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Physical Therapy Examination for Patients with Cervicogenic Dizziness

Amer Al-Saif, Hani Al-Nakhli and Samira Alsenany

Dizzinessis a common symptom resulting from a variety of medical conditions. An emerging area of physical therapy practice is the management of patients with cervicogenic dizziness. Patients with cervicogenic dizziness typically describe a vague sense of impaired orientation or disequilibrium that is exacerbated by neck pain. There is frequently a past medical history of cervical spine trauma, such as a whiplash associated disorder, and the physical examination often reveals orthopedic problems in the upper cervical spine causing mechanical compression of the vertebral artery network, irritation of the cervical sympathetic nervous system, and/or impaired upper cervical spine proprioception. The purpose of this paper is to introduce the etiology of cervicogenic dizziness and provide a brief overview of the physical therapy examination and intervention process. There is a growing body of evidence supporting the pathophysiology and physical therapy management of patients with CGD (Cervicogenic Dizziness); however, it is still not widely adopted in clinical practice. Cervicogenic dizziness is often the result of a sensory mismatch between the vestibular, somatosensory, and visual afferent inputs. Physical trauma involving the cervical spine, such as whiplash injury, is a common mechanism of injury in CGD patients. Therefore, the purpose of this paper is to discuss the etiology of cervicogenic dizziness, describe the proposed pathophysiology, and introduce the physical therapy examination and intervention process for patients with CGD. In order to determine the origin of the patient’s dizziness, the physical therapist must conduct thorough subjective and physical examinations to rule out all competing causes of dizziness. The patient history may include physical trauma involving the head and neck and cervical spine postural faults, which are commonly observed. Therefore, treating neck pain among this group of patients is one of the main objectives for physical therapists. Intervention strategies may include: (1) orthopedic manual techniques specific to the cervical spine region, (2) head and neck proprioceptive rehabilitation program, and (3) cervical-ocular motor exercises cervical spine proprioception impairments can be treated with a specific proprioceptive rehabilitation program. The program can be progressed by doing active head movements rather than passive head movements. In conclusion, physical therapy intervention has been shown to be effective in reducing CGD symptoms.