Execution
- 1Position the patient sitting with the trunk rotated relative to the head while the head remains facing forward.
- 2Present a moving visual target and ask the patient to follow it smoothly with the eyes.
- 3Record eye movement quality or gain in the neutral head-trunk position first.
- 4Repeat smooth pursuit with the neck torsioned to the right and then to the left by rotating the trunk under the stable head.
- 5Compare smooth pursuit performance and symptom provocation between neutral and torsioned positions.
Positive outcome
The test is positive when smooth pursuit becomes measurably worse or symptomatic during neck torsion compared with neutral, especially when the deficit is direction-specific. Neck torsion should alter cervical afferent input without moving the vestibular apparatus. Abnormal eye tracking can also occur with central or vestibular disorders, so it is not specific unless interpreted in context.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Tjell & Rosenhall (1998) | prospective double-blind clinical study | 90 | 91 | 10.0 | 0.11 |
| Treleaven et al. (2005) | whiplash-associated disorder study | NA | NA | NA | NA |
CommentSPNT is one of the more cited cervicogenic-dizziness tests, but results are influenced by testing equipment, target speed, age, anxiety, and coexisting vestibular pathology. Tjell's strong values should be interpreted cautiously because later work emphasizes subgroup and methodological effects. Use SPNT as part of a cervicogenic dizziness reasoning battery, not as a stand-alone diagnosis.
Moderate Clinical Value