RESUMO
A whiplash injury can alter neck muscle function, which remains years after the injury and may explain why symptoms such as persistent pain and disability occur. There is currently limited knowledge about dynamic neck muscle function in chronic whiplash-associated disorders (WAD), and about the extent to which altered muscle function can improve after rehabilitation. Ultrasound can detect mechanical neck muscle function by measuring real-time deformation and deformation rate in the muscles. This method was used for five dorsal neck muscles in participants with chronic WAD versus matched controls in resistant neck rotation. We obtained real-time, non-invasive ultrasound measurements using speckle tracking, multivariate analyses, and mixed-design ANOVA analyses. The results showed altered deformation in the three deepest neck muscle layers, with less deformation area in the WAD group compared to controls in rotation to the most painful side at baseline. Participants in the WAD group performed three months of neck-specific exercises, resulting in improved deformation in the deep neck muscles in WAD and with a similar deformation pattern to controls, and the significant group differences ceased. We reveal new and important insights into the capability of ultrasound to diagnose altered neck muscle function and evaluate an exercise intervention.
Assuntos
Terapia por Exercício , Músculos do Pescoço , Ultrassonografia , Traumatismos em Chicotada , Humanos , Traumatismos em Chicotada/diagnóstico por imagem , Traumatismos em Chicotada/fisiopatologia , Músculos do Pescoço/diagnóstico por imagem , Músculos do Pescoço/fisiopatologia , Masculino , Ultrassonografia/métodos , Feminino , Adulto , Estudos de Casos e Controles , Terapia por Exercício/métodos , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/fisiopatologia , Cervicalgia/etiologia , Adulto JovemRESUMO
OBJECTIVE: To compare the effects of a neck-specific exercise programme with internet support and 4 physiotherapist sessions (NSEIT) and the same neck-specific exercises supervised by a physiotherapist (NSE) on neck muscle endurance and cervical range of motion. DESIGN: Randomized controlled trial. PATIENTS: A total of 140 participants with chronic whiplash-associated disorders grade II or grade III were randomly assigned to the NSEIT or NSE groups. METHODS: Outcomes were changes in active cervical range of motion, cranio-cervical flexion test, neck muscle endurance, and neck pain, at 3- and 15-month follow-ups. RESULTS: There were no significant differences between the NSEIT and NSE groups. There was a significant group-by-time inter-action effect in active cervical range of motion flexion/extension where the NSEIT group improved to 3-month follow-up, but the NSE group did not. Both groups were significantly improved over time in all other outcomes (p < 0.001) at 3- and 15-month follow-ups, with effect size between 0.64 and 1.35 in active cervical range of motion, cranio-cervical flexion test, dorsal neck muscle endurance, and neck pain, and effect size between 0.22 and 0.42 in ventral neck muscle endurance. CONCLUSION: Both NSE and NSEIT led to improved neck function. Depending on the patients' needs, either NSE or NSEIT could be used as treatment for patients with chronic whiplash-associated disorders.
Assuntos
Terapia por Exercício , Músculos do Pescoço , Cervicalgia , Amplitude de Movimento Articular , Traumatismos em Chicotada , Humanos , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/reabilitação , Amplitude de Movimento Articular/fisiologia , Masculino , Feminino , Adulto , Terapia por Exercício/métodos , Músculos do Pescoço/fisiopatologia , Cervicalgia/fisiopatologia , Cervicalgia/reabilitação , Cervicalgia/etiologia , Cervicalgia/terapia , Pessoa de Meia-Idade , Resultado do Tratamento , Internet , Doença Crônica , Resistência Física/fisiologiaRESUMO
Postural sway has not been investigated before or after a neck exercise intervention in individuals with chronic whiplash-associated disorders (WAD). The aim of the study was to investigate postural sway in individuals with chronic WAD grades 2 and 3: (a) compared with healthy matched controls at baseline; (b) after three months of neck-specific exercise and (c) to investigate the correlation between postural sway with self-reported dizziness during motion and balance problems/unsteadiness. This is a longitudinal prospective experimental case-control intervention study. Individuals with WAD (n = 30) and age- and gender-matched healthy volunteers (n = 30) participated. Postural sway was assessed using an iPhone application. Measurements were carried out at baseline, and for those with WAD a second measurement was performed at the three-month follow-up when neck-specific exercise intervention ended. The WAD group performed significantly worse than the healthy group in both pathway and ellipse area double stance eyes closed at baseline (main outcome), but not at the three-month follow-up. The WAD group significantly improved after rehabilitation in both pathway double stance eyes closed and pathway single stance eyes open. The correlation between postural sway and self-rated dizziness during motion and balance problems was low to moderate. One may conclude that postural sway was improved after a neck-specific exercise programme. The study results strengthen earlier findings that individuals with WAD have worse balance outcome when they have to rely on neck proprioception (eyes closed). The study results may be important for the development of improved rehabilitation methods for WAD.
Assuntos
Terapia por Exercício , Equilíbrio Postural , Traumatismos em Chicotada , Humanos , Masculino , Feminino , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/reabilitação , Equilíbrio Postural/fisiologia , Adulto , Estudos de Casos e Controles , Estudos Longitudinais , Terapia por Exercício/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Tontura/fisiopatologia , Tontura/etiologia , Pescoço/fisiopatologia , Doença CrônicaRESUMO
INTRODUCTION: Cervical kinesthesia is an important part of movement control and of great importance for daily function. Previous research on kinesthesia in whiplash-associated disorders (WAD) has focused on grades I-II. More research is needed on WAD grade III. The aim of this study was to investigate cervical kinesthesia in individuals with WAD grades II-III before and after a neck-specific exercise intervention and compare them to healthy controls. METHODS: A prospective, case-control study with a treatment arm (n = 30) and a healthy control arm (n = 30) was conducted in Sweden. The WAD group received a neck-specific exercise program for 12 weeks. The primary outcome to evaluate kinesthesia was neck movement control (the Fly test). Secondary outcomes were neck disability, dizziness and neck pain intensity before and after the Fly test. Outcomes were measured at baseline and post-treatment. The control arm underwent measurements at baseline except for the dizziness questionnaire. A linear mixed model was used to evaluate difference between groups (WAD and control) and over time, with difficulty level in the Fly test and gender as factors. RESULTS: Between-group analysis showed statistically significant differences in three out of five kinesthetic metrics (p = 0.002 to 0.008), but not for the WAD-group follow-up versus healthy control baseline measurements. Results showed significant improvements for the WAD-group over time for three out of five kinaesthesia metrics (p < 0.001 to 0.008) and for neck disability (p < 0.001) and pain (p = 0.005), but not for dizziness (p = 0.70). CONCLUSIONS: The exercise program shows promising results in improving kinesthesia and reducing neck pain and disability in the chronic WAD phase. Future research might benefit from focusing on adding kinesthetic exercises to the exercise protocol and evaluating its beneficial effects on dizziness or further improvement in kinesthesia. IMPACT STATEMENT: Kinesthesia can be improved in chronic WAD patients without the use of specific kinesthetic exercises. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03664934), first registration approved 11/09/2018.
Assuntos
Terapia por Exercício , Cinestesia , Traumatismos em Chicotada , Humanos , Feminino , Masculino , Traumatismos em Chicotada/terapia , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/complicações , Adulto , Estudos de Casos e Controles , Estudos Prospectivos , Cinestesia/fisiologia , Terapia por Exercício/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Cervicalgia/terapia , Cervicalgia/etiologia , Doença Crônica , Suécia , Vértebras Cervicais/fisiopatologiaRESUMO
Clinical management of whiplash-associated disorders is challenging and often unsuccessful, with over a third of whiplash injuries progressing to chronic neck pain. Previous imaging studies have identified muscle fat infiltration, indicative of muscle weakness, in the deep cervical extensor muscles (multifidus and semispinalis cervicis). Yet, kinematic and muscle redundancy prevent the direct assessment of individual neck muscle strength, making it difficult to determine the role of these muscles in motor dysfunction. The purpose of this study was to determine the effects of deep cervical extensor muscle weakness on multi-directional neck strength and muscle activation patterns. Maximum isometric forces and associated muscle activation patterns were computed in 25 test directions using a 3-joint, 24-muscle musculoskeletal model of the head and neck. The computational approach accounts for differential torques about the upper and lower cervical spine. To facilitate clinical translation, the test directions were selected based on locations where resistance could realistically be applied to the head during clinical strength assessments. Simulation results reveal that the deep cervical extensor muscles are active and contribute to neck strength in directions with an extension component. Weakness of this muscle group leads to complex compensatory muscle activation patterns characterized primarily by increased activation of the superficial extensors and deep upper cervical flexors, and decreased activation of the deep upper cervical extensors. These results provide a biomechanistic explanation for movement dysfunction that can be used to develop targeted diagnostics and treatments for chronic neck pain in whiplash-associated disorders.
Assuntos
Contração Isométrica , Força Muscular , Músculos do Pescoço , Humanos , Músculos do Pescoço/fisiologia , Músculos do Pescoço/fisiopatologia , Força Muscular/fisiologia , Contração Isométrica/fisiologia , Traumatismos em Chicotada/fisiopatologia , Modelos Biológicos , Fenômenos Biomecânicos , Cervicalgia/fisiopatologia , Pescoço/fisiopatologia , Pescoço/fisiologia , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/fisiologia , Feminino , Simulação por Computador , Debilidade Muscular/fisiopatologiaRESUMO
Cervicogenic headache, described almost 100 years ago, only had its clinical awakening at the end of the century with the work of Professor Sjaastad. Its classic definition is the induction of trigeminal symptoms from cervical disorders, thanks to trigeminocervical convergence mechanisms. For this reason, it can manifest several features typical of migraine, leading to diagnostic errors. Classically, subjects complain of fixed unilateral headaches, with cervical onset and trigeminal irradiation, associated with reduced neck mobility and flexion strength. The headache is mild to moderate, described as pulsatile or compressive, accompanied by nausea, vomiting, photophobia, phonophobia, and may present autonomic symptoms and dizziness. The pain duration varies from one day to weeks, and its frequency is unpredictable. A history of whiplash injury is common. The differential diagnosis encompasses migraine and tension-type headache. Management includes physiotherapy rehabilitation, anesthetic blocks, and selectively surgical procedures. In this article, all these aspects were extensively covered.
Assuntos
Cefaleia Pós-Traumática , Humanos , Cefaleia Pós-Traumática/terapia , Cefaleia Pós-Traumática/diagnóstico , Cefaleia Pós-Traumática/fisiopatologia , Cefaleia Pós-Traumática/etiologia , Diagnóstico Diferencial , Traumatismos em Chicotada/terapia , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/diagnóstico , Traumatismos em Chicotada/complicações , Transtornos de Enxaqueca/terapia , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Modalidades de FisioterapiaRESUMO
OBJECTIVE: The objective of this study was to synthesize the current evidence regarding the predictive ability of measures of physical function (PF) of the neck region and perceived PF on prognosis following a whiplash injury. MATERIALS AND METHODS: Electronic databases were searched by 2 independent reviewers up to July 2020, including MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science as well as gray literature. Eligible studies were selected by 2 reviewers who then extracted and assessed the quality of evidence. Observational cohort studies were included if they involved participants with acute whiplash-associated disorders (WAD), followed for at least 3 months postinjury, and included objective measures of neck PF or self-reported measures of PF as prognostic factors. Data could not be pooled and therefore were synthesized qualitatively. RESULTS: Fourteen studies (13 cohorts) were included in this review. Low to very low quality of evidence indicated that initial higher pain-related disability and higher WAD grade were associated with poor outcome, while there was inconclusive evidence that neck range of motion, joint position error, activity of the superficial neck muscles, muscle strength/endurance, and perceived functional capacity are not predictive of outcome. The predictive ability of more contemporary measures of neck PF such as the smoothness of neck movement, variability of neck motion, and coactivation of neck muscles have not been assessed. DISCUSSION: Although initial higher pain-related disability and higher WAD grade are associated with poor outcome, there is little evidence available investigating the role of neck PF on prognosis following a whiplash injury.
Assuntos
Cervicalgia/etiologia , Traumatismos em Chicotada/complicações , Doença Aguda , Estudos de Coortes , Humanos , Músculos do Pescoço/patologia , Músculos do Pescoço/fisiopatologia , Estudos Observacionais como Assunto , Dor , Prognóstico , Traumatismos em Chicotada/epidemiologia , Traumatismos em Chicotada/fisiopatologiaRESUMO
BACKGROUND: More than 40% of individuals with whiplash injury experience persistent neck pain and disability years later, called whiplash-associated disorders (WAD). A randomized controlled trial evaluated three exercise interventions in WAD and found that neck-specific exercise (NSE) and NSE with a behavioral approach (NSEB) significantly improve disability compared to prescribed physical activity (PPA). However, the relationship between neck-related function and disability is inconclusive and needs to be further investigated. AIM: The present study compares the effect of NSE, NSEB, and PPA on neck muscle endurance (NME), active cervical range of motion (AROM), grip strength, and pain intensity immediately before and after the physical tests, and neck disability in individuals who are below or above the cut-off for normative reference values regarding NME, AROM, and grip strength. DESIGN: Follow-up to a multicenter randomized clinical trial. SETTING: Primary healthcare centers and hospital outpatient services. POPULATION: The selected population of this study included 216 patients with persistent WAD grades II and III. METHODS: This is a secondary analysis including 12 months' follow-up. NME, AROM, grip strength, pain, and self-reported disability were recorded at baseline, 3, 6, and 12 months. Linear mixed models were used, and sub-group analyses evaluated by non-parametric tests. RESULTS: NSE and NSEB resulted in greater improvements compared to PPA (P<0.01) in ventral (only males) and dorsal NME, AROM, and pain intensity during testing. We found no significant between-group differences in grip strength and no significant differences between the NSE and NSEB groups. Improvement in disability was seen at the 12-month follow-up of NSE and/or NSEB for individuals both below and above the cut-off reference values for NME and AROM. Individuals in the PPA group below the reference values for NME and AROM reported increasing disability at 12 months compared to baseline. CONCLUSIONS: The results suggest that neck-specific exercises (i.e., NSE, NSEB) improve clinical function and decrease disability in chronic WAD compared to PPA, but PPA can increase disability for patients with low neck-related function. CLINICAL REHABILITATION IMPACT: Higher neck-related function seems to be important for reduced disability in persistent WAD grades II and III. Neck-specific exercises could lead to higher neck-related function.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Pessoas com Deficiência/reabilitação , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Músculos do Pescoço/fisiopatologia , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/reabilitação , Adulto , Doença Crônica/reabilitação , Terapia Combinada , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Medição da Dor , Amplitude de Movimento Articular/fisiologiaRESUMO
OBJECTIVE: To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account. DATA SOURCES: PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed. STUDY SELECTION: Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected. DATA EXTRACTION: Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version). DATA SYNTHESIS: Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24-0.62]) and extension (0.33 [95%CI: 0.08-0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05-0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22-0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37-0.88] and 0.78 [0.56-0.99], respectively) and EC (0.69 [0.46-0.91] and 0.80 [0.58-1.02]) conditions. CONCLUSION: The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.
Assuntos
Equilíbrio Postural/fisiologia , Traumatismos em Chicotada/fisiopatologia , Animais , Estudos Transversais , Tontura/fisiopatologia , Cabeça/fisiopatologia , Humanos , Movimento/fisiologiaRESUMO
OBJECTIVE: To compare the accuracy of a whiplash-specific risk screening tool (WhipPredict) with that of the modified generic short-form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMPSQ) for predicting poor recovery in patients following whiplash injury. STUDY DESIGN: Inception cohort study. METHODS: Two hundred two participants with acute whiplash completed the WhipPredict and modified SF-ÖMPSQ at baseline. Poor recovery was measured at 6 and 12 months using the Neck Disability Index (greater than 10%), numeric pain-rating scale (greater than 3/10), global perceived recovery (less than +4), and inability to return to preinjury work level. Accuracy statistics were calculated to predict poor recovery. RESULTS: Seventy-one percent (n = 143) of participants completed the 6-month assessment and 56% (n = 113) completed the 12-month assessment. At baseline, agreement between the WhipPredict and modified SF-ÖMPSQ was fair (prevalence-adjusted and bias-adjusted κ = 0.26; 95% confidence interval: 0.12, 0.39). Depending on the outcome, 20% to 72% of people had not recovered at 6 months and 12% to 71% had not recovered at 12 months. At 6 and 12 months, the WhipPredict tool showed high sensitivity (88%-96%) and low specificity (all outcomes less than 31%) on all 4 separate outcomes. The modified SF-ÖMPSQ showed moderate sensitivity (67%-75%) for the Neck Disability Index, numeric pain-rating scale, and global perceived recovery, high sensitivity for return to work (81%-90%), and moderate specificity (54%-77%) for all 4 outcomes. CONCLUSION: Both tools showed acceptable accuracy in predicting poor recovery. The WhipPredict tool is recommended to correctly identify patients who will not recover but may falsely classify those who recover well. Using the modified SF-ÖMPSQ will result in fewer patients falsely categorized as being at risk of poor recovery and may result in some people being undertreated. J Orthop Sports Phys Ther 2021;51(5):207-215. Epub 19 Feb 2021. doi:10.2519/jospt.2021.9987.
Assuntos
Avaliação da Deficiência , Medição da Dor , Inquéritos e Questionários/normas , Traumatismos em Chicotada/classificação , Traumatismos em Chicotada/fisiopatologia , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função FisiológicaRESUMO
PURPOSE: Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS: 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS: Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS: VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.
Assuntos
Acidentes de Trânsito , Eletronistagmografia/métodos , Movimentos Oculares , Náusea/diagnóstico , Náusea/etiologia , Vertigem/diagnóstico , Vertigem/etiologia , Gravação em Vídeo/métodos , Traumatismos em Chicotada/complicações , Traumatismos em Chicotada/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/fisiopatologia , Vertigem/fisiopatologia , Adulto JovemRESUMO
ViVA Open Human Body Model (HBM) is an open-source human body model that was developed to fill the gap of currently available models that lacked the average female size. In this study, the head-neck model of ViVA OpenHBM was further developed by adding active muscle controllers for the cervical muscles to represent the human neck muscle reflex system as studies have shown that cervical muscles influence head-neck kinematics during impacts. The muscle controller was calibrated by conducting optimization-based parameter identification of published-volunteer data. The effects of different calibration objectives to head-neck kinematics were analyzed and compared. In general, a model with active neck muscles improved the head-neck kinematics agreement with volunteer responses. The current study highlights the importance of including active muscle response to mimic the volunteer's kinematics. A simple PD controller has found to be able to represent the behavior of the neck muscle reflex system. The optimum gains that defined the muscle controllers in the present study were able to be identified using optimizations. The present study provides a basis for describing an active muscle controller that can be used in future studies to investigate whiplash injuries in rear impacts.
Assuntos
Vértebras Cervicais/fisiologia , Cabeça/fisiologia , Modelos Biológicos , Músculo Esquelético/fisiologia , Pescoço/fisiologia , Traumatismos em Chicotada/fisiopatologia , Acidentes de Trânsito , Fenômenos Biomecânicos , Feminino , Análise de Elementos Finitos , Movimentos da Cabeça/fisiologia , HumanosRESUMO
The active cervical range of motion (aROM) is assessed by clinicians to inform their decision-making. Even with the ability of neck motion to discriminate injured from non-injured subjects, the mechanisms to explain recovery or persistence of WAD remain unclear. There are few studies of ROM examinations with precision tools using kinematics as predictive factors of recovery rate. The present paper will evaluate the performance of an artificial neural network (ANN) using kinematic variables to predict the overall change of aROM after a period of rehabilitation in WAD patients. To achieve this goal the neck kinematics of a cohort of 1082 WAD patients (55.1% females), with mean age 37.68 (SD 12.88) years old, from across Spain were used. Prediction variables were the kinematics recorded by the EBI® 5 in routine biomechanical assessments of these patients. These include normalized ROM, speed to peak and ROM coefficient of variation. The improvement of aROM was represented by the Neck Functional Holistic Analysis Score (NFHAS). A supervised multi-layer feed-forward ANN was created to predict the change in NFHAS. The selected architecture of the ANN showed a mean squared error of 308.07-272.75 confidence interval for a 95% in the Monte Carlo cross validation. The performance of the ANN was tested with a subsample of patients not used in the training. This comparison resulted in a medium correlation with R = 0.5. The trained neural network to predict the expected difference in NFHAS between baseline and follow up showed modest results. While the overall performance is moderately correlated, the error of this prediction is still too large to use the method in clinical practice. The addition of other clinically relevant factors could further improve prediction performance.
Assuntos
Inteligência Artificial , Traumatismos em Chicotada/reabilitação , Adulto , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento , Traumatismos em Chicotada/fisiopatologiaRESUMO
Neck injury is one of the most frequent spine injuries due to the complex structure of the cervical spine. The high incidence of neck injuries in collision accidents can bring a heavy economic burden to the society. Therefore, knowing the potential mechanisms of cervical spine injury and dysfunction is significant for improving its prevention and treatment. The research on cervical spine dynamics mainly concerns the fields of automobile safety, aeronautics, and astronautics. Numerical simulation methods are beneficial to better understand the stresses and strains developed in soft tissues with investigators and have been roundly used in cervical biomechanics. In this article, the simulation methods for the development and application of cervical spine dynamic problems in the recent years have been reviewed. The study focused mainly on multibody and finite element models. The structure, material properties, and application fields, especially the whiplash injury, were analyzed in detail. It has been shown that simulation methods have made remarkable progress in the research of cervical dynamic injury mechanisms, and some suggestions on the research of cervical dynamics in the future have been proposed.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Lesões do Pescoço/fisiopatologia , Traumatismos em Chicotada/diagnóstico por imagem , Fenômenos Biomecânicos , Simulação por Computador , Feminino , Análise de Elementos Finitos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Incidência , Masculino , Modelos Anatômicos , Modelos Teóricos , Pescoço , Fatores Sexuais , Estresse Mecânico , Vibração , Traumatismos em Chicotada/fisiopatologiaRESUMO
BACKGROUND AND PURPOSE: Whiplash-associated disorders frequently develop following motor vehicle collisions and often involve a range of cognitive and affective symptoms, though the neural correlates of the disorder are largely unknown. In this study, a sample of participants with chronic whiplash injuries were scanned by using resting-state fMRI to assess brain network changes associated with long-term outcome metrics. MATERIALS AND METHODS: Resting-state fMRI was collected for 23 participants and used to calculate network modularity, a quantitative measure of the functional segregation of brain region communities. This was analyzed for associations with whiplash-associated disorder outcome metrics, including scales of neck disability, traumatic distress, depression, and pain. In addition to these clinical scales, cervical muscle fat infiltration was quantified by using Dixon fat-water imaging, which has shown promise as a biomarker for assessing disorder severity and predicting recovery in chronic whiplash. RESULTS: An association was found between brain network structure and muscle fat infiltration, wherein lower network modularity was associated with larger amounts of cervical muscle fat infiltration after controlling for age, sex, body mass index, and scan motion (t = -4.02, partial R 2 = 0.49, P < .001). CONCLUSIONS: This work contributes to the existing whiplash literature by examining a sample of participants with whiplash-associated disorder by using resting-state fMRI. Less modular brain networks were found to be associated with greater amounts of cervical muscle fat infiltration suggesting a connection between disorder severity and neurologic changes, and a potential role for neuroimaging in understanding the pathophysiology of chronic whiplash-associated disorders.
Assuntos
Músculos do Pescoço/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Traumatismos em Chicotada/fisiopatologia , Acidentes de Trânsito , Tecido Adiposo/diagnóstico por imagem , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Rede Nervosa/diagnóstico por imagem , Traumatismos em Chicotada/diagnóstico por imagemRESUMO
Up to 90% of people with neurological deficits following whiplash injury report chronic symptoms. A recent unique study of neck-specific exercise showed positive results (post-intervention at 12 weeks), regarding arm pain and neurological deficits in people with chronic whiplash associated disorders (WAD). This 1-year follow-up of that randomised controlled study with assessor blinding aimed to examine whether neck-specific exercise with (NSEB) or without (NSE) a behavioural approach has long-term benefits over physical activity prescription (PPA) regarding arm pain and neurological deficits (n = 171). Interventions were: NSE, NSEB, or PPA. Follow-up of arm pain, paraesthesia bothersomeness (questionnaires) and clinical neurological tests were performed after 3, 6 and 12 months and analysed with Linear Mixed Models and General Estimating Equations. The NSE and/or NSEB groups reported significantly less pain and paraesthesia bothersomeness as well as higher odds of normal key muscle arm strength and of normal upper limb neural tension over the year (all p < 0.03), compared with PPA. In conclusion, results suggest that neck-specific exercise with or without a behavioural approach may have persisting long term benefits over PPA regarding arm pain and clinical signs associated with neurological deficits in chronic WAD.
Assuntos
Dor Crônica/terapia , Exercício Físico/fisiologia , Cervicalgia/terapia , Traumatismos em Chicotada/terapia , Adolescente , Adulto , Braço/fisiopatologia , Dor Crônica/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/fisiopatologia , Dor/fisiopatologia , Manejo da Dor/métodos , Modalidades de Fisioterapia , Traumatismos em Chicotada/fisiopatologia , Adulto JovemRESUMO
INTRODUCTION: This study aimed to investigate the differences in the Injustice Experience Questionnaire (IEQ) scores during the early period after the diagnosis of Whiplash-associated disorder (WAD) between Japanese and Canadian samples, and the associations between the IEQ scores and treatment terms in Japanese patients with acute WAD. METHODS: We used secondary data for the IEQ scores of Canadian patients with acute WAD. In Japan, we collected data from 85 consecutively enrolled patients with acute WAD, and their treatment terms were collected; these referred to the number of days between the date of injury and the closure date of the insurance claim and the number of treatment visits. Before treatment, the Numeric Rating Scale, Neck Disability Index, Hospital Anxiety and Depression Scale, IEQ, and Euro Quality of Life five-dimensional questionnaire were administered. The variables were subjected to multivariate analysis with each treatment term. RESULTS: The IEQ scores were higher in Japan than in Canada. Through multiple regression analysis, IEQ scores were independently correlated with treatment terms. The optimal cutoff point of the IEQ scores for a prolonged treatment term was 21 and 22 points, respectively. CONCLUSIONS: The IEQ scores were associated with treatment terms in patients with acute WAD in Japan.
Assuntos
Depressão/epidemiologia , Mialgia/epidemiologia , Dor/epidemiologia , Traumatismos em Chicotada/epidemiologia , Canadá/epidemiologia , Depressão/fisiopatologia , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Seguro , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Mialgia/psicologia , Mialgia/terapia , Dor/fisiopatologia , Dor/psicologia , Manejo da Dor , Análise de Regressão , Inquéritos e Questionários , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/psicologia , Traumatismos em Chicotada/terapiaRESUMO
BACKGROUND: Motor vehicle accidents (MVA) are the most common causes of whiplash injuries. Difficulties with driving and changes in driving behavior are reported by subjects with chronic whiplash associated disorders (WAD). Proper eye and head coordination is required for driving tasks. Disturbances of eye and head coordination were found in these subjects with chronic WAD. OBJECTIVES: The objective of this pilot study is to evaluate eye, head and trunk coordination in subjects with chronic WAD due to MVA and healthy controls during a target-tracking task using a functionally oriented approach in the context of driving. DESIGN: Cross-sectional. METHOD: The subjects performed target tracking tasks that reproduced eye and head movements required while driving. Head and trunk motion was captured using a motion capture system and eye movement was captured with an eye-tracker. Response time, time to target, and eye, head, and trunk contribution of movement were measured. RESULTS/FINDINGS: Subjects with chronic WAD presented delayed response time and time to reach the targets with both eyes and head compared to the control group, and tended to compensate the lack of neck motion with increased eye motion. CONCLUSIONS: This study shows indications of impairments of eye and head coordination in chronic WAD due to MVA when compared to healthy subjects. These alterations may have implications for driving safety.
Assuntos
Ataxia/fisiopatologia , Condução de Veículo , Movimentos Oculares/fisiologia , Movimentos da Cabeça/fisiologia , Tronco/fisiologia , Traumatismos em Chicotada/fisiopatologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Projetos Piloto , Tempo de Reação , Análise e Desempenho de TarefasRESUMO
INTRODUCTION: Living with whiplash-associated disorders (WAD) means living every day under the influence of pain and limitations. As the incidence of WAD and the related intensity of pain are somewhat higher among women than men, the aim of the present study was to describe women's experiences of living with WAD. METHODS: A purposive sample of seven women participated in individual in-depth qualitative interviews, the transcripts of which were subjected to qualitative content analysis. RESULTS: The results of the analysis suggested six themes of women's experiences with WAD: living with unpredictable pain; trying to manage the pain; living with limitations; being unable to work as before; needing support and understanding; and learning to live with limitations. The findings showed that unpredictable pain limited women's strength to engage in activities of daily life and be as active as before. Support and understanding were important for their ability to manage changes in their daily lives. CONCLUSIONS: Pain considerably affects the daily lives of women with WAD, particularly by limiting their ability to perform activities and to enjoy their professional and social lives. As women with WAD need support with managing their daily lives, nurses and other healthcare personnel should adopt a person-centred approach, in order to support such women according to their individual needs and circumstances.