Cervicogenic dizziness Flashcards
Cervicogenic dizziness
Symptoms of dizziness unsteadiness or lightheadedness that is thought to originate from dysfunction within the cervical spine
nonspecific form of altered orientation in space and disequilibrium
Different from vertigo and vertebrobasilar artery insufficiency
normal sensorimotor function results from
Collaborative input from the visual vestibular and postural control systems
neurophysiological mechanisms
mechanoreceptors
reflexes
Sympathetic nervous system
Cervical receptors
Wide network of connections
Important role in neck reflect activity
relates to Head orientation, eye movement control, and postural stability
Crucial role in proprioception, posture, spatial awareness, and coordination of eye movements
Visual acuity
controlled by the cervical ocular reflex COR
And
Vestibular ocular reflex VOR
Postural stability
Assessed with tests as the Romberg test or balance error scoring system
dysfunctional cervical afferents
Result from direct trauma or from alterations in afferent feedback due to incorrect muscular function
susceptible to chemical neural irritation from local inflammatory mediations in surrounding tissue
dysfunction may also occur in the presence of nociception
Sympathetic nervous system may exert effect on muscle spindle activity, resulting in alterations in muscle activity
treatment strategies for CGD
Specifically targeted to impairments in
Cervical spine
Vestibular system
sensorimotor system
cluster of symptoms of CGD
Lightheadedness and steadiness unbalanced and feeling clumsy
Increased neck pain, sitting and standing up, and neck movements are exacerbating features
Commonly associated symptoms were headache, nausea, blurred vision, and decreased concentration
Physical examination tests
Smooth pursuit test
Gaze stability test
Head thrust test
likely dysfunctions in CGD
joint position error, optokinetic system
gaze stability and smooth pursuit, oculomotor system
balance
neck pain
vestibular dysfunction
targeted interventions for CGD
Manual therapy for cervical spine
Vestibular and balance rehabilitation
Joint position sense
Gaze stability and smooth pursuit retraining
Exercise therapy
vestibular and balance rehabilitation
Progress patient through tasks that increasingly challenge the postural system by altering
Foot position
Visual input
Supporting balance
joint position sense
Measure ability to relocate the natural head posture with eyes closed
Joint position error is angular difference between starting postural position and that assumed after a neck position
use of laser pointer
patient sits 90 cm away from the wall
Starting position, projected by laser onto the wall and marked
Patient closes eyes and moves into extension, then relocate to the start position
Second mark is placed on the wall
Measure the difference between the two marked points and centimeters as negative or positive value undershoot or overshoot
