TABLE 7.

Physical test and findings, safe for all patients.

	Contributing*	Common*	Diagnostic*
Observation based tests
Posture, full body, sitting and/or standing, and segmental alignment	X	X
Breathing pattern (chest vs. diaphragmatic, excessive accessory muscle use)	X	X
Significant muscle guarding or reluctance to move neck		X
Observe gait for ataxia, gross, and fine motor dyscoordination not due to other joint hypermobility			X
Observe for cranial nerve VII dysfunction: Lip drooping, unequal smile, eyelid twitching			X
Observe for dystonia, myoclonic jerking			X
Neurological tests
Cranial nerve III, IV, VI tests: Oculomotor nerve/eye movement			X
Reflex tests not involving neck: e.g., Hoffmann, Babinski, clonus			X
Cranial nerve X, XII tests: Uvula, tongue (avoid gag)			X
Dysdiadochokinesia: e.g., rapidly alternating pronation/supination, fast finger or foot tapping			X
Testing of hand dexterity (need to distinguish from finger hypermobility). E.g., grip release test			X
Other tests
Palpation for muscle spasm, especially suboccipitals, sternocleidomastoid, levator scapulae, upper trapezius		X
Use of a rigid cervical brace for several weeks decreases signs and symptoms			X

*Contributing factors = not diagnostic but providing information about potential causes.

*Common = findings that are likely to be fairly common, but not necessarily diagnostic.

*Diagnostic = findings that are likely to be less common, but more diagnostic.