Table 4 Details of the exercise progression
Exercise | Level | Details | Targeted repetitions |
|---|---|---|---|
Cervical flexors | 1 | Re-education of CCF movement pattern | |
Supine, knees bent | |||
- Gentle and controlled nodding action facilitated with eye movement | 10 reps | ||
Holding capacity | |||
Supine, knees bent | |||
- Repeated and sustained CCF progressing from 22 to 30 mmHg | 10 s holds × 10 reps | ||
2 | Interaction between the deep/superficial cervical flexors | ||
Sitting | |||
- Controlled head movement through range of extension and return to neutral | 10 reps | ||
Co-contraction of the deep cervical flexors/extensors | |||
Sitting | |||
- Isometric cervical rotation facilitated with eye movement (left/right sides) | 5 s holds × 5 reps | ||
3 | Strength/endurance of the cervical flexors | ||
Sitting | |||
- Isometric CCF in a range of cervical extension | 10 s holds × 10 reps | ||
- Lifting the head off the wall (with the chair up to 30 cm away from the wall) | 10 s holds ×  10 reps | ||
Supine | |||
- Lifting the head off a pillow (2, 1 then 0 pillows as per participant’s capacity) | 10 s holds × 10 reps | ||
Cervical extensors | 1 | Re-education of extension movement pattern | |
Prone on elbows/four-point kneeling positions | |||
- Craniocervical extension | 3 sets of 5 reps | ||
- Craniocervical rotation (< 40°) | 3 sets of 5 reps | ||
- Cervical extension while keeping the craniocervical region in a neutral position | 3 sets of 5 reps | ||
2 | Co-contraction of the deep cervical flexors/extensors | ||
Sitting | |||
- Isometric cervical rotation facilitated with eye movement (left/right sides) | 5 s holds × 5reps | ||
3 | Strength/endurance of the cervical extensors | ||
Prone on elbows/four-point kneeling positions | |||
- Isometric hold in range of cervical extension | 10 s holds × 10 reps | ||
- Addition of progressive load (light weights attached to head) as per patient’s capacity |  | ||
Axioacapular control | 1 | Re-education of scapular movement control | |
Side lying with arm elevated 140°/sitting | |||
- Passive repositioning of the scapular | 10 reps | ||
- Active repositioning of the scapular | 10 reps | ||
Holding capacity | |||
Side lying with arm elevated 140°/sitting | |||
- Active repositioning the scapular posture and isometric hold | 10 s holds × 10 reps | ||
2 | Axioscapular muscle control | ||
Sitting | |||
- Arm movement without load (external rotation/abduction/flexion < 30°) | 10 reps | ||
- Arm movement without load throughout range | 10 reps | ||
Prone on elbows/four-point kneeling position | |||
- Thoracic lift (serratus anterior) and isometric hold | 5 s holds × 5 reps | ||
3 | Strength/endurance of axioscapular muscles | ||
Sitting | |||
- Arm movement with load (external rotation/abduction/flexion < 30°) | 10 reps | ||
- Arm movement with load throughout the range | 10 reps | ||
Prone | |||
- Lift the shoulder off the bed and hold without arm load | 10 s holds × 10 reps | ||
- Lift the shoulder off the bed and hold with arm load | 10 s holds ×  10 reps | ||
Postural correction | 1 | Correction of spinal posture | |
Sitting | |||
- Active upright sitting initiated with lumbo-pelvic movement | 10 s holds × 10 reps | ||
2 | Correction of spinal posture and scapular orientation | ||
Sitting | |||
- Actively positioning the scapular in a neutral posture while maintaining spinal posture | 10 s holds ×  10 reps | ||
3 | Spinal and scapular correction plus occipital lift | ||
Sitting | |||
- Actively lengthen the back of the neck while maintaining spinal and scapular posture | 10 s holds ×  10 reps | ||
Cervical joint position sense | 1 | Relocation with laser feedback | |
Sitting | |||
- Head relocating to neutral position with eyes opened (vertical/horizontal) | 5 reps × 3 sets | ||
- Head relocating to predetermined position in range with eyes opened (vertical/horizontal) | 5 reps × 3 sets | ||
2 | Relocation with laser feedback | ||
Sitting | |||
- Head relocating to neutral position with eyes opened (diagonal) | 5 reps × 3 sets | ||
- Head relocating to predetermined position in range with eyes opened (diagonal) | 5 reps × 3 sets | ||
- Head relocating to specific targets with eyes opened (all directions) | 5 reps × 3 sets | ||
3 | Relocation with laser feedback | ||
Sitting | |||
- Head relocating to neutral position with eyes closed (all directions) | 5 reps × 3 sets | ||
- Head relocating to predetermined position in range with eyes closed (all directions) | 5 reps × 3 sets | ||
Cervical movement sense | 1 | Movement sense training with laser feedback | |
Sitting | |||
- Tracing a line (vertical/horizontal) | 5 reps × 3 sets | ||
2 | Movement sense training with laser feedback | ||
Sitting position | |||
- Tracing an intricate pattern at a slow speed (a figure of eight/zig-zag/alphabet) | 5 reps × 3 sets | ||
3 | Movement sense training with laser feedback | ||
Sitting position | |||
- Tracing an intricate pattern at a fast speed (a figure of eight/zig-zag/alphabet) | 5 reps × 3 sets | ||
Oculomotor control | 1 | Eye follow, gaze stability and eye-head coordination | |
Sitting | |||
- Eyes following a target with slow speed while keeping the head still (vertical/horizontal) | 5 reps × 3 sets | ||
- Head moving while fixing eyes on a single spot (vertical/horizontal) | 5 reps × 3 sets | ||
- Eyes and head moving together to the same direction (vertical/horizontal) | 5 reps × 3 sets | ||
2 | Eye follow, gaze stability and eye-head coordination | ||
Sitting | |||
- Eyes following a target with fast speed while keeping the head still (vertical/horizontal) | 5 reps × 3 sets | ||
- Head moving while fixing eyes on complex targets (vertical/horizontal) | 5 reps × 3 sets | ||
- Moving the eyes first then the head to the same direction | 5 reps × 3 sets | ||
3 | Eye follow, gaze stability and eye-head coordination | ||
Sitting | |||
- Eyes following a target with neck in 45° torsion (vertical/horizontal) | 5 reps × 3 sets | ||
- Head moving while fixing eyes on a word target with complex backgrounds (vertical/horizontal) | 5 reps × 3 sets | ||
- Eyes and head moving to the opposite direction (vertical/horizontal) | 5 reps × 3 sets | ||
Balance control | 1 | Static balance | |
Standing | |||
- Narrow stance (firm/soft surfaces with eyes open/closed) | 30 s holds × 10 reps | ||
- Tandem stance (firm/soft surfaces with eyes open/closed) | 30 s holds × 10 reps | ||
2 | Dynamic balance and gait | ||
Standing | |||
- Throwing/catching a ball while tandem stance (firm/soft surfaces) | 30 s holds ×  10 reps | ||
Walking | |||
- Normal walking with fast speed (forward/backward, side way) | 10 reps | ||
- Tandem walking (forward/backward) | 10 reps | ||
3 | Dynamic balance and gait with head movement | ||
Standing | |||
- Throwing/catching a ball while single leg standing (firm/soft surfaces) | 30 s holds × 10 reps | ||
Walking | Â | ||
- Normal walking (forward/backward, side way) with head movement (left/right, up/down) | 10 reps | ||
- Tandem walking (forward/backward) with head movement (left/right, up/down) | 10 reps | ||