterised by dizziness and disequilibrium associated with neck pain. The pathophysiology is unclear and the neurophysiological basis remains to be ascertained. The aim of this study is to compare the vestibulo-ocular reflex and postural control between patients with cervicogenic dizziness and asymptomatic subjects, and to assess the association between debilitating dizziness and other psychosocial variables. MATERIALS AND METHODS A total of 20 patients and 22 asymptomatic subjects were selected. Vestibulo-ocular reflex was assessed by performing the head impulse test. Computerised dynamic posturography was used to evaluate the postural control by means of the sensory organisation test. In addition, subjects self-reported their degree of disability due to dizziness, cervical disability, kinesiophobia, and state of anxiety and depression. RESULTS There were no differences in the vestibulo-ocular reflex (P>.05). However, we found differences with a medium-to-large effect size (d>0.60) in variables related to proprioception and visual information integration; the former variable set was related to disability due to dizziness. Disability due to dizziness presents strong-to-moderate associations with cervical disability, kinesiophobia, and anxiety. CONCLUSION Our data rule out changes in the vestibular system in cervicogenic dizziness, but they do point to proprioceptive impairment. According to our results, the association between dizziness-related disability and other psychosocial factors in cervicogenic dizziness is very relevant for clinical medicine and for future research projects.
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Affiliation(s)
- M Grande-Alonso
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Cátedra de Investigación en Rehabilitación Sensoriomotora y Análisis Posturográfico, Madrid, España
| | - B Moral Saiz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Cátedra de Investigación en Rehabilitación Sensoriomotora y Análisis Posturográfico, Madrid, España; Laboratorio de Análisis del Movimiento, Hospital Universitario Niño Jesús, Madrid, España
| | - A Mínguez Zuazo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Cátedra de Investigación en Rehabilitación Sensoriomotora y Análisis Posturográfico, Madrid, España
| | - S Lerma Lara
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Cátedra de Investigación en Rehabilitación Sensoriomotora y Análisis Posturográfico, Madrid, España; Laboratorio de Análisis del Movimiento, Hospital Universitario Niño Jesús, Madrid, España; Grupo de Investigación en Ciencias de Movimiento, Bioconducta y Estudio del Dolor, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.
| | - R La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Cátedra de Investigación en Rehabilitación Sensoriomotora y Análisis Posturográfico, Madrid, España; Laboratorio de Análisis del Movimiento, Hospital Universitario Niño Jesús, Madrid, España; Grupo de Investigación en Ciencias de Movimiento, Bioconducta y Estudio del Dolor, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Instituto de Neurociencias y Dolor Craneofacial (INDCRAN), Madrid, España
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Minguez-Zuazo A, Grande-Alonso M, Saiz BM, La Touche R, Lara SL. Therapeutic patient education and exercise therapy in patients with cervicogenic dizziness: a prospective case series clinical study. J Exerc Rehabil 2016; 12:216-25. [PMID: 27419118 PMCID: PMC4934967 DOI: 10.12965/jer.1632564.282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/30/2016] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to evaluate the effectiveness of a treatment for patients with cervicogenic dizziness that consisted of therapeutic education and exercises. The Dizziness Handicap Inventory and Neck Disability Index were used. Secondary outcomes included range of motion, postural control, and psychological variables. Seven patients (two males and five females) aged 38.43±14.10 with cervicogenic dizziness were included. All the participants received eight treatment sessions. The treatment was performed twice a week during a four weeks period. Outcome measures included a questionnaire (demographic data, body chart, and questions about pain) and self-reported disability, pain, and psychological variables. Subjects were examined for cervical range of motion and postural control. All of these variables were assessed pre- and postintervention. Participants received eight sessions of therapeutic education patient and therapeutic exercise. The majority of participants showed an improvement in catastrophism (mean change, 11.57±7.13; 95% confidence interval [CI], 4.96–18.17; d=1.60), neck disability (mean change, 5.14±2.27.28; 95% CI, 3.04–7.24; d=1.32), and dizziness disability (mean change, 9.71±6.96; 95% CI, 3.26–16.15; d=1.01). Patients also showed improved range of motion in the right and left side. Therapeutic patient education in combination with therapeutic exercise was an effective treatment. Future research should investigate the efficacy of therapeutic patient education and exercise with larger sample sizes of patients with cervicogenic dizziness.
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Affiliation(s)
- Ana Minguez-Zuazo
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain
| | - Mónica Grande-Alonso
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Research Gruop Motion in Brains. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain
| | - Beatriz Moral Saiz
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Movement Analysis Laboratory Niño Jesús University Hospital, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Movement Analysis Laboratory Niño Jesús University Hospital, Madrid, Spain
| | - Sergio Lerma Lara
- Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; La Salle-Optomic Balance Researching Chair: Sensorio-Motor Rehabilitation and Posturography, Madrid, Spain; Research Gruop Motion in Brains. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid, Spain; Movement Analysis Laboratory Niño Jesús University Hospital, Madrid, Spain
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Current concepts and future approaches to vestibular rehabilitation. J Neurol 2016; 263 Suppl 1:S65-70. [PMID: 27083886 PMCID: PMC4833789 DOI: 10.1007/s00415-015-7914-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 02/05/2023]
Abstract
Over the last decades methods of vestibular rehabilitation to enhance adaptation to vestibular loss, habituation to changing sensory conditions, and sensory reweighting in the compensation process have been developed. However, the use of these techniques still depends to a large part on the educational background of the therapist. Individualized assessment of deficits and specific therapeutic programs for different disorders are sparse. Currently, vestibular rehabilitation is often used in an unspecific way in dizzy patients irrespective of the clinical findings. When predicting the future of vestibular rehabilitation, it is tempting to foretell advances in technology for assessment and treatment only, but the current intense exchange between clinicians and basic scientists also predicts advances in truly understanding the complex interactions between the peripheral senses and central adaptation mechanisms. More research is needed to develop reliable techniques to measure sensory dependence and to learn how this knowledge can be best used--by playing off the patient's sensory strength or working on the weakness. To be able using the emerging concepts, the neuro-otological community must strive to educate physicians, physiotherapists and nurses to perform the correct examinations for assessment of individual deficits and to look for factors that might impede rehabilitation.
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Abstract
Cervicogenic or cervical dizziness is debated as an entity. However, there exists both a physiologic basis and a multitude of clinical data to make such a disease concept at least possible and worth considering. In addition, the interaction of proprioceptive and vestibular mechanisms may amplify dizziness of other origin. Cervical pain and dizziness are both common symptoms and may coincide, and neck pain or obvious dysfunction does not necessarily cause dizziness or balance disturbances. So far, there is also the lack of a proper diagnostic test for cervicogenic dizziness. On the other hand, there is growing evidence that cervical proprioceptive input is important for balance and postural control not only in animals but also in humans, and that intervention in disorders affecting the human cervical segment may relieve dizziness in some patients. It is advocated that the diagnosis should be used with care and that there is a need for better diagnostic tests. In the absence of such a test, one has to rely on preliminary criteria and a diagnosis ex juvantibus. A possible approach would require patients to present with neck pain before or in close temporal relation with dizziness; that other causes should be made at least unlikely; and that treatment of a cervical dysfunction reduces also dizziness or balance disturbance.
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Affiliation(s)
- M Magnusson
- Department of Otorhinolaryngology, Lund University, Skane University Hospital, Lund, Sweden.
| | - E-M Malmström
- Department of Otorhinolaryngology, Lund University, Skane University Hospital, Lund, Sweden; Department of Pain Rehabilitation, Lund University, Skane University Hospital, Lund, Sweden
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A slouched body posture decreases arm mobility and changes muscle recruitment in the neck and shoulder region. Eur J Appl Physiol 2015; 115:2491-503. [PMID: 26429723 DOI: 10.1007/s00421-015-3257-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Long-term use of unfavorable postures, congenital deformations and degenerative processes associated with aging or disease may generate an increased thoracic curvature resulting in pain and disability. We wanted to examine whether a slouched postural alignment with increased thoracic kyphosis changes the shoulder kinematics and muscle activity in upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA) during arm elevation. The aim was to determine if a slouched posture influences range of motion, muscle activation patterns, maximal muscle activity and the total muscle work required when performing arm elevations. METHOD Twelve male subjects (23.3 ± 1.5 years) performed maximum arm elevations in upright and slouched postures. A combined 3D movement and EMG system recorded arm movements and spine curvature simultaneously with EMG activity in the UT, LT and SA. RESULTS Slouched posture affected the biomechanical conditions by significantly decreasing maximum arm elevation by ~15° (p < 0.001) and decreasing arm movement velocity by ~8 % during movements upwards (p < 0.001) and downwards (p = 0.034). The peak muscle activity increased in all muscles: UT (p = 0.034, +32.3 %), LT (p = 0.001, +48.6 %) and SA (p = 0.007, +20.9 %). The total muscle work increased significantly in the slouched posture during movements upwards: UT (p = 0.003, +36.6 %), LT (p < 0.001, +89.0 %), SA (p = 0.002, +19.4 %) and downwards: UT (p = 0.012, +29.8 %) and LT (p < 0.001, +122.5 %). CONCLUSION An increased thoracic kyphosis was found associated with marked increased physical costs when performing arm movements. Hence, patients suffering from neck-shoulder pain and disability should be investigated and treated for defective thoracic curvature issues.
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Manual therapy for cervicogenic dizziness: Long-term outcomes of a randomised trial. ACTA ACUST UNITED AC 2015; 20:148-56. [DOI: 10.1016/j.math.2014.08.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/29/2014] [Accepted: 08/05/2014] [Indexed: 11/22/2022]
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Zur O, Shaki T, Carmeli E. Concurrent Validity and Reliability of a New Balance Scale Used in Older Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 910:63-70. [PMID: 26820734 DOI: 10.1007/5584_2015_207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Adults over the age of 70 are at risk of falling. Various balance tests have been developed to identify balance dysfunctions. Their disadvantages including ceiling effects and low sensitivity and duration led to the development of a new balance test. The present study was conducted to determine the concurrent validity, reliability, sensitivity, and specificity of the Zur Balance Scale (ZBS). In this descriptive, cross-sectional study, 76 senior adults were recruited from an independent senior living community and were administered the Berg Balance Scale (BBS) and the ZBS. The BBS was used as the standard of comparison. The ZBS includes head movements and time to maintain to balance. All the subjects completed the tests. Concurrent validity was r = 0.782 (p < 0.0001). The ZBS had high intra-test (0.897) and inter-test (0.934) correlation coefficients. Its sensitivity was 60 % and specificity 91 % for identifying falls. The dynamic portions of the ZBS capture the integration of the visual, vestibular, and somatosensory systems, as it mimics dynamic spatial aspects of daily activities. We conclude that the ZBS is reliable compared with BBS. It is a simple, easy to administer test that may predict future risk of falls.
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Affiliation(s)
- Oz Zur
- Department of Physical Therapy, Ben Gurion University of the Negev, Beer Sheva, Israel. .,The Israeli Center for Dizziness and Balance Disorders, 142 Ahuza St, Ra'anana, 4330010, Israel.
| | - Tamar Shaki
- Department of Physical Therapy, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, 199 Aba Khoushy Ave, Haifa, Israel
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Reid SA, Callister R, Katekar MG, Rivett DA. Effects of Cervical Spine Manual Therapy on Range of Motion, Head Repositioning, and Balance in Participants With Cervicogenic Dizziness: A Randomized Controlled Trial. Arch Phys Med Rehabil 2014; 95:1603-12. [DOI: 10.1016/j.apmr.2014.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Reneker JC, Clay Moughiman M, Cook CE. The diagnostic utility of clinical tests for differentiating between cervicogenic and other causes of dizziness after a sports-related concussion: An international Delphi study. J Sci Med Sport 2014; 18:366-72. [PMID: 24933505 DOI: 10.1016/j.jsams.2014.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/11/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Dizziness after a sports-related concussion is very common and is associated with prolonged recovery. The events in sports that cause concussion include strong mechanical forces exerted to the head and neck, potentially injuring the cervical region, the peripheral vestibular and central nervous system, all of which can contribute to a sensation of dizziness. The purpose of this study was to identify proper clinically administered tests and measures that are useful in differentiating between cervicogenic and other causes of dizziness after a sports-related concussion. DESIGN The Delphi method. METHODS The workgroup identified the initial list of suggested clinical tests and the initial list of content experts on dizziness and/or concussion through a search of peer-reviewed and grey literature. The respondent group included all invited experts who opted to participate. A sequential three-round process was used for elicitation of consensus opinions from the targeted content experts. RESULTS The respondent group included 25 members from several medical disciplines who were experts in concussion and dizziness. At the conclusion of the study, ten clinical tests achieved the designation of strong clinical utility, six were determined to have weak clinical utility and seven achieved no consensus among the experts. CONCLUSIONS The majority of clinical tests identified as having strong clinical utility are tests used to identify dizziness originating from the vestibular or central nervous system. No clinical tests specific for the cervical region achieved consensus. Expert opinion from different medical professions and even within professions was widely divergent regarding the utility of clinical tests to assess cervical dysfunction.
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Affiliation(s)
- Jennifer C Reneker
- Division of Physical Therapy, Walsh University, North Canton, OH, USA; Community Based Outpatient Therapy, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Akron, OH, USA.
| | - M Clay Moughiman
- Community Based Outpatient Therapy, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Akron, OH, USA
| | - Chad E Cook
- Division of Physical Therapy, Walsh University, North Canton, OH, USA
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Comparison of mulligan sustained natural apophyseal glides and maitland mobilizations for treatment of cervicogenic dizziness: a randomized controlled trial. Phys Ther 2014; 94:466-76. [PMID: 24336477 DOI: 10.2522/ptj.20120483] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is short-term evidence for treatment of cervicogenic dizziness with Mulligan sustained natural apophyseal glides (SNAGs) but no evidence for treatment with Maitland mobilizations. OBJECTIVE The purpose of this study was to compare the effectiveness of SNAGs and Maitland mobilizations for cervicogenic dizziness. DESIGN A double-blind, parallel-arm randomized controlled trial was conducted. SETTING The study was conducted at a university in Newcastle, Australia. PARTICIPANTS Eighty-six people with cervicogenic dizziness were the study participants. INTERVENTIONS Included participants were randomly allocated to receive 1 of 3 interventions: Mulligan SNAGs (including self-administered SNAGs), Maitland mobilizations plus range-of-motion exercises, or placebo. MEASUREMENTS The primary outcome measure was intensity of dizziness. Other outcome measures were: frequency of dizziness, the Dizziness Handicap Inventory (DHI), intensity of pain, and global perceived effect (GPE). RESULTS Both manual therapy groups had reduced dizziness intensity and frequency posttreatment and at 12 weeks compared with baseline. There was no change in the placebo group. Both manual therapy groups had less dizziness intensity posttreatment (SNAGs: mean difference=-20.7, 95% confidence interval [95% CI]=-33.6, -7.7; mobilizations: mean difference=-15.2, 95% CI=-27.9, -2.4) and at 12 weeks (SNAGs: mean difference=-18.4, 95% CI=-31.3, -5.4; mobilizations: mean difference=-14.4, 95% CI=-27.4, -1.5) compared with the placebo group. Compared with the placebo group, both the SNAG and Maitland mobilization groups had less frequency of dizziness at 12 weeks. There were no differences between the 2 manual therapy interventions for these dizziness measures. For DHI and pain, all 3 groups improved posttreatment and at 12 weeks. Both manual therapy groups reported a higher GPE compared with the placebo group. There were no treatment-related adverse effects lasting longer than 24 hours. LIMITATIONS The therapist performing the interventions was not blind to group allocation. CONCLUSIONS Both SNAGs and Maitland mobilizations provide comparable immediate and sustained (12 weeks) reductions in intensity and frequency of chronic cervicogenic dizziness.
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Malmström EM, Eva-Maj M, Westergren H, Hans W, Fransson PA, Per-Anders F, Karlberg M, Mikael K, Magnusson M, Måns M. Experimentally induced deep cervical muscle pain distorts head on trunk orientation. Eur J Appl Physiol 2013; 113:2487-99. [PMID: 23812089 DOI: 10.1007/s00421-013-2683-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/14/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE We wanted to explore the specific proprioceptive effect of cervical pain on sensorimotor control. Sensorimotor control comprises proprioceptive feedback, central integration and subsequent muscular response. Pain might be one cause of previously reported disturbances in joint kinematics, head on trunk orientation and postural control. However, the causal relationship between the impact of cervical pain on proprioception and thus on sensorimotor control has to be established. METHODS Eleven healthy subjects were examined in their ability to reproduce two different head on trunk targets, neutral head position (NHP) and 30° target position, with a 3D motion analyser before, directly after and 15 min after experimentally induced neck pain. Pain was induced by hypertonic saline infusion at C2/3 level in the splenius capitis muscle on one side (referred to as "injected side"). RESULTS All subjects experienced temporary pain and the head repositioning error increased significantly during head repositioning to the 30° target to the injected side (p = 0.011). A post hoc analysis showed that pain interfered with proprioception to the injected side during acute pain (p < 0.001), but also when the pain had waned (p = 0.002). Accuracy decreased immediately after pain induction for the 30° target position to the side where pain was induced (3.3 → 5.3°, p = 0.033), but not to the contralateral side (4.9 → 4.1°, p = 0.657). There was no significant impact of pain on accuracy for NHP. A sensory mismatch appeared in some subjects, who experienced dizziness. CONCLUSIONS Acute cervical pain distorts sensorimotor control with side-specific changes, but also has more complex effects that appear when pain has waned.
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Affiliation(s)
- Eva-Maj Malmström
- Unit for Specialized Pain Rehabilitation, Department of Rehabilitation Medicine, Skåne University Hospital, 221 85, Lund, Sweden,
| | - Malmström Eva-Maj
- Unit for Specialized Pain Rehabilitation, Department of Rehabilitation Medicine, Skåne University Hospital, 221 85, Lund, Sweden,
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Characteristics of a new episode of neck pain. ACTA ACUST UNITED AC 2013; 18:254-7. [DOI: 10.1016/j.math.2012.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
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Reid SA, Rivett DA, Katekar MG, Callister R. Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain: protocol of a randomised controlled trial. BMC Musculoskelet Disord 2012; 13:201. [PMID: 23078200 PMCID: PMC3488326 DOI: 10.1186/1471-2474-13-201] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 09/26/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Cervicogenic dizziness is a disabling condition characterised by postural unsteadiness that is aggravated by cervical spine movements and associated with a painful and/or stiff neck. Two manual therapy treatments (Mulligan's Sustained Natural Apophyseal Glides (SNAGs) and Maitland's passive joint mobilisations) are used by physiotherapists to treat this condition but there is little evidence from randomised controlled trials to support their use. The aim of this study is to conduct a randomised controlled trial to compare these two forms of manual therapy (Mulligan glides and Maitland mobilisations) to each other and to a placebo in reducing symptoms of cervicogenic dizziness in the longer term and to conduct an economic evaluation of the interventions. METHODS Participants with symptoms of dizziness described as imbalance, together with a painful and/or stiff neck will be recruited via media releases, advertisements and mail-outs to medical practitioners in the Hunter region of NSW, Australia. Potential participants will be screened by a physiotherapist and a neurologist to rule out other causes of their dizziness. Once diagnosed with cervciogenic dizziness, 90 participants will be randomly allocated to one of three groups: Maitland mobilisations plus range-of-motion exercises, Mulligan SNAGs plus self-SNAG exercises or placebo. Participants will receive two to six treatments over six weeks. The trial will have unblinded treatment but blinded outcome assessments. Assessments will occur at baseline, post-treatment, six weeks, 12 weeks, six months and 12 months post treatment. The primary outcome will be intensity of dizziness. Other outcome measures will be frequency of dizziness, disability, intensity of cervical pain, cervical range of motion, balance, head repositioning, adverse effects and treatment satisfaction. Economic outcomes will also be collected. DISCUSSION This paper describes the methods for a randomised controlled trial to evaluate the effectiveness of two manual therapy techniques in the treatment of people with cervicogenic dizziness for which there is limited established evidence-based treatment. TRIAL REGISTRATION ACTRN12611000073909.
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Affiliation(s)
- Susan A Reid
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Darren A Rivett
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michael G Katekar
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Robin Callister
- The Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia
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Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropr Man Therap 2011; 19:21. [PMID: 21923933 PMCID: PMC3182131 DOI: 10.1186/2045-709x-19-21] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 09/18/2011] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness. METHODS A comprehensive search was conducted in the databases Scopus, Mantis, CINHAL and the Cochrane Library for terms related to manual therapy, vestibular rehabilitation and cervicogenic dizziness. Included studies were assessed using the Maastricht-Amsterdam criteria. RESULTS A total of fifteen articles reporting findings from thirteen unique investigations, including five randomised controlled trials and eight prospective, non-controlled cohort studies were included in this review. The methodological quality of the included studies was generally poor to moderate. All but one study reported improvement in dizziness following either unimodal or multimodal manual therapy interventions. Some studies reported improvements in postural stability, joint positioning, range of motion, muscle tenderness, neck pain and vertebrobasilar artery blood flow velocity. DISCUSSION Although it has been argued that manual therapy combined with vestibular rehabilitation may be superior in the treatment of cervicogenic dizziness, there are currently no observational and experimental studies demonstrating such effects. A rationale for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is presented. CONCLUSION There is moderate evidence to support the use of manual therapy, in particular spinal mobilisation and manipulation, for cervicogenic dizziness. The evidence for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is lacking. Further research to elucidate potential synergistic effects of manual therapy and vestibular rehabilitation is strongly recommended.
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Affiliation(s)
- Reidar P Lystad
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Gregory Bell
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Influence of prolonged unilateral cervical muscle contraction on head repositioning--decreased overshoot after a 5-min static muscle contraction task. ACTA ACUST UNITED AC 2010; 15:229-34. [PMID: 20083423 DOI: 10.1016/j.math.2009.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 10/29/2009] [Accepted: 12/14/2009] [Indexed: 12/16/2022]
Abstract
The ability to reproduce a specified head-on-trunk position can be an indirect test of cervical proprioception. This ability is affected in subjects with neck pain, but it is unclear whether and how much pain or continuous muscle contraction factors contribute to this effect. We studied the influence of a static unilateral neck muscle contraction task (5 min of lateral flexion at 30% of maximal voluntary contraction) on head repositioning ability in 20 subjects (10 women, 10 men; mean age 37 years) with healthy necks. Head repositioning ability was tested in the horizontal plane with 30 degrees target and neutral head position tests; head position was recorded by Zebris((R)), an ultrasound-based motion analyser. Head repositioning ability was analysed for accuracy (mean of signed differences between introduced and reproduced positions) and precision (standard deviation of the differences). Accuracy of head repositioning ability increased significantly after the muscle contraction task, as the normal overshoot was reduced. An average overshoot of 7.1 degrees decreased to 4.6 degrees after the muscle contraction task for the 30 degrees target and from 2.2 degrees to 1.4 degrees for neutral head position. The increased accuracy was most pronounced for movements directed towards the activated side. Hence, prolonged unilateral neck muscle contraction may increase the sensitivity of cervical proprioceptors.
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Strimpakos N. The assessment of the cervical spine. Part 1: Range of motion and proprioception. J Bodyw Mov Ther 2009; 15:114-24. [PMID: 21147427 DOI: 10.1016/j.jbmt.2009.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/29/2009] [Accepted: 06/05/2009] [Indexed: 02/02/2023]
Abstract
Neck pain and headache of cervical origin are complaints affecting an increasing number of the general population. Mechanical factors such as sustained neck postures or movements and long-term "abnormal" physiologic loads on the neck are believed to affect the cervical structures and compromise neck function. A comprehensive assessment of neck function requires evaluation of its physical parameters such as range of motion, proprioception, strength and endurance/fatigue. The complicated structure of the cervical spine however, makes it difficult for any clinician to obtain reliable and valid results. The aim of the first part of this systematic critical review is to identify the factors influencing the assessment of range of motion and proprioception of the cervical spine.
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Affiliation(s)
- Nikolaos Strimpakos
- Department of Physiotherapy, TEI Lamias, 3rd Km Old National Road Lamia-Athens, Lamia 35100, Greece.
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Cervical proprioception is sufficient for head orientation after bilateral vestibular loss. Eur J Appl Physiol 2009; 107:73-81. [PMID: 19506897 DOI: 10.1007/s00421-009-1097-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
Abstract
The aim was to investigate the relative importance of cervical proprioception compared to vestibular input for head movements on trunk. Subjects with bilateral vestibulopathy (n = 11) were compared to healthy controls (n = 15). We studied their ability to move the head accurately to reproduce four specified target positions in the horizontal yaw plane (neutral head position, 10 degrees target, 30 degrees target, and 30 degrees target with oscillating movements applied during target introduction). Repositioning ability was calculated as accuracy (constant error, the mean of signed differences between introduced and reproduced target) and precision (variable error, the standard deviation of differences between introduced and reproduced targets). Subjects with bilateral vestibulopathy did not differ significantly from controls in their ability to reproduce different target positions. When the 30 degrees target position was introduced with oscillating movements, overshoot diminished and accuracy improved in both groups, although only statistically significantly when performed towards the right side. The results suggest that at least in some conditions, accurate head on trunk orientation can be achieved without vestibular information and that cervical somato-sensory input is either up-regulated as a compensatory mechanism after bilateral vestibular loss or is important for such tasks.
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