There has been substantial additional research into the effects of cervical movements on vertebral artery blood flow since 1988, when the APA first formalised a Protocol for Pre-Manipulative Testing of the Cervical Spine and recommended its use in patients with upper quarter dysfunction. The development of duplex Doppler ultrasound equipment with colour enhancement, which allows measurements of velocity and flow rate of vertebral artery blood flow, has resulted in a burgeoning of in-vivo blood flow studies.
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