BRIEF REPORT Cervicocephalic Relocation Test to the Neutral Head Position: Assessment in Bilateral Labyrinthine-Defective and Chronic, Nontraumatic Neck Pain Patients Nicolas Pinsault, MSc, PT, Nicolas Vuillerme, PhD, Paul Pavan, PT ABSTRACT. Pinsault N, Vuillerme N, Pavan P. Cervicoce- phalic relocation test to the neutral head position: assessment in bilateral labyrinthine-defective and chronic, nontraumatic neck pain patients. Arch Phys Med Rehabil 2008;89:2375-8. Objective: To determine whether vestibular or cervical pro- prioceptive information influence the cervicocephalic reloca- tion test to the neutral head position, by comparing head repositioning errors obtained in asymptomatic, unimpaired control subjects with those obtained in bilateral labyrinthine- defective patients and chronic, nontraumatic neck pain patients. Design: A group-comparison study. Setting: University medical bioengineering laboratory. Participants: Labyrinthine-defective patients (n=7; mean age  SD, 6715y), nontraumatic neck pain patients (n=7; 569y), and asymptomatic, unimpaired control subjects (n=7; 6412y). Interventions: Participants were asked to relocate the head on the trunk, as accurately as possible, after full active cervical rotation to the left and right sides. Ten trials were performed for each rotation side. Main Outcome Measures: Absolute and variable errors were used to assess accuracy and consistency of the reposi- tioning, respectively. Results: No significant difference in repositioning errors was observed between labyrinthine-defective patients and con- trol subjects, whereas nontraumatic neck pain patients demon- strated significantly increased absolute errors in horizontal and global components and higher variable errors in horizontal component. Conclusions: These findings suggest that the vestibular sys- tem is not involved in the performance of the cervico- cephalic relocation test to neutral head position, and further support this test as a measure of cervical proprioceptive acuity. Key Words: Neck; Proprioception; Rehabilitation. © 2008 by the American Congress of Rehabilitation Medi- cine and the American Academy of Physical Medicine and Rehabilitation D UE TO THE CRUCIAL role of proprioceptive afferent input from neck muscles on the perception of body seg- ment position, body orientation in space, and control of posture and gait, accurate and reliable evaluation of neck propriocep- tive abilities is of great importance. Revel et al 1 defined a test for the clinical assessment of the cervical joint position sense, the “cervicocephalic relocation test to the neutral head posi- tion.” In this assessment, a blindfolded subject seated on a chair with the head in NHP is asked to relocate the head on the trunk, as accurately as possible, after full active cervical rotation to the left and right sides. Recent studies have demonstrated excellent test-retest reliability 2,3 and discriminant validity of this test, 1,4-8 allowing its use as a measure of cervical propri- oceptive acuity. 9-11 At this point, however, considering that the cervicocephalic relocation test to NHP not only involves head movements, but also has been shown to successfully discrim- inate between healthy subjects and whiplash patients 4-6 (eg, individuals who could exhibit differences in their vestibular function 12,13 ), it is important to ascertain that the vestibular system is not involved in the performance of the cervico- cephalic relocation test to NHP. Comparing the performances of asymptomatic, unimpaired control subjects with those of bilateral labyrinthine-defective patients and chronic, nontraumatic neck pain patients could represent a relevant way to determine whether vestibular or cervical proprioceptive information influences the cervicoce- phalic relocation test to NHP. The present experiment was designed to address this issue. It was hypothesized that com- pared with control subjects, the labyrinthine-defective patients would show no difference in the cervicocephalic relocation test to NHP, whereas the nontraumatic neck pain patients would exhibit increased repositioning errors. METHODS Subjects Seven bilateral labyrinthine-defective patients (4 men and 3 women; mean age  SD, 6715y; range, 41– 84y), 7 chronic, nontraumatic neck pain patients (3 men and 4 women; 569y; range, 44 – 65y), and 7 asymptomatic, unimpaired control sub- jects (4 men and 3 women; 6412y; range, 43– 82y) voluntar- ily participated in the experiment. They gave their informed consent to the experimental procedure as required by the Hel- sinki declaration (1964) and the local ethics committee. The labyrinthine-defective patients group consisted of 7 patients presenting bilateral vestibular loss. Three standardized clinical tests were performed by a vestibular rehabilitation expert in all 7 patients to assess the bilateral vestibular areflexy: (1) the caloric vestibular tests, performed with hot (44°C) and cold (30°C) water, were negative on both right and left sides; (2) the rotary chair test, performed at low (20°.s -1 ) and high (600°.s -1 ) frequencies, did not evidence any nystagmus From the Laboratoire TIMC-IMAG, UMR CNRS 5525, (Pinsault, Vuillerme); Cabinet de Réhabilitation Vestibulaire (Pavan), Grenoble, France. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organi- zation with which the authors are associated. Supported by the Ministère de l’Education Nationale, de la Recherche et de la Technologie, France. Reprint requests to Nicolas Pinsault, MSc, PT, Laboratoire TIMC-IMAG, UMR CNRS 5525, Faculté de Médecine, 38706 La Tronche cédex, France, e-mail: nicolas.pinsault@ imag.fr. 0003-9993/08/8912-00272$34.00/0 doi:10.1016/j.apmr.2008.06.009 List of Abbreviations NHP neutral head position 2375 Arch Phys Med Rehabil Vol 89, December 2008