{
  "resourceType": "ActivityDefinition",
  "id": "suboccipital-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/suboccipital-exercise",
  "version": "1",
  "name": "SuboccipitalExercise",
  "title": "Upper Cervical (Suboccipital) Exercise with Release",
  "status": "draft",
  "experimental": true,
  "description": "Craniocervical flexion and extension targeting C0-C2. Five incremental stages using pressure biofeedback (20-30 mmHg). Suboccipital release combined with CCF is superior to CCF alone for improving craniovertebral angle, ROM, and reducing superficial muscle overactivity.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "suboccipital-exercise",
          "display": "Upper Cervical (Suboccipital) Exercise with Release"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "cervical-spine",
          "display": "Cervical Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "20292002",
          "display": "Structure of atlantooccipital joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "62555009",
          "display": "Structure of atlantoaxial joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "68818006",
          "display": "Structure of cervical intervertebral disc"
        }
      ],
      "text": "Cervical Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "12 sessions over 6 weeks. Progress through 5 pressure stages (20-30 mmHg). Combine with suboccipital release [Pardos-Aguilella 2024, Kim 2016]"
    }
  ],
  "usage": "Evidence: moderate. DCF: linear EMG-pressure relationship [Falla 2003]. Suboccipital release + CCF superior to CCF alone [Kim 2016]",
  "note": [
    {
      "text": "Soft chin nod — base of skull lengthens",
      "authorString": "focus:internal"
    },
    {
      "text": "Float the gauge from 20 toward 30 mmHg in stages",
      "authorString": "focus:external"
    },
    {
      "text": "Eyes circle the ceiling while the head stays anchored",
      "authorString": "focus:external"
    },
    {
      "text": "Tennis balls press just under the skull, not the spine",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Deep Cervical Flexors"
        },
        {
          "url": "role",
          "valueCode": "primary"
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Sternocleidomastoid"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "22823000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Semispinalis Capitis"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "2666009"
          }
        }
      ]
    }
  ]
}