Test: Deep Neck Flexion Endurance - Domenech

Video Link

Background/Purpose

The deep cervical flexors (longus capitis, longus colli,
rectus capitis anterior and lateralis), are postulated to assist in stabilizing the cervical spine.
Some studies indicate that patients with a history of cervical spine pain demonstrate a delay in DNF activation when associated with use of the arm, which indicates a significant deficit in the DNF automatic feedforward
control of the cervical spine. This delayed response may leave the cervical spine
vulnerable to reactive forces and therby compromise in deep neck flexor control may lead to cervical spinal dysfunction, where a cycle of pain and weakness is established.

Procedure

The subjects began in a supine, hook-lying position, with the
hands resting on the abdomen. If the subject could not lie flat
on the plinth because of excessive kyphosis, then the subject’s
head was supported by a standardized flat sandbag in
the kyphotic position. Upon request, with the chin in maximally
tucked position and maintained isometrically, the subject
lifted the head and neck approximately 2.5 cm from
resting position (Figure 1). While in this position, a line was
drawn across 2 approximated skin folds along the subject’s
anterior-lateral neck, and the tester slid the widths of stacked
index and middle fingers under the subject’s head at the most
posterior aspect of the occiput (Figure 2). The subject was
then asked to relax the neck, resting the head on the tester’s
fingers. Next, the subject again was directed to “tuck the
chin” completely and then raise the head to the point that the
back of the subject’s head maintained contact with the tester’s
stacked fingers. During the test, the examiner gently moved
the stacked fingers side to side under the subject’s head,
which provided a tactile cue for maintaining proper head
position above the plinth. Time recording was started when
the subject raised his or her head and was terminated when 1
of 4 criteria was met: (1) the edges of the drawn lines across
the skin folds no longer approximated each other because of
a loss of chin tuck, (2) the subject’s head rested on the tester’s
folded fingers for more than 1 second, (3) the tester noted
when the subject raised his or her head such that there was no
longer maintained contact with the tester’s fingers, or (4) the
subject was unwilling to continue.
Performed: Bilaterally

Dialog

DNF stabilizations

Criteria

• Maintain elevated head position
• Maintain chin tuck

Measurement

0.00

LOINC Code

0

Scale/Grading

Pass/Fail