Tag Archives: rehabilitation

Cervical Spine Proprioceptive Retraining

There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms.(1) The evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits.(1)

Dizziness that occurs after concussion/mTBI presents with varied characteristics and several potential sources and mechanisms, including the inner ear, the brain, the cervical spine, and/or the integration of afferent input and tuning within the sensorimotor control system.(2) Vestibular rehabilitation therapy (VRT) has been used to treat persistent dizziness after concussion/mTBI, but recent attention has examined the possible role of the cervical spine in post-concussive dizziness.(2) Dizziness after concussion/mTBI has been shown to improve when manual therapy and specific sensorimotor control exercises for the cervical spine were added to standard care VRT.(2)

Hammerle et al (2) compared traditional VRT with cervical spine proprioceptive retraining (CSPR) in patients with recurring dizziness after concussion/mTBI who had at least 1 abnormal cervical spine proprioceptive test (e.g. cervical joint position error or smooth pursuit neck torsion test), regardless of the presence or absence of neck pain. Patients were excluded from the study if they had dizziness with a clear peripheral vestibular or central symptom origin (e.g. BPPV, consistent saccadic intrusions on smooth pursuits, gaze holding nystagmus, loss of gaze holding during VOR cancellation testing). The results demonstrated that patients who received CSPR were 30 times more likely to report improvement in dizziness symptoms compared with those who received VRT when abnormal CSP tests were present.(2) 


1. Treleaven J. Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain. J Orthop Sports Phys Ther [Internet]. 2017;47(7):492–502. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=28622488&retmode=ref&cmd=prlinks

2. Hammerle M, Swan AA, Nelson JT, Treleaven JM. Retrospective Review: Effectiveness of Cervical Proprioception Retraining for Dizziness After Mild Traumatic Brain Injury in a Military Population With Abnormal Cervical Proprioception. J Manipulative Physiol Ther [Internet]. 2019;42(6):399–406. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0161475418300411

Patient Adherence and Treatment Outcomes

Adherence has been defined as: “the extent to which a person’s behaviour… corresponds with agreed recommendations from a healthcare provider” (1)

Adherence with treatment is an important factor which can influence the outcome of that treatment (2). It has been suggested that adherent patients are likely to have better treatment outcomes than non-adherent patients (3).

For practitioners of manual therapy, rehabilitation and exercise therapy prescription is part of a multimodal management strategy utilised to improve clinical outcomes. It has been shown that patients who are more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.(4) Conversely, it has been suggested that non-adherence with treatment could be as high as 70% (5).

Martin et al (6)  have stated: “Patient non-adherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice.”

While no single intervention strategy can improve the adherence of all patients, home exercise programs – such as the ones you can create on Erepsonline – have been shown to increase patient adherence.(4, 7-9)

Visit the Help & Support page to watch short video clips of the various features of Erepsonline.



  1. WHO . World Health Organisation; Geneva: 2003. Adherence to Long Term Therapies – Evidence for Action.
  2. Hayden J.A., van Tulder M.W., Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine. 2005;142(9):776–785.
  3. Vermeire E., Hearnshaw H., Van Royen P., Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics. 2001;26(5):331–342.
  4. Marker DR, Seyler TM, Bhave A, Zywiel MG, Mont MA. Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty? Journal of Orthopaedic Surgery and Research 2010, 5:20
  5. Vasey L. DNAs and DNCTs – why do patients fail to begin or complete a course of physiotherapy treatment? Physiotherapy. 1990:76575–76578.
  6. Martin LR, Wiliams SL, HAskars KB, DiMatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005 Sep; 1(3): 189–199.
  7. Coulter CL, Scarvell JM, Neeman TM, Smith PN. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. J Physio. 2013;59(4):219-26
  8. Latham NK, Harris BA, Bean JF, Heeren T, Goodyear C, Zawack S, Heislein DM, Mustafa J, Pardasaney P, Giorgetti M, Holt N, Lori Goehring L, Jette AM. Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture: A Randomized Clinical Trial. JAMA. 2014;311(7):700-708.
  9. Jan MH, Hung JY, Lin JC, Wang SF, Liu TK, Tang PF. Effects of a home program on strength, walking speed, and function after total hip replacement. Arch Phys Med Rehabil. 2004 Dec;85(12):1943-51.