Database of movement control in the cervical spine : Reference normal of 180 asymptotic persons

Oddsdottir, G.L. and Kristjannson, E. and Gislason, Magnus Kjartan (2013) Database of movement control in the cervical spine : Reference normal of 180 asymptotic persons. Manual Therapy, 18 (3). pp. 206-210. ISSN 1356-689X (

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No database of reference normal values exists for movement control of the cervical spine. The Fly Test is a clinical test designed to detect impaired neck proprioception while subjects are moving their head and neck [1]. Recently the Fly Test was developed further and was found to be both a reliable and a valid test for detecting deficient movement control of the cervical spine. The test has been carried out on patients with traumatic and non-traumatic neck pain as well as asymptomatic persons [2]. The Fly Test addresses an important proprioceptive function, which is the regulation of movements, i.e. the detection and correction of errors through feedback and reflex mechanisms, while performing active movements [2-4]. There are three outcome measures in the Fly Test, amplitude accuracy (AA), directional accuracy (DA) and smoothness of movement indicated by jerk index (JI). These variables represent three different but interrelated aspects of movement control [3, 5-8]. In the reliability testing of the Fly Test, progressively wider limits of agreement (LOA) were observed across the study groups; control – non-trauma neck pain – whiplash-associated disorders (WAD). In order to detect clinically important changes between two measurements, for example as a result of treatment intervention, LOA with 95% confidence interval can be used as a reference range [9]. According to the wide LOA in the WAD group it became clear that to be capable of detecting a real change in performance on the test, individual improvement would have to exceed the scores of the asymptomatic group. Instead of using LOA as a reference range, a reference normal of asymptomatic persons, classified according to age and gender was suggested to be more useful when assessing improvements in the symptomatic groups. In a one year prospective study, the Fly Test revealed diverging courses of impaired cervical movement control in persons involved in motor vehicle collisions [10]. Half of the participants who depicted the worst results at the start of the study improved their movement control gradually over the one-year period without any form of treatment whereas the opposite was true for the other half of the participants [10]. Therefore it is movement control in the cervical spine can be measured against. A 3-space Fastrak system was used in the Fly Test to track the position of sensors positioned on the subject’s head. This instrumentation has been widely used in research and has been shown to be accurate [11], but for clinical use it is expensive and inconvenient. Advances in wireless technologies have stimulated the development of miniature motion sensors which can be implemented for human movement analysis in addition to being relatively inexpensive. Given that a considerable data from the Fly Test have been collected by using the Fastrak system, it would be beneficial to determine whether using a wireless motion sensor would give comparable results. The main purpose of this current paper is to publish a normative database of movement control of the cervical spine, measured by the Fly Test, and to make the database available to interested clinicians and researchers. Secondly, to provide a method for converting the values from the Fastrak measurements to corresponding values for the wireless orientation motion sensors (InertiaCube BT™).