Prac Viva

• - area of pain- occipital- C1-C2
• - arm pain, paraesthesia, numbness
• - headache- type
• - facial pain, paraesthesia (where and what fingers), numbness
• - diziness
• - trauma

• -turning head to reverse car
• - reading- flexion problems
• - computer use- using mouse- forward movement
• - holding phone (with ear and shoulder) (LF), hanging washing (ext)
• - sports- swimming
• - sleeping position- pillows sleep on- edge of pillow

• - lie down
• - get up, move around, walk
• - night position
• - pillows

• - dizziness
• - dysphagia (swallow)
• - dysarthria (speech)
• - diplopia (double vision)
• - drop attacks (like fainting)

• - 5 ds
• - nausea/vomiting
• - spinal cord (tingling hands/ feet), bilateral limb paraesthesia, unsteadiness on feet (ataxia- wide BOS)
• - medication (long term, steriods)
• - medical history- RA- ligs unstable
• - weight loss

• - lordosis (FHP- forward head posture)
• - lateral tilt
• - arm supported (nerve root compromise)
• - dowager's hump (senile osteoporosis- kyphosis)
• - mm spasm
• - is the posture correct?

• - flex
• - ext
• - rot
• - lat flex
• etc

• All done in sitting:
• - flex- OP for just cervical flexion cross hands over
• - flex + rotation test_ FRT-can differentiate
• - ext- hold jaw to OP
• - Rot- look left, then right OP- one hand behind head with elbow on shoulder
• - lateral- low/mid/upper- using hand to block level and OP

• range
• rhythm
• pain reproduction
• local restrictions
• - effect of correcting deviations
• - OP, repeated, quick, sustained

• -flexion- chin tuck
• - ext- stick chin out

• - used to clear the neck
• - upper Csp
• - lower Csp

• look up to the roof- ext
• lateral flex to the same side
• rot to the same side turn head towards to side u laterally flexed
• then compress

• Ext- bring chin forward
• - rot same side
• - lateral flex- chin goes away
• O1, C2, C3

• - it is to reproduce nerve root problems
• - compression to reproduce pain in the arm (sustained sl E/ sl LF)
• - distraction- (to relieve arm symptoms)
• Stages 1- compression in neutral
• 2- compression in ext
• 3- compression in both ext ad lateral felx to side effected

• - TMJ- open mouth, side to side, clearing scalenes, traps, SCM
• - shoulder- flex, ext, abd- OP
• - elbow- flex, ext- OP

• - median nerve test
• - can tell if the P is from shoulder or neck
• - no pillow- person needs to be flat
• - lateral flex of neck and taking arm in ext pulls the nerve more
• - any tightness or pain reproduced
• - sh dep, sh abd, wrist ext, ER, elb ext, Csp LF
• Once pain is brought on pt laterlly flexes away and towards, if P isbrought on and relieve it is a +ve test.
• Way to know is to compare to the other side.

• - clear jts
• - neurodynamic test
• - neurological examination
• - vertebral artery testing

• - sensation- reproduced- pin prick
• - motor power (C5-T1)
• - reflexes
• - +/- clonus/ babinski- shows an UMNL

• Need to see pts eyes at all times
• Hold 10 sec one side, rest for 10 sec, hold 10 sec other side
• Do in sitting because the heart has to work against gravity
• - sustained bilateral rotation- both sides
• - additional tests as indicated- eg going to put pt in ext u conduct the test in ext
• - differentiate between VA and vestibular. Done by pt in standing and getting them to rotate there body holding there head still

• arms by side- want pts head and mm relaxed
• - temp, sweating- use back of hands
• - spinal body alignment
• - spasm
• - tenderness
• - soft tissue thickening
• - A/C jt (C7- T1)

• - spinous process (C2, C7 prominent)- ensure u angle at the curve of the lordosis
• - Zjts- will feel the ridge- use dom thum and reinforce with the other
• - Transverse process of C1- much further out near jaw
• - cervical rib- sit at 45 degrees
• - arch of C1- angle fingers towards pts eyes

• 
• C2- big
• C3- small
• C6- should be big but disappear when pt ext
• C7- sticks out

• - Central PA- in line with lordosis- on spinous processes
• - Unilateral PA- Z jts
• - transverse- only on C1 C6, C7
• Looking at range, P reproduction, vary angle pressure

• PPIVMS- passive physiological movements
• PAIVMS- passive accessory movements

• - flexion- for C6/7 hold the pt in more flex, pt head off end of bed, you support with belly, trying to feel the gap of the spinous processes
• - Ext same as above- using legs, can hold head as a Basket ball
• - Rot- hands on side of head- rot away from side palpating
• - lateral flexion- hands either side of head, using side of fingers to feel the movement

Support head with belly- have bed at the right height, bend knees more to make the movements- alows you to concentrate on what you are feeling.

• C0-C1- can feel transverse process move away from the skull
• ALWAYS COMPARE TO THE OTHER SIDE

• - accessory
• - central PA grade as you go
• - central due to central pain

Rot and lateral flex to left decrease ROM, palpate find level- use unilateral on level of pain and side of pain

• - 30 sec - look at problems eg rot then do 3 x 30
• - in reassessment can look at PIVMS
• - if pt is irritable- open jt via lateral flex away from side. if close MUST be low grades
• NOTE/ if PNS down arm as well as neck pain- always do an open tech

• - lateral glide
• - lateral flex away
• - distraction- pull up
• - rot away
• - transverse- push towards side
• - take pressure off nerve with pillows under arm

Traction for C6 neck in flexion- hold chin and occiput, one leg in front of the other and lean back for 30 sec/ min support head on tummy

• - traction
• - manipulation- to get afew degrees of movement, where oscillating tech might aggravate
• - pillows

• - local heat, ice
• - EPA
• - Isometric exercise
• - Postural advice/ correction
• - deep cervical flexor strengthening
• - Scap control

- bilateral symptoms

unilateral symptoms

- unilateral pain/ movt abilities

- unilateral pain/ movt abnormalities