title: [The vestibular craniovertebral joints].
abstract: BACKGROUND
  The significance of cervical proprioception for human balance has thus far not been sufficiently elucidated. The aim of this study was to provoke selective cervico-vestibular stimulation using the trunk excursion test (TET) we ourselves constructed. This chair is designed to enable evaluation of cervico-ocular reactions during isolated trunk excursion and possible effects of aging.
  
  
  METHODS
  The previously used head excursion test (HET) was statistically compared to the TET. In both methods, 100 healthy subjects of two age groups (group(26): median age = 26 years, n = 50; group(50): median age = 50 years, n = 50) were randomized for comparison of similar neck-to-trunk-positions.
  
  
  RESULTS
  HET enabled detection of significant nystagmus modulation in horizontal and vertical dimensions; whereas in pure cervical stimulation using the new TET, this was only evident in the horizontal dimension and only during trunk torsion. Comparison of the two methods confirmed significantly stronger nystagmus modulation through head excursion. In terms of the HET, group(50) showed significantly more vertical nystagmus activity than group(26). However, no significant difference was found between the groups in terms of their reactions to trunk excursion in the TET. In a group-specific comparison of the methods, group(26) showed a significant increase in horizontal nystagmus in head compared to trunk excursion, whereas group(50) generally displayed a significantly greater response to provocation by head excursion in HET. Analysis of the significant vertical nystagmus modulation produced with the TET method showed predominance of upbeat- (UBN) over downbeat-nystagmus (DBN). Through head excursion with the HET, DBN was more frequently evoked in group(50) than in group(26). No significant age-dependent difference could be derived in UBN.
  
  
  CONCLUSIONS
  The results of the pilot study indicate that head-to-trunk provocation is a suitable means of evaluating cervicotonic provocation nystagmus. Only by evaluation of adequate excursion limits and consistent analysis of patients with cervical deficiency can the effects of the method be further assessed.
authors.affiliation: Klinik für Hals-Nasen-Ohrenheilkunde, Sankt Gertrauden Krankenhaus, Paretzer Straße 12, Berlin, 10713, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Lappat
authors.affiliation: Klinik für Hals-Nasen-Ohrenkrankheiten, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, Berlin, 10117, Deutschland.
authors.forename: L J
authors.initials: LJ
authors.lastname: Dorn
authors.affiliation: Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland. matthias.hoelzl@hno.de.|HNO Zentrum Traunstein, Maxplatz 5, 83278, Traunstein, Deutschland. matthias.hoelzl@hno.de.
authors.forename: M
authors.initials: M
authors.lastname: Hölzl
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000294:innervation*; D004584:Electronystagmography / Q000295:instrumentation; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D009760:Nystagmus, Physiologic / Q000502:physiology*; D010812:Physical Stimulation / Q000295:instrumentation; D011187:Posture / Q000502:physiology*; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014724:Vestibular Function Tests / Q000295:instrumentation*
keywords: Cervicotonic provocation nystagmus; Gravity vector; Head excursion test; Trunk excursion test; Upbeat-nystagmus