Goniometry: Cervical and Atlanto-occipital
- Collective motion from the occiput - C7-T1 - all of these done in sitting, make sure there is a back to the chair so you have support of the lower back - normative values are for PROM - want them in ideal alignment before you take the measurement 3 ways to measure - conventional goniometer - gravity goniometer - measuring tape
Goniometry: Lateral Flexion
Lateral Flexion 0-45 degrees (Conventional Goniometer) - ideal alignment, back supported - PIVOT - at C7 (feel for prominent spinous process) - STATIC ARM - in line with spinous processes - MOVING ARM - back up the center of the occiput - Substitute movement - make sure they don’t flex or extend, stay neutral - R or L ear to shoulder (Gravity Goniometer) - put it on crown of the head (where parietal meets occipital bones, 0 out goniometer, ask pt to bring ear to shoulder (Measuring Tape) - palpate mastoid process from behind ear, drop down a little, measure from the mastoid process to the lateral portion of the acromion - measure in CM - bring ear to shoulder and measure again - take the difference (excursion) - linear measurement - no normative data for this, just compare each visit
Goniometry: Rotation
Rotation 0-60-80 Conventional Goniometer - P - come over the pt, place goniometer on the center of the cranium - SA - in line with the acromions (imaginary line) - MA - in line with the nose Tape measure - chin to the acromion, take measurement - have them rotate and take measurement again and record the difference (excursion) Gravity goniometer - supine, put it on forehead and have them rotate - put a roll under neck to keep neck neutral - hooklying
Goniometry: Flexion/Extension
Flexion 0-45-60 / Extension 0-60-75 Conventional Goniometer - pivot external auditory meatus - static arm perpendicular to ceiling - moving arm in line with base of nose - goniometer at a R angle - move your pivot to stay in line with the opening of the ear - make sure all the movement is AO and cervical, none in thoracic Gravity Goniometer - crown of head, 0 it out Tape measure - chin to sternal notch
MMT: Cervical and Atlanto-occipital (SCM)
MMT - Right SCM - Supine - turn head to the left and laterally flex (away from the table) - 5x - hold the last one up - place light resistance over the temple and try to push it back down gently Substitutions - trunk flexion instead of cervical flexion - using gravity to bring the head to full rotation (want to see a controlled descent) Tests rotation and lateral flexion
MMT - Cervical and Atlanto-occipital Flexion (C1-C8)
MMT Flexion - AO and Cervical (C1-C8) - RCA - RCL - Longus Capitis - Longus Cervicis If you just want to look at the AO joint: - supine - roll the head forward, bring the chin down to the neck We will look at both AO and Cervical - roll chin down - then bring head off the mat and then back down 5x, hold on the 5th and gently push down on forehead - looking at how they perform both motions in addition to strength - gravity eliminated: sidelying
MMT - Cervical and Atlanto-occipital Extension (C1-C8)
MMT - AO and Cervical Extension (C1-C8) - RCP Major and Minor - Splenious Capitus - Erector Spinae - Transverse Spinae - Prone - Head hanging off table - start with head in flextion (dangling), have a person look up toward ceiling (want to see head at least come to neutral position) 5x, apply pressure to occiput - if someone is very weak, have them completely supported on the table and see if they can unweigh their forehead off the table - to test left vs right, do extension with some rotation - gravity eliminated - possibly side lying, but usually just support head on table
