Cervical Joint Position Error Test

Original Editor - Laura Ritchie, posting on behalf of Tyler Shalansky, MPT Class of 2021 at Western University, project for PT9584.

Top Contributors - Laura Ritchie and Oyemi Sillo

Introduction[edit | edit source]

The Cervical Joint Position Error (JPE) Test is a measurement tool used to clinically assess an individual’s cervicocephalic proprioception ability. Cervicocephalic proprioception describes one’s sense of position of their head and neck in space. [1] The Cervical JPE Test measures the ability of a blindfolded patient to accurately relocate their head position back to a predetermined neutral point after cervical joint movement. The test is most commonly performed with head movement in the transverse and sagittal planes. The Cervical JPE Test has strong clinical value in identifying proprioceptive deficits in patients with neck pain, where neck pain originating from trauma (e.g. WAD) or those with gradual onset both demonstrating a higher JPE those without neck pain (Cheng et al., 2010).[2]

Theory[edit | edit source]

The cervical muscles play an essential role in relaying important sensory information regarding head position to our central nervous system.[3] Sensory organs called muscle spindle receptors respond to changes in length of cervical muscles. The afferent information provided from cervical muscle length changes will converge at the vestibular nuclei with information from the visual and vestibular systems.[4] Together this information is then relayed to the cerebellum and cerebrum and contributes to our body’s sense of head-neck position sense. Patients suffering from traumatic neck injury (e.g. whiplash) or chronic neck pain may have disturbances to cervical afferent input leading to abnormalities with sensorimotor control of the neck and head.[5]

Technique[edit | edit source]

To best isolate the head and neck the cervical JPE test should be performed with the patient in sitting to reduce any contribution of balance impairments or other postural compensations affecting the findings of the test.

A target is placed on a wall 90cm away from the patient, at the patient’s head height in sitting. The target is typically 40cm in diameter with concentric circles in 1cm increments.[6]

A laser pointer or similar targeting device is mounted onto a lightweight headband is then placed on the patient’s head.[6]

The patient is then asked to focus on finding natural resting head position so that the laser pointer is in line with the centre or “bullseye” of the target.

With eyes closed, the patient will actively move their head in one plane of motion and attempt to return to the starting position as accurately as possible.[6]

The patient should verbally indicate when they feel they have returned to the starting position before opening their eyes again.[7]

Three trials should be performed for each direction of motion assessed (the best score recorded), with the subject given opportunity to re-centre their starting position prior to each test.[7]

The difference between the position of the laser beam on the target at starting position and end test is measured with greater displacement indicating cervical JPE and greater impairment of proprioception.

Positive Result[edit | edit source]

The difference between the starting and finishing position of the laser beam on the wall is measured in centimeters and then converted into degrees:

(angle = tan-1[error distance/90 cm]).

Thus, an approximately 7.1-cm error distance indicates meaningful error of 4.5° (Revel et al. 1991).

Other clinical findings of the cervical JPE test include:

  • Jerky or altered movement patterns
  • Overshooting of the position in order to gain more proprioceptive feedback for the task
  • “Searching” for the position.

Evidence[edit | edit source]

Normative Results[edit | edit source]

Revel et al. in 1991 found in healthy controls less than 4.5 degrees error denotes “normal” cervical proprioception, with a reported sensitivity of 86% and specificity of 93%.

Test/Retest Reliability[edit | edit source]

Heikkilä and Aström in 1996 found when testing healthy controls, no significant difference (p<0.001) between test results separated by 1- and 2-month time periods.[10]

Inter/Intra-rater Reliability[edit | edit source]

Louden et al. in their study on JPE is subjects with whiplash report:[11]

  • Inter-rater reliability ICC = 0.972
  • Intra-rater reliability ICC = 0.975 (for therapist 1) and 0.985 (for therapist 2)

Validity[edit | edit source]

Sterling et al. in 2003 report a significant difference between whiplash group average: 5.01 degrees compared to healthy controls: 1.75 degrees (P<0.05)[12]

In 2015 de Vries et al. published a systematic review on Joint position sense error in people with neck pain.[13] Their review found withing the field of research participants with traumatic neck pain had a significantly higher JPSE than healthy controls ( Kristjansson et al., 2003; .[7][12][14] The 2015 systematic review concluded that the current body of literature shows the JPSE to be a relevant measure when it is used correctly, with JPSE is overall higher in subjects with neck pain of chronic or traumatic origin when measured over at least six trials.[13]

References[edit | edit source]

  1. Newcomer L, Yu, Larson, An. Repositioning error in low back pain: comparing trunk repositioning error in subjects with chronic low back pain and control subjects. Spine 2000;25:245.
  2. Feipel V, Salvia P, Klein H, Rooze M. Head repositioning accuracy in patients with whiplash-associated disorders. Spine 2006;31:E51e8
  3. Bolton PS, Kerman IA, Woodring SF, Yates BJ. Influences of neck afferents on sym- pathetic and respiratory nerve activity. Brain Res Bull 1998;47:413e9
  4. Corneil BD, Olivier E, Munoz DP. Neck muscle responses to stimulation of monkey superior colliculus. II. Gaze shift initiation and volitional head movements. J Neurophysiol 2002;88:2000e18
  5. Treleaven, J., Jull, G., & LowChoy, N. (2006). The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash. Manual therapy, 11(2), 99-106
  6. 6.0 6.1 6.2 Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. journal of orthopaedic & sports physical therapy. 2009 May;39(5):364-77
  7. 7.0 7.1 7.2 Treleaven, J., Jull, G., & Sterling, M. (2003). Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Journal of rehabilitation medicine, 35(1), 36-43
  8. Chris Worsfold. Assessing proprioception of the neck. Available from: https://www.youtube.com/watch?v=SFjAMaAdqXY [last accessed 24/05/21]
  9. Physiotutors. Joint Position Sense Assessment | Cervicogenic Dizziness. Available from: https://www.youtube.com/watch?v=UuNkX2B1vWw [last accessed 24/05/21]
  10. Heikkilä, H., & Aström, P. G. (1996). Cervicocephalic kinesthetic sensibility in patients with whiplash injury. Scandinavian journal of rehabilitation medicine, 28(3), 133–138
  11. Loudon, J. K., Ruhl, M., & Field, E. (1997). Ability to reproduce head position after whiplash injury. Spine, 22(8), 865–868
  12. 12.0 12.1 Sterling, M., Jull, G., Vicenzino, B., Kenardy, J., & Darnell, R. (2003). Development of motor system dysfunction following whiplash injury. Pain, 103(1-2), 65–73
  13. 13.0 13.1 de Vries, J., Ischebeck, B. K., Voogt, L. P., Van Der Geest, J. N., Janssen, M., Frens, M. A., & Kleinrensink, G. J. (2015). Joint position sense error in people with neck pain: a systematic review. Manual therapy, 20(6), 736-744
  14. Heikkil€a HV, Wenngren B-I. Cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury. Arch Phys Med Rehabil 1998;79:1089e94