DIZZINESS, UNSTEADINESS, VISUAL DISTURBANCES, AND SENSORIMOTOR CONTROL IN TRAUMATIC NECK PAIN-CLINICAL COMMENTARY

Review written by Dr Xiaoqi Chen info

BACKGROUND & OBJECTIVE

This is an excellent clinical commentary by Dr Julia Treleaven who has extensive publications in the area of sensorimotor dysfunction in people with neck pain and whiplash. This paper discusses the signs, symptoms, and potential origins of sensorimotor impairments in people following neck trauma. The sensorimotor control system includes the visual, vestibular and proprioceptive systems. Proprioceptors are in abundance in the muscles and joints of the cervical spine, reflecting the importance of the neck in relaying information to the central nervous system (CNS) to control postural stability. It is important to consider potential impairment(s) to the sensorimotor control system in patients who have sustained a traumatic neck injury.

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SIGNS AND SYMPTOMS

Altered cervical nociceptive input and/or CNS representation may occur following traumatic neck injury due to the following reasons: “inflammation, functional impairment, morphological changes to musculature, pain, and psychological distress”. Some symptoms associated with a disturbed sensorimotor control system include a vague sense of unsteadiness or light-headedness. Vertigo, or a spinning sensation, is rarely reported in cervicogenic dizziness as this is generally attributed to vestibular dysfunction. Visually, a patient might report difficulty concentrating and reading, visual fatigue, difficulty judging distances, and light sensitivity. It is important to note that some of these symptoms overlap with those of a post-concussion syndrome, but those with concussion may additionally report losing the location on a page, and ineffective reading speed. Other symptoms such as headaches and fatigue may have cervicogenic and/or concussion sources also.

CLINICAL/OBJECTIVE ASSESSMENT

The following are examples of tests relevant for the clinical assessment of sensorimotor impairments related to the neck. The author recommended that these tests should be performed in all patients with traumatic neck pain.

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