Cervical Torsion Test | Dizziness Assessment
The Cervical Torsion Test examines dizziness and nystagmus provoked by neck torsion and has demonstrated strong diagnostic utility in confirming a diagnosis of cervicogenic dizziness compared to benign paroxysmal positional vertigo according to a study of L’heureux-Lebeau et al. (2014).
However, it was previously suggested that nystagmus during this test may often be present in people who are healthy because of activation of the cervico-ocular reflex.
Furthermore, the precise amount of nystagmus required to determine a positive test would be difficult to observe with the naked eye and may require video-oculography that may not be available in the clinic. Thus the use of subjective symptoms has been suggested as an alternative clinical measure.
Trealeaven et al. (2019) have performed this test in a group of healthy subjects to determine the test’s specificity. They found a specificity of 98.5% in patients during the torsion part of the test. As sensitivity values first have to be evaluated in symptomatic groups, the clinical use of this test is unknown at this moment.
To perform the test, have the patient seated on a swivel chair with the hip and knees flexed to 90 degrees. The patient closes his eyes in order to minimize afferent activity from the visual system.
Then, the examiner fixates the patient’s head in neutral position and asks the patient to actively rotate the trunk to one side for at least 45 degrees and up to 90 degrees and to hold it for 30 seconds.
This test is scored positive if the patient reports dizziness, visual disturbances, unusual eye movements after opening the eyes after the test, speech disturbance, motion sickness or nausea, slurred speech, dysphagia, light-headedness, tinnitus, headache or paresthesia. These symptoms can occur during any of the four positions or immediately after the test.
Next to the Cervical Torsion Test, your dizziness exam should include the following assessments:
- Gaze stability
- Saccadic Eye Movement
- Eye-Head Coordination
- Postural Stability
- Joint Position Sense Error
- Smooth Pursuit Neck Torsion Test
- Head-Neck Differentiation Test
Treleaven, J., Joloud, V., Nevo, Y., Radcliffe, C., & Ryder, M. (2020). Normative responses to clinical tests for cervicogenic dizziness: Clinical cervical torsion test and head-neck differentiation test. Physical Therapy, 100(1), 192-200.
- Mads Louis25/11/22
Vestibular Rehabilitation EXCELLENT COURSE, THAT MAKES YOU READY TO TREAT DIZZINESS WITH CONFIDENCE
This course provides an excellent opportunity to learn how to treat and diagnose vertigo/dizziness patients, who previously were a mystery to treat.Jordi Holierhoek18/08/22
Vestibular Rehabilitation EXCELLENT COURSE!
Fantastic course, very practical with enough depth! I learned a lot from first. He is an excellent teacher who knows his stuff. I would totally recommend this course.Stephen08/08/22
Vestibular Rehabilitation GREAT COURSE FOR BEGINNERS AND THERAPISTS WITH SOME EXPERIENCE
Loved the course, can be done relatively quickly if you are like me and have a little bit of vestibular knowledge (it took me around 2 weeks), but the basics are all there so you can spend a bit more time getting into it if needed
I luckily had two patients in my ward needing vestibular rehabilitation just as I had finished this course, and I was able to help them straight away
- Kim Hansen30/03/22
Vestibular Rehabilitation VESTIBULAR REHABILITATION
Really good and professional layout with Firat's professional experience as well as nice software touches by Physiotutors with questions in some videos for example. Firat approaches you in different ways of teaching with small videos, summaries, lectures and so on. Also fun to see that some of his references are people that I have a cooperation with here in Sweden. Even if there’s a whole division of information regarding vestibular hypofunction it would still be fun to have separate chapter for vestibular neuritis, but that’s just a small note. On the whole I’m totally happy and satisfied with this course, really good job done by Firat and Physiotutors, I will be keeping an eye out for more advanced courses in the future regarding this topic, maybe Firat can do a Masterclass version?Steve van Rijen26/03/22
Vestibular Rehabilitation VESTIBULAR REHABILITATION
By far the best course i ever had.
It will take you a lot of time and effort to make it your own.
But i can tell, the reward is great.
you won’t be disappointedMarine Gandin27/01/22
Vestibular Rehabilitation REALLY COMPLETE COURSE AND EASY TO LEARN
It takes me 6 full days to finish that course but it was a really good course!
I enjoyed every part of the “vestibular rehabilitation” by Firat.
I’m excited to start doing some practice with patient!
I didn’t need any further explanation but I saw that Firat answers very fast to the question on the unit.
Thank you very much for this amazing course!
Even if it is in an other language than mine, it was really easy to understand.
- Christiena den Tek28/12/21
Vestibular Rehab COMPLETE COURSE ABOUT DIZZINESS AND THE WAY TO TREAT FOR PHYSIO'S
In the past I finished/followed a few courses about dizziness and treatment. I really enjoyed following this course because it’s very complete. There is overall information about the systems involved with dizziness problems, the pathologies, the exams and the overall physiotherapy treatment or other treatments. There is a nice mix between the way the information is given and the information is up to date science. The teacher (Firat) is a teacher that loves helping you out and if you have any questions he is quickly in his response.
I would recommened this course highly not only for those who just start learning things about the dizziness (patient) but also for those who are already working with these patients.Elisabetta12/12/21
Vestibular Rehabilitation INCREDIBLY THOROUGH COURSE
Such a fantastic course!
The learning experience is enhanced by interactive material found in each module.
The instructor provides clear information, both theoretical and practical, easy to apply in clinical practice.
This is an excellent course, and I would definitely recommend it!Physiotutors27/08/21
Vestibular Rehabilitation Firat really delivered on this course! While we have had some training in vestibular diagnostics and rehab in our own training, this course is on a whole other level! Building this course with Firat has increased our knowledge dramatically and we can absolutely recommend this course to any Physiotherapist as patients with vestibular problems will be among the most grateful patients when treated right.
- Anne Cahill02/08/21
Vestibular Rehabilitation Thank You!!
This is a brilliant course. The learning materials are concise, clear and comprehensive. All the information given is easy to navigate, up to date and very useful for daily clinical vestibular rehabilitation practice. It is a much appreciated educational resource. Amazing!! Thank you for this excellent course.Astrid Schubart27/06/21
Vestibular Rehabilitation I finished this course Vertigo this weekend and it’s been a long time since I’ve done such a great structured training. Lots of practical content. The lecturer shows in detail what is important. Firat Kesgin offers a lot of additional information and patient information.
I am really excited and looking forward to apply my new knowledge in practice.