The purpose of this test is to isolate and provoke cervicogenic dizziness (i.e., dizziness of cervical origin) to facilitate diagnosis.
Area of Assessment
Range of Motion
Cost of equipment (stool or chair that swivels)
- The patient is seated in a stool or chair that swivels, thighs parallel to the floor.
- Part 1 : The seated patient closes his/her eyes and actively rotates (“shakes”) the head sinusoidally under high velocity and frequency conditions “as far and as quickly as possible” (Fritz-Ritson, 1991).
Note: Head shaking duration guidelines are not provided in the literature however the clinician may consider head shaking for 10-20 seconds as tolerated by the patient.
Note: Head movement stimuli are intended to provoke vestibular symptoms (via activation of the peripheral vestibular end organs) and/or cervicogenic symptoms from cervical proprioceptors in neck muscles and joints.
- Part 2 : The examiner now stands behind the seated patient and provides gentle cephalad directed manual traction to the head to “pre-stretch” the cervical musculature and to gently but firmly fix the patient’s head in space. (Fritz-Ritson, 1991).
- The patient is next instructed to actively rotate his or her torso in a sinusoidal manner from the neck down.
Note: Again, neck-down rotation frequency and duration guidelines are not specified in the literature however the examiner may consider rotation for a period of 10-20 seconds or until symptoms are produced.
Note: Though not specified in the test description, the examiner should delay initiating Part 2 of this test until any residual symptoms from Part 1 have resolved.
- Symptoms of dizziness elicited during Part 2 of this procedure are believed to be associated with cervicogenic dizziness vs. vestibular dizziness.
- Stool or chair that swivels
Jennifer L. Stoskus, PT, MSPT, DPT, Matthew R. Scherer PT, PhD, NCS and the Vestibular EDGE task force of the Neurology section of the APTA
- Patient should be cleared of vascular and orthopedic contraindications before attempting any vigorous head shaking of the nature described in this test to ensure vertebral artery integrity and cervical stability.
- In general, this test is inadequately described in the available literature leaving the examiner without specific guidance on how the test ought to be administered.
- This assessment lacks an objective outcome with which to determine if the test is “positive” or “negative” relying only on an ill-defined report of patient symptoms (i.e., vertigo) to document test findings.
- Test interpretation is further confounded by the possibility that a symptomatic patient may elicit symptoms during the first phase of the assessment (Part 1) with vigorous head shaking making it difficult to distinguish between vestibular dizziness and dizziness of a cervicogenic etiology.
- Though no psychometrics are available due to the absence of a gold standard with which to confirm a diagnosis of cervicogenic dizziness, this procedure will yield poor specificity for reasons stated above limiting its utility as a diagnostic test.
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