Cranio-corpo-graphy is a measurement procedure used to detect, analyze, and document balance dysfunction. The procedure was first introduced in 1968 and is also used for objective and standardized documentation of results of certain examination procedures such as the Unterberger kick test, the Romberg test, and several other generally accepted diagnostic procedures. The CCG is an examination procedure recognized on the part of the Employer’s Liability Insurance Association within Guideline G-41 (Work involving a risk of falling).
What is cranio-corpo-graphy?
One of the main uses of cranio-corpo-graphy is to determine fitness for work in workplaces with fall hazards. Cranio-corpo-graphy (CCG) was first introduced by German neurootologist Claus-Frenz Claussen in 1968. CCG does not involve an examination procedure of its own, but serves to improve and objectify the documentation of recognized examination methods for the areas of vestibular capacity and vestibular disorders. The procedure is computer-assisted, and the integrated algorithms allow immediate analyses. The procedure is mainly used in occupational medicine to comply with the German employers’ liability insurance association guideline G-41 for work at workplaces with a risk of falling and is primarily used to demonstrate fitness for work at workplaces with a risk of falling. In addition, the CCG is also used to examine all types of balance disorders in “normal patients”. To mark the movements of the head and shoulders, the test person wears a helmet with two lamps and two additional lamps on the shoulders. The movement patterns are recorded by an instant camera located above the subject. Since 1993, there has been a more advanced method in which the luminous markers are replaced by ultrasound markers.
Function, effect, and goals
One of the main applications of cranio-corpo-graphy is to determine fitness for work at workplaces with a risk of falling in accordance with the guideline G-41 of the German employers’ liability insurance association. Fitness can be demonstrated, for example, with the Romberg standing test and the treading test according to Unterberger. To perform the Romberg test, the test person or patient stands upright on both feet in a closed stance with arms outstretched and eyes closed. It is important that no visual or acoustic orientation possibilities are present, such as a bright light at a point in the room or a sound source (e.g., ticking clock). During the stance test, the compensatory movements of the body are recorded via the light or ultrasound markers and subsequently evaluated. By pushing the body slightly, the experiment can be performed under somewhat more difficult conditions. If the compensatory movements of the body exceed a certain level and increase during the course of the test, or if the test has to be stopped because of the risk of falling, there is very probably a neuronally caused coordination problem. A tendency to fall to a certain side rather indicates a disturbance of one of the macular organs (sacculus or utriculus), which are responsible for the detection of linear accelerations within the vestibular system (organs of equilibrium). Unterberger’s pedaling test involves testing the reflex pathways between the vestibular centers in the brain and the spinal cord (vestibulospinal reflexes). The pedaling test was named after the Austrian physician Siegfried Unterberger and consists of pedaling evenly on the spot with the eyes closed. The same preconditions apply as in the Romberg experiment. If the subject or patient has unintentionally and unconsciously turned more than 45 degrees after 50 steps, the result is considered striking. An unintentional rotation of more than 45 degrees within 50 steps suggests a lesion of a specific region in the cerebellum or indicates a problem of the vestibular system. The CCG procedure also supports specialized examination methods such as the LOLAVHESLIT, NEFERT, and WOFEC tests. LOLAVHESLIT is an acronym composed of the terms longitudinal, lateral and vertical, head sliding-test. While sitting, the patient performs successive and repetitive head rotations and head movements, which are recorded by CCG and evaluated immediately.The test allows conclusions to be drawn about movement disorders in the neck and identifies diseases related to the cervical vertebrae and spinal cord. The NEFERT (Neck Flex Rotation Test) can be used to detect sprains and stiffness of the neck, as well as any whiplash that may be present. The procedure was introduced in 1998. An additional test method for detecting gait ataxia is the so-called WOFEC test (Walk on Floor Eyes Closed), the results of which can also be documented, interpreted and stored using CCG.
Risks, side effects, and hazards
Cranio-Corpo-Graphy is a non-invasive recording and diagnostic procedure that cannot be associated with any risks or side effects. However, in cases of acute suspicion of infarction of the cerebellum or brainstem, diagnostic imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), or functional magnetic resonance imaging (fMRI) should be used in favor of rapid and accurate diagnoses. In this respect, the suspected presence of a brainstem or cerebellar infarction can be understood as a contraindication to the use of a CCG. The German Occupational Health and Safety Act (ArbSchG) implements the binding EU directives on occupational health and safety and addresses both employers and employees. Work involving a fall hazard is not explicitly listed in the Occupational Health and Safety Act, but employers are required not only to provide technical training to their employees who perform work involving a fall hazard, but also to require them to provide proof of their health in accordance with the employers’ liability insurance association’s guideline G-41. Proof of balance and full functional capacity of the musculoskeletal system are part of the required proof of health. When under 25 years of age, the proof of health must be repeated every 36 months; when 25 to under 50 years of age, every 24 to 36 months; and when 50 years of age or older, every 12 to 18 months.
