Cervicocephalic Relocation Test Research Articles

Biometric Image-Analysis Techniques for Monitoring Chronic Neck Pain

The term “mechanical neck pain” is a generic term used to define neck pain in people with neck injuries, neck dysfunction, or shoulder and neck pain. Several factors must be considered during the physical-therapy evaluation of cervical disorders, including changes in the visual systems and postural and proprioceptive balance. Currently, the Cervicocephalic Relocation Test (CRT) is used by physiotherapists to detect changes in cervical proprioception. This procedure requires precise equipment, customized installation in a dedicated area and, above all, a significant amount of time post-treatment for the doctor to make the diagnosis. An innovative system composed of Google’s MediaPipe library combined with a personal laptop and camera is proposed and evaluated. The system architecture was developed, and a user interface was designed with the goal of allowing the system to be used more easily, more quickly, and more effectively by the healthcare practitioner. The tool is presented in this paper and tested in a use case, and the results are presented. The final user report, containing the visualization of the results of the CRT, which are ready for analysis by the physical therapist, can be exported from the developed tool.

Cervical joint positioning error and its association with cervical spine mechanics among undergraduate students.

A cross sectional analytical study was conducted from September 26 to December 28 2018 at Shifa Tameer-e-Millat University Islamabad with 111 undergraduate students aged 17-26 years as participants. The aim of the study was to establish the normative values of cervical joint positioning error (CJPE) and its association with cervical spine mechanics. Neck discomfort was measured using the neck portion of the "student specific Cornell Musculoskeletal Discomfort Questionnaire" (ssCMDQ) and CJPE was measured via cervico-cephalic relocation test using a goniometer. Non-parametric tests of significance were used because the data was not normally distributed in terms of normality testing. Normative values of CJPE were noted to be highest in flexion (9o±9o), rotation towards left (9o±6o) and right (8o±7o), extension (6o±8o), and lastly lateral flexion towards left (5o±7o) and right (5o±5o). Higher CJPE in all movements was observed among females; however, no significant statistical differences were observed (p>0.05). In terms of correlation, important trends included significantly positive correlation of neck discomfort with CJPE in extension, and of CJPE in lateral flexion towards the left with CJPE in lateral flexion towards the right and flexion (p<0.05).

A study to analyze the effectiveness of exercise program in improving the proprioceptive acuity among patients with chronic neck pain

Introduction and Aim: Neck pain is estimated to affect 10% to 20% of the Indian population every year, with1/3rd of people developing chronicity, which is predominantly due to impaired proprioception. Clinical texts specifically recommend the assessment and management of proprioceptive dysfunction, there is lack of clear evidence for proprioceptive dysfunction in different subgroups of chronic neck pain Materials and Methods: Thirty-two subjects were included and sub-grouped based on their dysfunction. Group A- mechanical neck pain (n= 10), Group B- upper cervical involvement (n= 10) and Group C- cervical radiculopathy (n= 12). The baseline evaluation consisted of Cervico Cephalic Relocation (CCR) test, Deep Cervical Flexor (DCF) endurance, and Neck Disability Index (NDI) questionnaire, which was again taken at the end of two weeks following intervention. Results: In all three groups, joint position error was observed and following intervention, a significant improvement in the outcomes had occurred, with greater improvement in Group A, followed by B, then C. On comparison between the groups, the right and left rotations of CCR, DCF endurance and NDI (p value 0.05) were similar. Conclusion: Proprioception training should form an integral part of rehabilitating patients with chronic neck pain. Keywords: Neck pain; proprioception; cervical joint position error; Cervico cephalic relocation test.

Disturbance of neck proprioception and feed-forward motor control following static neck flexion in healthy young adults

The highly complex proprioceptive system provides neuromuscular control of the mobile cervical spine. Static neck flexion can induce the elongation of posterior tissues and altered afferent input from the mechanoreceptors. The purpose of this study was to examine the effect of prolonged static neck flexion on neck proprioception and anticipatory postural adjustments. Thirty-eight healthy participants (20 females and 18 males) between the ages of 20–35 years with no history of neck, low back, and shoulder pain enrolled in this study. Neck proprioception and anticipatory muscle activity were tested before and after 10-min static neck flexion. For assessment of neck proprioception, each participant was asked to perform 10 trials of the cervicocephalic relocation test to the neutral head position after active neck rotation to the left and right sides. Anticipatory postural adjustments were evaluated during a rapid arm flexion test. Following the flexion, the absolute and variable errors in head repositioning significantly increased (p < 0.05). The results also showed that there was a significant delay in the onset of myoelectric activity of the cervical erector spinae muscles after flexion (p = 0.001). The results of this study suggested that a 10-min static flexion can lead to changes in the neck proprioception and feed-forward control due to mechanical and neuromuscular changes in the viscoelastic cervical spine structures. These changes in sensory-motor control may be a risk factor for neck pain and injury.

Alteration of neck proprioceptive capacity in women with fibromyalgia

Fibromyalgia (FM) is a syndrome whose primary symptoms include chronic widespread muscle pain and fatigue. Muscles of neck and shoulder are often painful and fatigable. According to the literature, pain and fatigue of the muscles of the neck can induce proprioceptive troubles. The aim of this study was to determine if patients with FM have more often a reduction of neck proprioceptive capacity. We compared individuals affected by fibromyalgia to healthy individuals without any cervical problems. Cervicocephalic Relocation Test was used to determine deficit of proprioception. Head repositioning absolute value of the global error (AE) was calculated after 20 active head rotations (10 right, 10 left). According to Revel (1991), the cut-off of 4.5° error has been chosen. After calculation of the necessary sample size (power 80%), an overall of 20 subjects were included in the study (10 in each group), they were from 27 to 68 years old. The 10 healthy subjects showed normal AE. Their AE was 2.5 ± 1.0° (m ± SD). Five of the 10 FM patients showed deficit ( P < 0.01) with AE > 4.5°. Mean AE of FM patients was 4.5 ± 1.3° (median = 4.7°). Fibromyalgia Impact Questionnaire score was 47.5 ± 17.6. It would be interesting to pursue the study to seek a global proprioception alteration within subjects who suffer from fibromyalgia. Postural deficit described in literature could be occurred by proprioceptive deficit. Moreover, it would be also interesting to see the effects of a rehabilitation targeted on proprioception, pain and tiredness.

Cervicocephalic relocation test to evaluate cervical proprioception in adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine associated with disturbed postural control. Cervical proprioception participates in controlling orthostatic posture via its influence on head stabilization. We hypothesized that patients with AIS exhibit altered cervical proprioception. We conducted a case-control study to evaluate cervical proprioception using the cervicocephalic relocation test (CRT) in 30 adolescents with AIS (15.5±1.5years; Cobb 24.8°±9.5°) versus 14 non-scoliotic controls (14.6±2.0years). CRT evaluates cervical proprioception by measuring the capacity to relocate the head on the trunk after active rotation of the head in the transversal plane without visual control. Each subject performed ten right and then ten left head rotations. The CRT results were pathological in 12 AIS patients (40%). The CRT mean was significantly different between AIS patients with a pathological CRT (5°±1.4° for right rotation; 4.2°±0.9° for left rotation) compared with AIS patients with a normal CRT (2.7°±0.6° for right rotation; 2.9°±0.8° for left rotation) or with the control group (3.5°±2.1° for right rotation; 3.1°±1.2° for left rotation). Cervical proprioception is impaired in certain AIS patients. This anomaly may worsen the prognosis of AIS (headache; balance disorders; worsened spinal deformity; complication after spinal fusion). We recommend systematic screening for altered cervical proprioception in AIS patients.

Cervical joint position sense in rugby players versus non-rugby players

Objective To determine whether cervical joint position sense is modified by intensive rugby practice. Design A group-comparison study. Setting University Medical Bioengineering Laboratory. Participants Twenty young elite rugby players (10 forwards and 10 backs) and 10 young non-rugby elite sports players. Interventions Participants were asked to perform the cervicocephalic relocation test (CRT) to the neutral head position (NHP) that is, to reposition their head on their trunk, as accurately as possible, after full active left and right cervical rotation. Rugby players were asked to perform the CRT to NHP before and after a training session. Main Outcome Measurements Absolute and variable errors were used to assess accuracy and consistency of the repositioning for the three groups of Forwards, Backs and Non-rugby players, respectively. Results The 2 groups of Forwards and Backs exhibited higher absolute and variable errors than the group of Non-rugby players. No difference was found between the two groups of Forwards and Backs and no difference was found between Before and After the training session. Conclusions The cervical joint position sense of young elite rugby players is altered compared to that of non-rugby players. Furthermore, Forwards and Backs demonstrated comparable repositioning errors before and after a specific training session, suggesting that cervical proprioceptive alteration is mainly due to tackling and not the scrum.

Degradation of Cervical Joint Position Sense Following Muscular Fatigue in Humans

Before and after intervention trials. To investigate the effect of cervical muscular fatigue on joint position sense. Although fatigue-related degradation of proprioceptive acuity at lower and upper limbs is well documented, to date no study has investigated whether muscular fatigue induced at the neck could modify joint position sense. A total of 9 young healthy adults were asked to perform the cervicocephalic relocation test to the neutral head position, that is, to relocate the head on the trunk, as accurately as possible, after full active cervical rotation to the left and right sides. This experimental task was executed in 2 conditions of No fatigue and Fatigue of the scapula elevator muscles. Absolute and variable errors were used to assess the cervical joint repositioning accuracy and consistency, respectively. Less accurate and less consistent repositioning performances were observed in Fatigue relative to No fatigue condition, as indicated by increased absolute and variable errors, respectively. Results of the present experiment evidence that cervical joint position sense, assessed through the cervicocephalic relocation test to the neutral head position, is degraded by muscular fatigue.

The Effect of Free Fly Expertise on Cervical Joint Position Sense: A Pilot Study

This study aimed to assess the effect of free fly expertise on cervical joint position sense. To this aim, four young elite freeflyers and 20 young sportsmen nonfreeflyers were asked to perform the cervicocephalic relocation test to the neutral head position. During the test, they had to reposition their head in a neutral position on their trunk, as accurately as possible, after full active cervical rotation to the left and right. Absolute and variable errors were used to assess accuracy and consistency of the repositioning for the two groups. Absolute and variable errors observed in the group of freeflyers were significantly lower than those observed in the group of nonfreeflyers. These results suggest a more accurate and consistent head repositioning performance in the group of freeflyers than in the group of nonfreeflyers. The present findings suggest that the cervical joint position sense could be improved through extensive specific sports training.

Cervicocephalic Relocation Test to the Neutral Head Position: Assessment in Bilateral Labyrinthine-Defective and Chronic, Nontraumatic Neck Pain Patients

Pinsault N, Vuillerme N, Pavan P. Cervicocephalic relocation test to the neutral head position: assessment in bilateral labyrinthine-defective and chronic, nontraumatic neck pain patients. Objective To determine whether vestibular or cervical proprioceptive information influence the cervicocephalic relocation test to the neutral head position, by comparing head repositioning errors obtained in asymptomatic, unimpaired control subjects with those obtained in bilateral labyrinthine-defective patients and chronic, nontraumatic neck pain patients. Design A group-comparison study. Setting University medical bioengineering laboratory. Participants Labyrinthine-defective patients (n=7; mean age ± SD, 67±15y), nontraumatic neck pain patients (n=7; 56±9y), and asymptomatic, unimpaired control subjects (n=7; 64±12y). Interventions Participants were asked to relocate the head on the trunk, as accurately as possible, after full active cervical rotation to the left and right sides. Ten trials were performed for each rotation side. Main Outcome Measures Absolute and variable errors were used to assess accuracy and consistency of the repositioning, respectively. Results No significant difference in repositioning errors was observed between labyrinthine-defective patients and control subjects, whereas nontraumatic neck pain patients demonstrated significantly increased absolute errors in horizontal and global components and higher variable errors in horizontal component. Conclusions These findings suggest that the vestibular system is not involved in the performance of the cervicocephalic relocation test to neutral head position, and further support this test as a measure of cervical proprioceptive acuity.

Cervical joint position sense is impaired in older adults

Although the role of afferent input from cervical muscles on the control of posture and locomotion is recognised, it is surprising that there is an absence of data reporting whether joint position sense at the cervical level is impaired in older healthy adults. The present experiment was designed to address this issue. Eighteen young (mean age=23 yrs) and 18 older healthy adults (mean age=68 yrs) were asked to perform the cervicocephalic relocation test (CRT) to the neutral head position (NHP), that is, to relocate the head on the trunk, as accurately as possible, after active cervical rotation to the left and right sides. Ten trials were performed for each rotation. Absolute and variable errors were used to assess cervical joint repositioning accuracy and consistency, respectively. Less accurate and less consistent repositioning performances were observed in older adults than in young adults, as indicated by increased absolute and variable errors, respectively. The present findings show that cervical joint position sense, assessed through the CRT to the NHP, is impaired in older adults.

Influence de stimulations nociceptives sur le sens de repositionnement céphalique

The goal of this study was to evaluate the impact of nociceptive stimuli upon the cervical proprioception ability. MethodThirty healthy young subjects performed a cervicocephalic relocation test (CRT) in two random conditions: the first one was based on a nociceptive electric stimulation called condition “pain”, whereas the second one was targeting a painless electric condition called condition “control”. The CRT consisted of repositioning the head on the trunk, after an active transversal movement of the head in the transverse field with closed eyes. The pointing was recorded at the beginning and at the end of each rotation using a custom video acquisition system. ResultsThe average mean of error repositioning was worth 3.98±0.99° (average mean, standard deviation) in the condition “pain”, and 1.75±0.37° in the condition “control” (p<0.01). ConclusionAcute pain provokes a disturbance of the cervical proprioception ability without damaging the anatomic structure. This observation suggests the interest of an early follow-up of the pain to avoid sensory disturbances, as well as the establishment of a cervical proprioceptive rehabilitation program after an algic event.

Test-retest reliability of cervicocephalic relocation test to neutral head position

Considering the important role of the cervical joint position sense on control of human posture and locomotion, accurate and reliable evaluation of neck proprioceptive abilities appears of great importance. Although the cervicocephalic relocation test (CRT) to the neutral head position (NHP) usually is used for both research and clinical purposes, its test-retest reliability has not been clearly established yet. The purpose of the present experiment was to 1) evaluate the test-retest reliability of the CRT to NHP and 2) to determine the number of trial recordings required to ensure reliable measurements. To this aim, 40 young healthy adults performed the CRT to NHP on two separate occasions. Ten trials were performed for each rotation side. Absolute and variable errors, processed along their horizontal, vertical, and global components, were used to assess the cervical joint repositioning accuracy and consistency, respectively. Mean difference between test and retest with 95% confidence interval, intraclass correlation coefficient, and Bland and Altman graphs with limits of agreement were used as statistical methods for assessing test-retest reliability. Results show that the CRT to NHP when executed in its original form (i.e., 10 trials) has a fair to excellent reliability (ICC ranged from 0.52 to 0.81 and from 0.49 to 0.77, for absolute and variable errors, respectively); the test-retest reliability of this test increases as the number of trials used to establish subject's repositioning errors increases; and using the mean of eight trials is sufficient to ensure fair to excellent reliability of the measurements (ICC ranged from 0.39 to 0.78 and from 0.44 to 0.78, for absolute and variable errors, respectively).

Test de repositionnement céphalique : étude de la stabilité de performance

Objective The purpose of the present experiment was to determine the reliability of the cervicocephalic relocation test (CRT). Methodology Thirteen young healthy adults were recruited to undergo a CRT test-retest. The test-retest reliability was determined by repeatedly measuring CR to a neutral position after active movement, with trials approximately 1 hour apart. Each CRT involved 20 CRs to a natural head position, 10 repositioning after right head rotation, and 10 repositioning after left head rotation (with the order of rotation sides randomized). The performance score for each subject for each CRT was the mean of the errors made during the 20 relocations (in degrees). Study Results The mean rate of error of the first and second trials was 3.2 ± 1.1° and 2.9 ± 0.9°, respectively. The intra class correlation coefficient was 0.81, and the standard error of measurement 0.90°. Conclusion: CRT testing supports evidence of reliable cervicocephalic performance stability in healthy young adults. CRT shows promise as a relevant tool of assessment in head and neck proprioception.