Monthly Archives: May 2012

New tool for predicting chronic whiplash

It’s estimated that between 10-40% of people with neck injuries from an auto collision develop chronic symptoms.1 Determining what causes chronic whiplash symptoms could reduce that number. Previous research has explored a myriad of factors contributing to chronicity of whiplash including but not limited to: degree of pain sensitization, psychological risk factors, presence of neck and head pain, dizziness, and limited neck range of motion.

Researchers from Denmark sought to integrate those various factors into one risk assessment score that moves beyond the oft-criticized Quebec Task Force guidelines.2-3 The new grading system from the Danish Whiplash Study Group divides patients into 7 strata based on their severity of neck and head pain, cervical range of motion, and how many “nonpainful symptoms” patients exhibit. Nonpainful symptoms include dizziness, vision disturbances, tinnitus, fatigue, irritation, concentration disturbances, memory difficulties, sleep disturbances, and more.

Researchers then tested this new grading system on 141 patients with whiplash and a control group of 40 ankle-injured patients. Whiplash patients with worse symptoms initially were more likely to develop chronic symptoms and less likely to have recovered from their injury after 12 months. The number of high-risk patients who returned to work after one year was as low as 50% in strata 6 and 20% in strata 7.

These results demonstrate that this new grading system could predict chronic whiplash based on a) active neck mobility, b) combined pain score of headache and neck pain and c) a summation of nonpainful symptoms.

This risk assessment score could be combined with an assessment of  pain sensitization and psychological distress to predict whether a patient may experience chronic conditions.  The researchers argued that the risk assessment score could be easily used by general practitioners.

This study confirms that multiple factors can combine to contribute to whiplash chronicity. It also suggests that addressing these symptoms comprehensively could prevent persistent whiplash problems.

References

1. Treleaven J. Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma. Spine 2011; 36(25S): S211-217.

2. Kasch H, Qerama E, Kongsted A, et al. The risk assessment score in acute whiplash injury predicts outcome and reflects biopsychosocial factors. Spine (2011): 26(25S): S263–S267.

3. Kivioja J , Jensen I , Lindgren U . Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients . European Spine Journal 2008 ; 17: 930 – 5 .

US soldiers suffer same brain damage as athletes

U.S. soldiers may be at risk for developing the same degenerative brain disease suffered by many professional athletes.

In a new study, autopsies of four young veterans revealed their brains were strikingly similar to the brains of former football and wrestling athletes with chronic traumatic encephalopathy (CTE). CTE is a degenerative brain disease caused by repeated concussions that lead to cognitive deficits, aggressive behavior,and  depression.

In the study, the brains of veterans and athletes had a build up of a protein called tau which is associated Alzheimer’s disease and CTE. The brains were also littered with constricted blood vessels and damaged axons which could disrupt the communication among neurons.

Advances in medical treatments means that more soldiers are surviving explosions than ever before. But as soldiers heal from the physical wounds of explosions, they’re often left  with the “invisible injury” of brain damage.  Medical advancements, combined with increased prevalence of IED explosions, has lead to a staggering increase in the number of soldiers surviving with the “signature wound of war.” .

In order to test whether soldiers’ brain injuries result from explosions, the researchers subjected lab mice to blasts akin to IED explosions. After the blasts, the mice had more difficulty with memory and learning — two key symptoms experienced by soldiers with brain injuries.

A recent Reuters  article pointed out that since mild traumatic brain injuries can’t be detected using normal CT scans or imaging, doctors and family members can be skeptical about whether the damage actually exists.  Using powerful microscopes, researchers in this study demonstrated that it possible to detect damage after brain injuries. The study confirms that the “invisible injuries” suffered by so many returning veterans are indeed real.

Photo by US Army Africa via Creative Commons.

Reference

Goldstein L, Fisher A, Tagge C,et al.  Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Science Translational Medicine 2012; 4:134ra60. doi 10.1126/scitranslmed.3003716.

Growing concussion risk for girls’ soccer

After football, the second riskiest sport for concussion may surprise you. Girls’ soccer ranked number two for having the most reported concussions in two years, surpassing boys’ wrestling, ice hockey, and girls’ basketball according to a study from the American Journal of Sports Medicine.  For girls and boys playing the same sport, girls had twice as many concussions than boys in another study.

Girls with mild traumatic brain injuries may suffer the consequence of concussions more so than their male counterparts. A new study found that females and younger athletes took longer to recover from concussions than college-aged males.

After receiving a concussion, girls scored lower on visual memory tests, reported more symptom,  and had poorer postural stability than boys. High-school athletes also suffered from memory impairment for longer than college-aged athletes.

Researchers believe anatomical differences in neck size could magnify the impact of a blow to the head for girls and younger athletes. ” The same force delivered to a girl’s head spins the head much more compared to guys,” explained Dr. Bob Cantu, director of sports medicine at Emerson Hospital in Mass., in an interview MSNBC News.

That means that girls and younger athletes may need to take a more cautionary approach to concussion recovery, argued lead author of the study Tracy Covassion in a New York Times article.

Recent research suggests that repeat concussions can cause long-lasting cognitive deficits in soccer and football players. Taking steps to prevent repeat concussions could allow young athletes to reduce their risk of developing long-term memory problems, headache, and other symptoms of mild traumatic brain injuries.

Reference:

Covassin T, Elbin RJ, Harris W, Parker T, and Kontos A. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. American Journal of Sports Medicine 2012;, doi:10.1177/0363546512444554

Photo by Keith Miner via Creative Commons.

More car crashes for returning soldiers

Newly-returned soldiers are more likely to be in car crashes to which they are at fault according to new research. The USAA study found that soldiers have an average of 13% more at-fault auto collisions in the first six months after deployment compared to the six months prior.

Army veterans had the highest increase in at-fault auto collisions (23%), followed by Marines (12.5%), Navy (3%), and Air force (2%). Those rates only increased among soldiers who had more deployments: incidents increased by 36% for soldiers deployed 3 or more times compared to just a 12% increase in soldiers deployed once.  The rates are based on 171,000 deployments and 158,000 USAA members. USAA is a major insurer that caters to military personnel and their families.

Analysts believe that soldiers bring home certain driving behaviors from war. Those behaviors, like reluctance to stop at intersections or speeding, may be life-saving in combat but are risky when used on suburban roads. Other research found that newly-returned soldiers often feel anxious when driving or when other cars approach their vehicles quickly. The USAA study also found that many soldiers are “overly attentive” to roadside elements or objects in the road, which could be residual from when they needed to be cautious of improvised explosives devices (IEDs) in combat.

This study adds to the growing body of research on the physical and psychological effects of war. As more soldiers return with mild traumatic brain injuries, they are likely to suffer from PTSD, depression, anxiety, and more.

References

Returning soldiers have more car crashes: study. Reuters Health. April  24, 2012. Accessed May 14, 2012. http://www.healthnews.com/en/news/Returning-soldiers-have-more-car-crashesstudy/2R1ZCI$QT5rgAfv_0mH5Jj/.

“Returning Warriors: Driving Safety Report 2012.” USAA. https://content.usaa.com/mcontent/static_assets/Media/Returning_Warriors_report_summary.pdf.

Risk of injury in low-speed frontal crashes

Can you be injured in a low-speed auto collision? The simple answer is yes. Numerous studies have documented that low-speed, rear-end auto collisions can cause injuries like whiplash and shoulder pain. Although many studies have investigated low-speed, rear-end collisions, fewer have examined exactly what happens during frontal crashes. A new study suggests that minor injury can occur in frontal crashes at less than 8 mph.

The study included 19 healthy, informed volunteers who underwent frontal crashes between 4.1-8.3 mph. Other than minor cosmetic damage and scuffs, the cars showed no sign of the collisions.Despite this, 88% of participants reported some form of mild to moderate pain or discomfort following the crash. The most common complaint was neck pain, followed by discomfort in the shoulders and upper back.

In another study of frontal crashes, the authors founds that injury was unlikely to occur in collisions under 8.1 mph. This newer study suggests though that injuries can indeed occur in frontal collisions under 8.1 mph, however minimal the injuries may be.

If you’ve been in a low-speed frontal crash and have mild pain, it’s important to monitor your symptoms to see if they worsen or linger. Consult with your doctor to see if treatment is necessary. Early treatment could make a difference in preventing the pain from worsening or becoming chronic.

References

Bunketorp O, Jakobsson L, Norin H. Comparison of frontal and rear-end impacts for car occupants with whiplash associated disorders: symptoms and clinical findings. Proceedings of the International IRCOBI Conference. Graz, Austria; 2004. p. 245-56.

 

Croft A and Eldridge R. Human subject rear passenger symptom response to frontal car-to-car low speed crash tests. Journal of Chiropractic Medicine 2011; 10: 141-146.

 

Another football player lost to brain injuries?

Brain InjuryJunior Seau’s family is donating his brain for research for football-related brain injuries. The former Chargers linebacker recently committed suicide with gun shot to his chest. That method was the same used by former Chicago Bears player Dave Duerson so that his brain could be preserved for examination of  chronic traumatic encephalopathy (CTE). The degenerative brain disease can develop after years of repeated concussions but can only be confirmed by a postmortem autopsy. Signs of CTE can include mood swings, memory loss, depression, addiction and impulsive behavior.

As more research emerges on the effects of repeat brain injuries on football players, Seau’s death is the latest in a string of suicides by professional football and hockey players who have been diagnosed with or suspected of having of CTE.

References

Wilson, Bernie. Junior Seau’s brain to be donated for research into head injuries, concussions. Huffington Post. May 5, 2012. Accessed May 10, 2012. http://www.huffingtonpost.com/2012/05/04/junior-seau-brain-research-concussions-head-injuries_n_1477810.html.

Hendricks, Maggie. NFL legend Junior Seau found dead at his California home. Yahoo News. May 2, 2012. Accessed May 10,2012. http://sports.yahoo.com/blogs/nfl-shutdown-corner/report-nfl-legend-junior-seau-dead-182120394.html.

 

When wearing a helmet isn’t enough

Growing awareness of sports-related brain injuries has sparked a new effort to establish guidelines for cycling-related head injuries. US Cycling is now collaborating with a physicians’ group called Medicine of Cycling to develop formal protocol for when professional riders get concussion during a race.
Cyclists would be evaluated for baseline cognitive function using a software that tracks motor and mental functioning. If cyclists crash or fall, they would be evaluated again to see whether they’re cognitively ready to continue riding. During the actual race though, cyclists would be evaluated for signs of a brain injury by a race doctor. The strategy is similar to one used by the National Football and National Hockey leagues.
Although cycling is not often thought of as a high-impact sport, cyclists are at risk of head injury as they turn tight corners and weave through traffic. For professional cyclists, crashing can become a normal experience. Often when cyclists have no broken bones, their impulse is to hop back on their bike and keep riding. That could be dangerous if the crash was particularly hard or involved a blow to the head.
While wearing a helmet does protect the skull and absorb some shock, a major blow to the head can force the brain to slam against the skull itself. This is similar to when the brain can be injured during an auto collision even if the occupant didn’t hit his or her head.
Experts recommend that cyclists recovering from concussions should get lots of rest– both physically and mentally. The brain requires extensive energy as it heals from injury even it the injuries aren’t visible. Riding a bike takes mental agility and concentration, and the mental confusion experienced after a concussion can impede a cyclist’s ability to make snap judgments or balance properly. How long you should rest after a concussion is dependent on the injury. To learn what’s right for you, consult with a doctor with experience in concussion recovery and working with athletes.

References

Johnson, Mark. “US Cycling, physicians develop head injury protocol.” Velo News. April 26, 2012. Accessed May 2, 2012.
http://velonews.competitor.com/2012/04/news/head-injuries-and-cycling_215165

” Undiagnosed concussions in cycling cost more than just minutes in the General Classification.” Medicine of Cycling. September 22,2011. Accessed May 7, 2012. http://www.medicineofcycling.com/blog/undiagnosed-concussions-in-cycling-cost-more-than-just-minutes-in-the-general-classification/.

Spike in children with concussions

The number of children diagnosed with concussions has more than doubled in the past decade according to a new analysis of emergency room data. Despite the increase in diagnoses, the injuries don’t appearing to be worsening since the percentage of children hospitalized for concussions actually decreased in the same period.

That could mean that awareness of concussions has grown rather than the actual number of injuries, suggested Dr. Jeffery Colvin, a key author of the new study.

Colvin pointed out that a decade ago, concussions were considered just “a ding” and children were frequently left to heal from the injury without going to the doctor. In recent years though, new research on the effects of concussions on football players has contributed to a heightened awareness of the condition. Studies have indicated that repeat concussions can cause brain damage with lasting detrimental effects, including cognitive deficiencies, depression, and a degenerative brain disease known as CTE. Now teams are starting to be penalized more for aggressive hits to other players . A new law in Illinois requires child athletes to be removed from play if they’re suspected of having a concussion.

Colvin and colleagues analyzed the medical records of 14 children’s hospitals. From 2001 to 2010, the number of children diagnosed with concussions increased by 58% –from 2,216 in 2001 to 4,967 in 2010. But while 25% of children with concussions were hospitalized in 2001, just 9%of children were hospitalized for their condition in 2010.

The study echoes recent research demonstrating a rise in the number young people in emergency rooms for concussions, and a growing number of high-school football players with catastrophic brain injuries.

For children, the causes of concussion are frequently sports, falls, and auto collisions.

All children with concussions should be evaluated by a doctor. If the child was knocked unconscious or has symptoms of headache, confusion or vomiting they should be taken to the emergency room.

References:

Tanner, Lindsey. Children’s ER treatment for concussions is way up. Associated Press. The Seattle Post Intelligencer. Friday April 27, 2012. Accessed May 2, 2012. http://www.seattlepi.com/sports/article/Children-s-ER-treatment-for-concussions-is-way-up-3516122.php.

Ganz C and Novak M. Children’s Mercy Hospitals Researchers Find Concussions in Children More Than Doubled From Ten Years Ago. http://www.childrensmercy.org/Content/uploadedFiles/Departments/Press_Room/Children%27s%20Mercy%20Researchers%20Find%20Concussions%20in%20Children%20More%20Than%20Doubled%20From%20Ten%20Years%20Ago.pdf.

Why whiplash is not just a neck injury

Tissue damage is difficult to detect in many patients with whiplash-associated disorders. Whether tissue damage is a pre-requisite for whiplash injury is still debated, and how tissue damage occurs is source of ongoing research. A recent literature review from the journal Spine examines current whiplash injury models to explore the various ways tissue damage can occur. The authors analyzed existing evidence of tissue damage of the facet joints and capsules, dorsal root ganglion, vertebral artery, and muscles.

There are various ways tissue damage can occur during whiplash. (Click on the links to learn more).

This literature review confirms that tissue damage occurs during whiplash despite that is undetectable using conventional imaging and radiography. Although small fractures can be detected by computed tomographic (CT ) scanning, CT scans did not reliably detect ligament and tissue damage in one cadaver study.

As researchers continue to grapple with these ongoing challenges, millions of patients continue to suffer from persistent neck pain and whiplash symptoms. Fortunately most researchers and practitioners “are well past the era when the pain and suffering of whiplash patients was discounted and dismissed.” The authors concluded that though “the suffering is real”, “the search for the cause must continue.”

Reference

Curatolo, M., Bogduk N., Ivancic P.,McLean S., Siegmund G., Winkelstein B. The Role of Tissue Damage in Whiplash-Associated Disorders.Spine 2011; 36 (255):S309-S315.