Week 3: Cervicogenic Dizziness Flashcards
Potential causes of dizziness?
- Cardiac
- Psychological
- Medication induced
- Vestibular
- Metabolic
- Neurally-mediated
- Cervicogenic
What is cervicogenic dizziness?
- Dizziness, unsteadiness, or light headedness thought to originate from dysfunction w/in the cervical spine
- Different from vertigo and vertebrobasilar artery insufficiency
Normal sensorimotor function
Collaborative inputs from visual, vestibular, and postural-control systems
What drives development of sensorimotor dysfunction
- Disturbance in cervicobrachial muscle activatiion
- Disturbance in eye movement control
- Disturbance in proprioceptive acuity
- Disturbance in balance
Neurophysiologic mechanisms for dizziness
- Mechanoreceptors
- Reflexes
- Sympathetic NS
Role of cervical receptors
Play crucial role in proprioception, posture, spatial awareness, and coordination of eye movements
Reflexes involved in sensorimotor function (visual acuity)
- Cervico-ocular reflex (COR)
- Vestibulo-occular reflex (VOR)
Reflexes involved in sensorimotor function (postural acuity)
Assessed with Rhomberg’s test or balance error scoring system (BESS)
Dysfunctional cervical afferents
- Can result from direct trauma
- Can result from alterations in afferent feedback from muscular dysfunction
- C-spine afferents are susceptible to chemical neural irritation
- Nociception
- Sympathetic NS may alter muscle activity
Treatment strategies for cervicogenic dizziness
Treat impairments in
- Cervical spine
- Vestibular system
- Sensorimotor system
What will the subjective exam look like to lead us to conclude cervicogenic dizziness is the culprit?
- Describe dizziness/unsteadiness
- How often?
- How long?
- What brings on symptoms?
- What do you when when you get symptoms?
- Anything else that occurs at the same time?
- Have you fallen or lost balance at the same time?
- How soon after the accident did these symptoms occur?
Cluster of symptoms for cervicogenic dizziness
- Lightheadedness, unsteadiness, unbalanced and feeling clumsy
- Exacerbated by increased neck pain, sitting and standing up, and neck movements
- Associated symptoms: headache, nausea, blurred vision, and decreased concentration
Components of the physical exam for cervicogenic dizziness
- Smooth pursuit test
- Gaze stability test
- Head thrust test
Likely dysfunctions with cervicogenic dizziness
- JPE (optokinetic system)
- Gaze stability and smooth pursuit (oculomotor system)
- Balance
- Neck pain
- Vestibular dysfunction
Targeted interventions for CGD
- C-spine manual therapy
- Vestibular and balance rehab
- Joint position sense
- Gaze stability and smooth pursuit retraining
- Exercise
