Assesses for adequate vertebral artery blood flow to the brain.

  • Vertebral Artery Test (VAT)
  • Extension Rotation Test
  • George’s Test
  • DeKleyn’s Test

  • Suspicion of decreased blood flow to the brain
  • Atherosclerosis of the vertebral artery

Patient Position
  • Supine
Examiner Position
  • Standing or sitting near patient’s head
Steps of Performance

Note: Active range of motion of the cervical spine is usually performed before passive assessment.

  1. Perform passive extension and lateral flexion of the cervical spine
  2. Perform passive rotation of the head to the same side as lateral flexion
  3. Hold for approximately 30 seconds
  4. Repeat steps 1–3 for the other side
Alternative Methods
  1. Maximally rotate the patient’s head opposite to the side to be tested and holds position for 10 seconds
  2. Return to neutral for 10 seconds
  3. Extend the cervical spine for 10 seconds
  4. Return to neutral for 10 seconds
  5. Combine steps 1 & 3 and hold for 10 seconds
  6. Repeat steps 1–5 for the other side

The VBI Stress Test places the cervical vertebra in such a position that the size of the arterial lumen at the third division of the vertebral artery is reduced, resulting in decreased blood flow of the intracranial vertebral artery that is contralateral to that of the direction of lateral cervical flexion performed in the test.

General

Positives

"The 5 D’s" — dizziness, diplopia, dysarthria, dysphagia, drop attacks

  • Vertebrobasilar insufficiency

Nausea, vomiting, sensory changes, nystagmus

  • Vertebrobasilar insufficiency

Dropping of the arms, loss of balance, or pronation of the hands

  • Vertebrobasilar insufficiency

Pertinent Negatives

DATA
TAGS
References
Alshahrani A, Johnson EG, Cordett TK. Vertebral artery testing and differential diagnosis in dizzy patients. Phys Ther Rehabil. 2014 Jun 5;1(1)
Côté P, Kreitz BG, Cassidy JD, Thiel H. The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis. J Manipulative Physiol Ther. 1996;19(3):159-164.
Mitchell J. Doppler insonation of vertebral artery blood flow changes associated with cervical spine rotation: Implications for manual therapists. Physiother Theory Pract. 2007;23(6):303-313. doi:10.1080/09593980701593771
Grant R. Vertebral artery testing - the Australian Physiotherapy Association Protocol after 6 years. Man Ther. 1996;1(3):149-153. doi:10.1054/math.1996.0264
Mitchell JA. Changes in vertebral artery blood flow following normal rotation of the cervical spine. J Manipulative Physiol Ther. 2003;26(6):347-351. doi:10.1016/S0161-4754(03)00074-5
Mitchell J, Keene D, Dyson C, Harvey L, Pruvey C, Phillips R. Is cervical spine rotation, as used in the standard vertebrobasilar insufficiency test, associated with a measureable change in intracranial vertebral artery blood flow?. Man Ther. 2004;9(4):220-227. doi:10.1016/j.math.2004.03.005

Assesses for adequate vertebral artery blood flow to the brain.

  • Suspicion of decreased blood flow to the brain
  • Atherosclerosis of the vertebral artery

Patient Position
  • Supine
Examiner Position
  • Standing or sitting near patient’s head
Steps of Performance

Note: Active range of motion of the cervical spine is usually performed before passive assessment.

  1. Perform passive extension and lateral flexion of the cervical spine
  2. Perform passive rotation of the head to the same side as lateral flexion
  3. Hold for approximately 30 seconds
  4. Repeat steps 1–3 for the other side
Alternative Methods
  1. Maximally rotate the patient’s head opposite to the side to be tested and holds position for 10 seconds
  2. Return to neutral for 10 seconds
  3. Extend the cervical spine for 10 seconds
  4. Return to neutral for 10 seconds
  5. Combine steps 1 & 3 and hold for 10 seconds
  6. Repeat steps 1–5 for the other side

The VBI Stress Test places the cervical vertebra in such a position that the size of the arterial lumen at the third division of the vertebral artery is reduced, resulting in decreased blood flow of the intracranial vertebral artery that is contralateral to that of the direction of lateral cervical flexion performed in the test.

General

Positives

"The 5 D’s" — dizziness, diplopia, dysarthria, dysphagia, drop attacks

  • Vertebrobasilar insufficiency

Nausea, vomiting, sensory changes, nystagmus

  • Vertebrobasilar insufficiency

Dropping of the arms, loss of balance, or pronation of the hands

  • Vertebrobasilar insufficiency

Pertinent Negatives