When working on older clients or people whom have had severe neck trauma we need to check that moving the neck into these various positions does not impinge the vertebral artery. An occluded vertebral artery does not deliver enough blood to the brain and is therefore a dangerous situation. This not only applies to therapists but also those involved with physical preparation. The importance of this test can not be over stressed but you rarely see it being performed.
Patient Position:
The patient is positioned supine with the head on a pillow.
Practitioner Position:
The practitioner is positioned sitting or standing at the head of the table.
Stabilizing / Mobilizing Hand:
The practitioner cradles both sides of the patient’s head with the thumbs resting on the mandible and pointing towards the patient’s feet.
Segmental Test:
The practitioner gently backward bends the patient’s occiput. The therapist then slowly moves the patient’s head into side bending to end-range. Third, the practitioner then rotates the patient’s head in the same direction as the side bending. The practitioner should engage the patient in light conversation and observe the patient’s eyes for nystagmus, pupillary changes or visual disturbances.
Question the patient regarding vertigo/dizziness.
STOP the test if the patient demonstrates any of the previously mentioned signs or symptoms