There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment o...There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.展开更多
Objective:To assess the correlation between expectations of recovery and whiplash patients' perceptions of injury severity using a simplified instrument.Expectations of recovery have been shown to predict rate of ...Objective:To assess the correlation between expectations of recovery and whiplash patients' perceptions of injury severity using a simplified instrument.Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies.The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis.Methods:Consecutive patients with whiplash-associated disorder grade 1 or 2,presenting in the acute stage to a primary care centre,were asked "do you think that your injury will…" with response options "get better soon;get better slowly;never get better;don't know." Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0-10,on which subjects were asked to rate how severe (in terms of damage) they thought their injury was.The anchors were labeled "no damage" (0) and "severe,and maybe permanent damage" (10).The primary outcome measure was the correlation between the subject's ISP score and expectation of recovery.Results:A total of 94 subjects (34 males,60 females,and mean age (40.6±10.0) years,range 19-60 years) were included.The initial responses to expectation of recovery were:get better soon (29/94);get better slowly (22/94);never get better (11/94);don't know (32/94).The mean ISP score was 4.9±1.7 (range 2-9 out of 10).There was a high correlation between expectations and ISP scores (Spearman's rank correlation coefficient 0.68).Those who expected to recover soon and those who expected to get better slowly had the lowest ISP scores.Conclusions:The more slowly whiplash patients expect to recover,or the less sure they are of recovery,the more severe their initial perceptions of injury.展开更多
Background:Expectations and beliefs appear to be important predictors of outcome following whiplash injury.Instruments for measuring these expectations in the general population have not been well studied.The objectiv...Background:Expectations and beliefs appear to be important predictors of outcome following whiplash injury.Instruments for measuring these expectations in the general population have not been well studied.The objective of this study was to develop a simple symptom expectation questionnaire for whiplash injury for use in future research studies. Methods:An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for whiplash injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter(a subject who expected at least one of these symptoms would remain chronic following whiplash injury).A total of seven of the 56 items were found to be discriminatory.The identified, discriminatory items were then tested in additional subject groups against the original questionnaire. Results:From the original database of 179 subjects completing a 56-item symptom expectation checklist,119 expected at least one of the 56 symptoms would be chronic following whiplash injury.The 119 expecters.however,all chose at least one of seven items:headache,anxious or worried,depressed,neck pain,problems sleeping,back pain,or jaw pain.Using these seven items,in two new groups of subjects given the 56- item symptom expectation checklist and then a new shortened(7-item) symptom expectation checklist one week later(and the same done for another group of 100 subjects in reverse order),all those who endorsed one of the 56 symptoms as likely to be chronic following whiplash injury (expecters) could also be identified on the 7-item checklist. Conclusion:A shortened(7-item) symptom expectation checklist of commonly reported symptoms following whiplash injury(headache, anxious or worried,depressed,neck pain,problems sleeping,back pain,and jaw pain) correctly identifies subjects who expect at least one symptom will be chronic following minor head injury(i.e.,an expecter).This shortened(7-item) symptom expectation checklist can be used in future population-based studies to understand the prevalence of belief patterns and expectations for whiplash injury.展开更多
Objective： To determine the test retest repeatability of the Injttry Severity Perception （ISP） score in participants with acute whiplash-associated disorders （WADs）. Methods： Consecutive patients with WAD, prese...Objective： To determine the test retest repeatability of the Injttry Severity Perception （ISP） score in participants with acute whiplash-associated disorders （WADs）. Methods： Consecutive patients with WAD, presenting in the acute stage to a primary care center, were asked to complete the 1SP score. ISP was measured with a numerical rating scale that ranged from 0 to 10, on which subjects were asked to rate how severe （in terms of damage） they thought their injury was. The anchors were labeled ＂no damage＂ （0） and ＂severe, and maybe permanent damage＂ （10）. The ISP questionnaire was administered to the participants at the time of recruitment and again 7 days later. Repeatability was evaluated by calculating percentage agreement and Cohen kappa statistic between the two time points of measurement. Results： A total of 94 subjects （34 males, 60 females, mean age 40.6 ± 10.0 years, range 19-60 years） were included. The mean 1SP score was 4.9 ± 1.7 （range 2-9 out of 10） at the time of recruitment and 5.1 ± 2.1 （range 2-9 out of 10） 7 days later. The percentage agreement between the two repeat measures of the ISP was 86% and the kappa coefficient was 0.79. Conclusion： This study suggests that the test-retest repeatability for the ISP is high and that it is thus likely to have a low risk of classification bias in prognostic studies. The ISP likely has adequate reliability for use in epidemiological research of WADs.展开更多
Central sensitization has been associated with chronic pain in whiplash patients.Methods:Consecutive whiplash patients were assessed at 3 months post-whiplash injury with the brachial plexus provocation test(BPPT)as a...Central sensitization has been associated with chronic pain in whiplash patients.Methods:Consecutive whiplash patients were assessed at 3 months post-whiplash injury with the brachial plexus provocation test(BPPT)as a sign of central sensitization.Self-reported recovery was assessed by the response to the question ‘Do you feel you have recovered fully from your accident injuries?'Results:Sixty-nine subjects(32 males,37 females,age 37.5±13.0 years(mean±SD),range 18-71)were included.Of these,34 reported a lack of recovery,and 35 reported recovery at 3 months post-injury.The mean BPPT elbow extension(from 180°)was 41.5±23.0°,and the mean VAS score for the BPPT was 2.2 ± 1.2(out of 10).Those who reported recovery had a mean BPPT elbow extension angle of 25.1±15.8 while those who did not report recovery had a mean BPPT angle of 58.4 ± 15.9(P＜0.05).The visual analogue scale(VAS)score for recovered subjects was 1.8 ± 1.1 and 2.7 ± 1.1(P＜0.05)for non-recovered.There was a moderate correlation between self-reported recovery and BPPT elbow extension angle(-0.44)and a lower correlation between self-reported recovery and VAS score(-0.30).Conclusion:Self-reported recovery correlates well with a lower likelihood of signs of central sensitization.Copyright(c)2012,Shanghai University of Sport.Production and hosting by Elsevier B.V.All rights reserved.展开更多
Objectives: To compare DITI vs US in a cohort of patients with whiplash syndrome for assessing soft tissues injuries of the cervical and dorsal spine. Methods: 70 patients presenting to clinic with traumatic cervical ...Objectives: To compare DITI vs US in a cohort of patients with whiplash syndrome for assessing soft tissues injuries of the cervical and dorsal spine. Methods: 70 patients presenting to clinic with traumatic cervical and/or dorsal spine injury and with a clinical diagnosis of whiplash syndrome underwent both DITI (AVIO TVS 2000) and US (GE Logic 5) of the following muscles: sternocleidomastoid, splenius, trapezius, longus colli and paravertebral muscles. DITI considered positive in the region with the most altered temperature among the injured area examinated (normal range 0℃ - 0.8℃). US valued the cervical and dorsal region with a comparative examination of the soft tissues. The images taken with DITI were compared with the clinical and the sonographic outcomes respectively. US and DITI were considered a) congruent whether both had a positive outcome for the same muscle clinically injured;b) not congruent whether one of the two instruments had a different outcome then the clinical evidence. Wilcoxon paired test was used for statistical analysis. Results: DITI and US matched 153 of 233 (65%) injured muscles. The association between DITI and US in the evaluation of the injured muscles was statistically significant for the following muscles: left trapezius (p Conclusions: According to our preliminary study, DITI and US were both helpful for assessing soft tissues injuries in patients with whiplash syndrome, defining the extent of the biologic damage for a correct clinical-therapeutical management.展开更多
Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors;the implicated processes, however, remain a matter of debate. The present study ...Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors;the implicated processes, however, remain a matter of debate. The present study used data from the ESPARR cohort (an on-going prospective study of a representative cohort of road accident victims in the Rh?ne administrative département of France). The objectives were to describe the consequences of whiplash injury and to determine prognostic factors for poor recovery and persistent pain at 1 year post-accident. Methods: The cohort included 255 “pure” whiplash victims, 173 of whom responded to the 1-year follow-up questionnaire. Correlations between explanatory variables and health and pain status were explored by modified Poisson regression to provide adjusted relative risk (RR) values. Results: Half of the victims had not fully recovered health status by 1 year. The main factor associated with non-recovery was pain (RR = 1.3;1.0-1.7). A birth in the family preceding the accident emerged as another factor (RR=1.5;1.2-1.9). Victims responsible for their accident were twice as likely to report being free of pain as those not responsible (RR = 0.5;0.3-0.8). No correlation emerged with accident-related characteristics or PTSD. Conclusions: The present results extend our understand- ing of whiplash injury. Residual pain is the fundamental factor causing whiplash victims to feel that they have not recovered good health. Our findings suggest this may be bound up with physical factors (gender susceptibility);external factors such as having to carry weights (such as a baby) and with perceiving oneself as a victim are not incompatible with this hypothesis.展开更多
Previously,it was shown that the use of a symptom diary for two weeks,even in generally healthy subjects,results in increased recall of daily symptoms and increased perception of symptom severity(Ferrari and Russell,2...Previously,it was shown that the use of a symptom diary for two weeks,even in generally healthy subjects,results in increased recall of daily symptoms and increased perception of symptom severity(Ferrari and Russell,2010).In that study,generally healthy female subjects were asked to recall symptoms experienced in the previous two weeks,after keeping a symptom diary for two weeks,while a control group was asked to recall symptoms experienced in the previous two weeks without having kept a symptom diary.While both groups had展开更多
Whiplash injuries are a global health problem and a significant financial burden for both health care systems,and insurance providers.The diverse symptomatology after whiplash injury both in the somatic,emotional and ...Whiplash injuries are a global health problem and a significant financial burden for both health care systems,and insurance providers.The diverse symptomatology after whiplash injury both in the somatic,emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders(WAD)as a separate category of diseases.The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological,emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction.As a result,the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent.Based on the presented here of Head Neutral Reference Point(HNRP),the objective of central desensitization is to restore valid somatosensory output from Cranio-cervical Junction(CCJ).This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.展开更多
A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway.He was found to have died after a respiratory and cardiac arrest at the scene.No sign of skin injuries was observ...A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway.He was found to have died after a respiratory and cardiac arrest at the scene.No sign of skin injuries was observed from the external inspection.The autopsy was not permitted by the family members because of the local culture.Multislice computed tomography(MSCT)was applied to the current case,showing dislocation of C3~4cervical vertebrae withⅡdegree,C4vertebral plate fractures,and spinal stenosis.Post-mortem MSCT confirmed the diagnosis as whiplash injuries.MSCT was verified to be effective in showing the severity of whiplash injuries,thus providing certain objective evidence for medicolegal expertise.展开更多
Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is n...Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics,facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3)The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury,potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in the impact. (5) There are several possible injury criteria to correlate with the duration of symptoms during reconstructions of actual crashes. These results form the biomechanical basis for a hypothesis that the facet joint capsule is a source of neck pain and that the pain may arise from large strains in the joint capsule that will cause pain receptors to fire.展开更多
Objective：To investigate and analyze the characteristics of Meridian Sinew（Jingjin） syndrome in patients with whiplash-associated disorders（WAD）.Methods：From August 2010 to September 2011,313 WAD cases from New ...Objective：To investigate and analyze the characteristics of Meridian Sinew（Jingjin） syndrome in patients with whiplash-associated disorders（WAD）.Methods：From August 2010 to September 2011,313 WAD cases from New York and California states were collected.The survey mostly collects the information of ＂Sinew Knotted Points＂ and symptoms of four types of Meridian Sinew differentiation—Taiyang,Shaoyin,Shaoyang and Yangming.Results：Among the cases which are on the average of medium injury level,the higher frequency of ＂Sinew Knotted Points＂ tenderness were found on Jianwaishu（SI 14）,Jianzhongshu（SI 15）,Tianchuang（SI 16）,C3-6 Spinous Process,Dazhui（GV 14）,Fengchi（GB 20）,Tianliao（SJ 15） and Tianding（LI 17）.The most commonly presented symptoms were widespread spasm and tenderness in the neck（Taiyang）,difficulty in lateral flexion（Shaoyang）,problems of extension and flexion（Taiyang）,and stiffness and pain during neck movement（Yangming）.Among the cases,237 cases（75.72%） were related to Taiyang Meridian Sinew syndrome,82 cases（26.20%） to Shaoyin syndrome and 175（55.91%） and176（56.23%） cases to Shaoyang and Yangming syndrome respectively.The most of cases presented in a combination format.The syndrome distribution under Grade Ⅰ,Ⅱ and Ⅲ reflected that more combination of the Meridian Sinew syndromes in the whiplash injury patients which is resulted from more severity of injury.Conclusion：It is practical to identify the location of abnormality through Meridian Sinew differentiation,considering both ＂Sinew Knotted Points＂ tenderness and corresponding symptoms,for the local neck symptoms of WAD.展开更多
Among vehicle collisions,rear-end collision is the main injury source of neck whiplash injury.With the increasing prevalence of autonomous emergency braking systems in new vehicles,occupant postures during rear-end co...Among vehicle collisions,rear-end collision is the main injury source of neck whiplash injury.With the increasing prevalence of autonomous emergency braking systems in new vehicles,occupant postures during rear-end collisions have become more diverse.Thus,it is imperative to study the occupant kinematics of out-of-position(OOP)passengers during rear-end collisions.This paper integrated both volunteer tests and computer-aided engineering methods to analyse the occupant kinematics and main whiplash injury indexes for OOP passengers among the braking-induced rear-end collision scenarios.The research results indicated that a larger velocity change of braking resulted in greater occupant head and chest displacements.In rear-end collisions of the same impact severity,the main injury indexes of the OOP occupants were worse when compared with those of the standard seated occupants,among which the lower neck Fz forces were 624%and 411%of the base model,respectively.Furthermore,the relative displacement increased both head and chest peak accelerations.These research results are beneficial for the development of active restraint systems,as well as the update of the whiplash test protocol.展开更多
基金supported by the Department of Odontology and the Faculty of Medicine,Umea University,the Folksam Research Foundation and grants from Vasterbotten County Council(TUA)
文摘There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.
文摘Objective:To assess the correlation between expectations of recovery and whiplash patients' perceptions of injury severity using a simplified instrument.Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies.The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis.Methods:Consecutive patients with whiplash-associated disorder grade 1 or 2,presenting in the acute stage to a primary care centre,were asked "do you think that your injury will…" with response options "get better soon;get better slowly;never get better;don't know." Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0-10,on which subjects were asked to rate how severe (in terms of damage) they thought their injury was.The anchors were labeled "no damage" (0) and "severe,and maybe permanent damage" (10).The primary outcome measure was the correlation between the subject's ISP score and expectation of recovery.Results:A total of 94 subjects (34 males,60 females,and mean age (40.6±10.0) years,range 19-60 years) were included.The initial responses to expectation of recovery were:get better soon (29/94);get better slowly (22/94);never get better (11/94);don't know (32/94).The mean ISP score was 4.9±1.7 (range 2-9 out of 10).There was a high correlation between expectations and ISP scores (Spearman's rank correlation coefficient 0.68).Those who expected to recover soon and those who expected to get better slowly had the lowest ISP scores.Conclusions:The more slowly whiplash patients expect to recover,or the less sure they are of recovery,the more severe their initial perceptions of injury.
文摘Background:Expectations and beliefs appear to be important predictors of outcome following whiplash injury.Instruments for measuring these expectations in the general population have not been well studied.The objective of this study was to develop a simple symptom expectation questionnaire for whiplash injury for use in future research studies. Methods:An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for whiplash injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter(a subject who expected at least one of these symptoms would remain chronic following whiplash injury).A total of seven of the 56 items were found to be discriminatory.The identified, discriminatory items were then tested in additional subject groups against the original questionnaire. Results:From the original database of 179 subjects completing a 56-item symptom expectation checklist,119 expected at least one of the 56 symptoms would be chronic following whiplash injury.The 119 expecters.however,all chose at least one of seven items:headache,anxious or worried,depressed,neck pain,problems sleeping,back pain,or jaw pain.Using these seven items,in two new groups of subjects given the 56- item symptom expectation checklist and then a new shortened(7-item) symptom expectation checklist one week later(and the same done for another group of 100 subjects in reverse order),all those who endorsed one of the 56 symptoms as likely to be chronic following whiplash injury (expecters) could also be identified on the 7-item checklist. Conclusion:A shortened(7-item) symptom expectation checklist of commonly reported symptoms following whiplash injury(headache, anxious or worried,depressed,neck pain,problems sleeping,back pain,and jaw pain) correctly identifies subjects who expect at least one symptom will be chronic following minor head injury(i.e.,an expecter).This shortened(7-item) symptom expectation checklist can be used in future population-based studies to understand the prevalence of belief patterns and expectations for whiplash injury.
文摘Objective： To determine the test retest repeatability of the Injttry Severity Perception （ISP） score in participants with acute whiplash-associated disorders （WADs）. Methods： Consecutive patients with WAD, presenting in the acute stage to a primary care center, were asked to complete the 1SP score. ISP was measured with a numerical rating scale that ranged from 0 to 10, on which subjects were asked to rate how severe （in terms of damage） they thought their injury was. The anchors were labeled ＂no damage＂ （0） and ＂severe, and maybe permanent damage＂ （10）. The ISP questionnaire was administered to the participants at the time of recruitment and again 7 days later. Repeatability was evaluated by calculating percentage agreement and Cohen kappa statistic between the two time points of measurement. Results： A total of 94 subjects （34 males, 60 females, mean age 40.6 ± 10.0 years, range 19-60 years） were included. The mean 1SP score was 4.9 ± 1.7 （range 2-9 out of 10） at the time of recruitment and 5.1 ± 2.1 （range 2-9 out of 10） 7 days later. The percentage agreement between the two repeat measures of the ISP was 86% and the kappa coefficient was 0.79. Conclusion： This study suggests that the test-retest repeatability for the ISP is high and that it is thus likely to have a low risk of classification bias in prognostic studies. The ISP likely has adequate reliability for use in epidemiological research of WADs.
文摘Central sensitization has been associated with chronic pain in whiplash patients.Methods:Consecutive whiplash patients were assessed at 3 months post-whiplash injury with the brachial plexus provocation test(BPPT)as a sign of central sensitization.Self-reported recovery was assessed by the response to the question ‘Do you feel you have recovered fully from your accident injuries?'Results:Sixty-nine subjects(32 males,37 females,age 37.5±13.0 years(mean±SD),range 18-71)were included.Of these,34 reported a lack of recovery,and 35 reported recovery at 3 months post-injury.The mean BPPT elbow extension(from 180°)was 41.5±23.0°,and the mean VAS score for the BPPT was 2.2 ± 1.2(out of 10).Those who reported recovery had a mean BPPT elbow extension angle of 25.1±15.8 while those who did not report recovery had a mean BPPT angle of 58.4 ± 15.9(P＜0.05).The visual analogue scale(VAS)score for recovered subjects was 1.8 ± 1.1 and 2.7 ± 1.1(P＜0.05)for non-recovered.There was a moderate correlation between self-reported recovery and BPPT elbow extension angle(-0.44)and a lower correlation between self-reported recovery and VAS score(-0.30).Conclusion:Self-reported recovery correlates well with a lower likelihood of signs of central sensitization.Copyright(c)2012,Shanghai University of Sport.Production and hosting by Elsevier B.V.All rights reserved.
文摘Objectives: To compare DITI vs US in a cohort of patients with whiplash syndrome for assessing soft tissues injuries of the cervical and dorsal spine. Methods: 70 patients presenting to clinic with traumatic cervical and/or dorsal spine injury and with a clinical diagnosis of whiplash syndrome underwent both DITI (AVIO TVS 2000) and US (GE Logic 5) of the following muscles: sternocleidomastoid, splenius, trapezius, longus colli and paravertebral muscles. DITI considered positive in the region with the most altered temperature among the injured area examinated (normal range 0℃ - 0.8℃). US valued the cervical and dorsal region with a comparative examination of the soft tissues. The images taken with DITI were compared with the clinical and the sonographic outcomes respectively. US and DITI were considered a) congruent whether both had a positive outcome for the same muscle clinically injured;b) not congruent whether one of the two instruments had a different outcome then the clinical evidence. Wilcoxon paired test was used for statistical analysis. Results: DITI and US matched 153 of 233 (65%) injured muscles. The association between DITI and US in the evaluation of the injured muscles was statistically significant for the following muscles: left trapezius (p Conclusions: According to our preliminary study, DITI and US were both helpful for assessing soft tissues injuries in patients with whiplash syndrome, defining the extent of the biologic damage for a correct clinical-therapeutical management.
文摘Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors;the implicated processes, however, remain a matter of debate. The present study used data from the ESPARR cohort (an on-going prospective study of a representative cohort of road accident victims in the Rh?ne administrative département of France). The objectives were to describe the consequences of whiplash injury and to determine prognostic factors for poor recovery and persistent pain at 1 year post-accident. Methods: The cohort included 255 “pure” whiplash victims, 173 of whom responded to the 1-year follow-up questionnaire. Correlations between explanatory variables and health and pain status were explored by modified Poisson regression to provide adjusted relative risk (RR) values. Results: Half of the victims had not fully recovered health status by 1 year. The main factor associated with non-recovery was pain (RR = 1.3;1.0-1.7). A birth in the family preceding the accident emerged as another factor (RR=1.5;1.2-1.9). Victims responsible for their accident were twice as likely to report being free of pain as those not responsible (RR = 0.5;0.3-0.8). No correlation emerged with accident-related characteristics or PTSD. Conclusions: The present results extend our understand- ing of whiplash injury. Residual pain is the fundamental factor causing whiplash victims to feel that they have not recovered good health. Our findings suggest this may be bound up with physical factors (gender susceptibility);external factors such as having to carry weights (such as a baby) and with perceiving oneself as a victim are not incompatible with this hypothesis.
文摘Previously,it was shown that the use of a symptom diary for two weeks,even in generally healthy subjects,results in increased recall of daily symptoms and increased perception of symptom severity(Ferrari and Russell,2010).In that study,generally healthy female subjects were asked to recall symptoms experienced in the previous two weeks,after keeping a symptom diary for two weeks,while a control group was asked to recall symptoms experienced in the previous two weeks without having kept a symptom diary.While both groups had
文摘Whiplash injuries are a global health problem and a significant financial burden for both health care systems,and insurance providers.The diverse symptomatology after whiplash injury both in the somatic,emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders(WAD)as a separate category of diseases.The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological,emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction.As a result,the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent.Based on the presented here of Head Neutral Reference Point(HNRP),the objective of central desensitization is to restore valid somatosensory output from Cranio-cervical Junction(CCJ).This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.
文摘A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway.He was found to have died after a respiratory and cardiac arrest at the scene.No sign of skin injuries was observed from the external inspection.The autopsy was not permitted by the family members because of the local culture.Multislice computed tomography(MSCT)was applied to the current case,showing dislocation of C3~4cervical vertebrae withⅡdegree,C4vertebral plate fractures,and spinal stenosis.Post-mortem MSCT confirmed the diagnosis as whiplash injuries.MSCT was verified to be effective in showing the severity of whiplash injuries,thus providing certain objective evidence for medicolegal expertise.
基金General Motors Corporation (GM) and National Natural Science Foundation of China (NSFC) pursuant to an agreement between GM and NSFC，Natural Science Foundation Project of CQ CSTC
文摘Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics,facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3)The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury,potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in the impact. (5) There are several possible injury criteria to correlate with the duration of symptoms during reconstructions of actual crashes. These results form the biomechanical basis for a hypothesis that the facet joint capsule is a source of neck pain and that the pain may arise from large strains in the joint capsule that will cause pain receptors to fire.
基金Supported by the Innovative Team Project of Beijing University of Chinese Medicine(No.2011-CXTD-08)Research Base Development Project of Beijing University of Chinese Medicine(No.2011-JDJS-09)the 111 Project of China Ministry of Education(No.B07007)
文摘Objective：To investigate and analyze the characteristics of Meridian Sinew（Jingjin） syndrome in patients with whiplash-associated disorders（WAD）.Methods：From August 2010 to September 2011,313 WAD cases from New York and California states were collected.The survey mostly collects the information of ＂Sinew Knotted Points＂ and symptoms of four types of Meridian Sinew differentiation—Taiyang,Shaoyin,Shaoyang and Yangming.Results：Among the cases which are on the average of medium injury level,the higher frequency of ＂Sinew Knotted Points＂ tenderness were found on Jianwaishu（SI 14）,Jianzhongshu（SI 15）,Tianchuang（SI 16）,C3-6 Spinous Process,Dazhui（GV 14）,Fengchi（GB 20）,Tianliao（SJ 15） and Tianding（LI 17）.The most commonly presented symptoms were widespread spasm and tenderness in the neck（Taiyang）,difficulty in lateral flexion（Shaoyang）,problems of extension and flexion（Taiyang）,and stiffness and pain during neck movement（Yangming）.Among the cases,237 cases（75.72%） were related to Taiyang Meridian Sinew syndrome,82 cases（26.20%） to Shaoyin syndrome and 175（55.91%） and176（56.23%） cases to Shaoyang and Yangming syndrome respectively.The most of cases presented in a combination format.The syndrome distribution under Grade Ⅰ,Ⅱ and Ⅲ reflected that more combination of the Meridian Sinew syndromes in the whiplash injury patients which is resulted from more severity of injury.Conclusion：It is practical to identify the location of abnormality through Meridian Sinew differentiation,considering both ＂Sinew Knotted Points＂ tenderness and corresponding symptoms,for the local neck symptoms of WAD.
基金funded by the National Natural Science Foundation of China(Grant No.51405050)the Science and Technology Research Program of Chongqing Municipal Education Commission(Grant no.KJQN201901141).
文摘Among vehicle collisions,rear-end collision is the main injury source of neck whiplash injury.With the increasing prevalence of autonomous emergency braking systems in new vehicles,occupant postures during rear-end collisions have become more diverse.Thus,it is imperative to study the occupant kinematics of out-of-position(OOP)passengers during rear-end collisions.This paper integrated both volunteer tests and computer-aided engineering methods to analyse the occupant kinematics and main whiplash injury indexes for OOP passengers among the braking-induced rear-end collision scenarios.The research results indicated that a larger velocity change of braking resulted in greater occupant head and chest displacements.In rear-end collisions of the same impact severity,the main injury indexes of the OOP occupants were worse when compared with those of the standard seated occupants,among which the lower neck Fz forces were 624%and 411%of the base model,respectively.Furthermore,the relative displacement increased both head and chest peak accelerations.These research results are beneficial for the development of active restraint systems,as well as the update of the whiplash test protocol.
