Monthly Archives: October 2012

Lateral Movement Training May Not Help Whiplash Patients

Coordination problems are common in whiplash patients, but a new study suggests that the injury does not impair lateral judgments. In the study, 64 patients with chronic whiplash were tested on their reaction time and accuracy when making lateral movements. Having a low pain tolerance did not worsen the participants’ ability to move laterally. Researchers concluded that laterality training is unnecessary in the management of chronic whiplash-associated disorders.

Motorcycle Crashes and Spinal Injuries

Image by Rob Swystun via Creative Commons

Internationally, traffic accidents are estimated to account for 50% or more of spinal injury cases. Many of these spinal injuries are sustained by motorcyclists, who are more likely to be injured severely compared to car occupants. A recent study analyzed the crash characteristics of motorcyclists who sustained spinal injuries in a collision, with the aim of identifying risk factors related to motorcyclists’ spinal injuries.

The researchers analyzed data from police case reports of motorcycle crashes both with and without spinal injury. A total of 363 collisions resulting in spinal injury and 873 that did not cause spinal injury were included in the study.

Three factors were found to have a significant influence on whether the motorcyclist sustained a spinal injury: crash configuration, single vehicle crash, and collision with a fixed object. Motorcyclists colliding with fixed objects such as poles or barriers faced more than a 90% increase in the risk of spinal injury. Spinal injury was twice as likely to occur in single-vehicle crashes than in multiple vehicle crashes. Rear-end collisions showed the highest risk; spinal injuries were up to 2.7 times more likely to occur in rear-end crashes compared to frontal collisions. Motorcyclists carrying an additional rider also had an elevated risk of spinal injury.

Most crash victims were male, between the ages of 16-25, who possessed a valid license to drive a motorcycle, reflecting the demographics of motorcycle riders in Malaysia, where the data was collected. There were no significant differences in age, sex, or possession of a motorcycle license between motorcyclists who sustained spinal injuries and those who did not.

In this study, helmets were seen to reduce head injury, but did not seem to offer similar protection from spinal injury. The researchers conclude that further efforts are needed to find effective ways to reduce the incidence of spinal injury in motorcycle collisions.

Reference

Zulkipli ZH, et al. Motorcycle-related spinal injury: Crash characteristics. Accident Analysis and Prevention 2012; (49): 237-44.

 

Fish Oil: A Natural Cure for Brain Injuries?

Fish oil, and omega 3 fatty acids in particular, could offer significant benefits for patients recovering from brain injuries. Although most research on omega 3s and the brain is based on animal studies, there are signs that omega 3s could also have advantages for the human brain as well. A recent CNN story highlights a case study of how high doses of fish oil helped a young man recover from a serious traumatic brain injury obtained an in auto collision. The story also delves into the potential mechanisms behind the process, including repairing the myelin sheath, reconnecting damage neurons, and inhibiting cell death.

Another recent study found fish oil supplements can improve working memory in young adults.

The Functional Somatic Model of Whiplash

Chronic whiplash can result in a wide range of symptoms affecting the whole body. Often, these symptoms are difficult to connect to the initial neck injury, and persist despite treatment. It is largely unknown why some people with whiplash trauma develop long-term symptoms, while others reach a full recovery.

Two opposing models have been proposed to explain these symptoms. In the organic model, the symptoms are caused by the mechanical forces during the trauma. Under the functional somatic model, the symptoms are an expression of psychosocial factors, compounded by the individual’s belief that they have a serious disease that is likely to worsen, leading them to adopt a “sick role.”

Although central sensitization offers an explanation for the development of many whiplash symptoms non-related to neck pain, recent research suggests that depression and anxiety are involved in this process. New research adds to the evidence for the functional somatic model by finding that whiplash is associated with increased rates of depression and anxiety. The findings are part of dissertation published by Hanne Gro Wenzel, doctoral candidate at the Norwegian University of Science and Technology. Wenzel’s research was based on data from the Health Study of Nord-Trøndelag (or HUNT), a large population-based survey. Since pre-injury anxiety, depression, or poor health are associated with later reports of chronic whiplash, he concluded that this evidence of psychosocial factors supports the functional somatic model of chronic whiplash.

The two competing models for chronic whiplash have different implications concerning diagnosis and treatment. The functional somatic model would focus on risk factors such as emotional health and depression, as well as the perception of whiplash injuries as a serious illness with poor prognosis. Treatment recommendations would focus on reducing stress, reducing focus on the symptoms, and avoiding unnecessary medical treatments, with the goal of resuming a normal activity level as quickly as possible.

This research comes just a few weeks after the the release of literature recent review discussed the debate between the functional somatic and organic injury models.

Article written by Megan Churchwell and Marissa Luck

Reference

Wenzel, Hanne Gro. Pre and post-injury health in persons with whiplash: The Hunt Study- Exploration of the functional somatic model for chronic whiplash.  PhD dissertation, Norewegian University of Science and Technology. Trondheim. ISBN 978-82-471-3711-6 (electronic ver.)

Brain Trauma Tied to Crime in Young People

Brain injuries in childhood could increase a person’s likelihood of committing crimes as a young adult, according to a new report from the UK. The study suggests that brain injuries can disrupt the normal development of impulse control, social judgment, and self-restraint by causing maturing brains to “misfire.”

Brain injuries in children often result from sports accidents, auto collisions, and falls. Unfortunately, concussions are often written off as non-serious injuries or are not treated properly. This latest research highlights the consequences of letting these injuries go untreated.

Kids Have High Risk of Brain Injury After Auto Collisions

Pediatric trauma is a growing public health concern. A previous study found motor vehicle accidents to be the most common cause of trauma injuries in children admitted to Intensive Care Units (ICU). New research adds to the understanding of pediatric trauma by outlining a profile of pediatric trauma victims and verifying the likelihood of trauma of children involved in collisions on a high traffic roadway.

This descriptive cohort study involved emergency medical responses to incidents on the Rio-Niterói Bridge, a high traffic area in Rio de Janeiro, Brazil. The incidents included in the study involved at least one child under the age of 12, and occurred between March 2002 and March 2003. Cases were stratified by patient age and by whether or not traumatic injury occurred. Additional information was collected about the injury, such as region and type of injury.

Trauma accounted for 514 of the 1,244 emergency medical responses included in the study. 52 of these involved children under the age of 12 years. Half of the victims were between the ages of 6 and 12 years. Children were unrestrained backseat passengers in 62% of the accidents. The most common injury sites were the extremities, followed by the facial and head injuries. Pre-hospital procedures were performed on 62% of the patients, and primarily involved immobilization on a long spine board or with a cervical collar. 44% of the children required transportation to the hospital.

Although no deaths occurred in the sample discussed in the study, all of the children sustained – at the least – mild traumatic brain injury. This could lead to a wide range of outcomes for the children involved. The researchers conclude that heavy traffic roadways are clearly an unsafe setting for children, with children at significantly higher odds than adults of being treated for trauma following a highway collision. They recommend that emergency medical providers be prepared with specialized education and equipment to treat children with traumatic injuries.

 

Reference

Junior IF, et al. Pediatric trauma due to motor vehicle accidents on high traffic roadway. Einstein (São Paul): 10(1): http://dx.doi.org/10.1590/S1679-45082012000100007.

Tinnitus may be worse for auto-injury patients

Tinnitus has a wide range of causes. Frequently, patients report developing tinnitus following traumatic injuries or auto collisions. However, scientists still do not completely understand to what extent this factor plays a role in the tinnitus, or whether the cause is a relevant criterion for defining subtypes of tinnitus.

A research team recently investigated a sample of tinnitus patients from the Tinnitus Research Initiative (TRI) Database in order to determine differences in clinical, demographic, and audiological characteristics between patients whose tinnitus developed following trauma and those without preceding trauma.

A total of 1,604 cases were examined. The data clearly indicates differences between patients with and without trauma. Patients suffering from trauma-associated tinnitus – especially those with head trauma or whiplash – experience a higher mental burden than patients with other or unknown causes of tinnitus. Patients with trauma-related tinnitus also had longer tinnitus duration and experience more frequent hyperacousis (oversensitivity to certain sound frequencies).

Trauma related to tinnitus onset appears to represent a relevant criterion for developing subtypes of tinnitus. Patients with tinnitus following trauma may require specific diagnostic or therapeutic approaches.In particular, patients with whiplash and temporomandibular disorder may be at risk for developing tinnitus.

Reference

Kreuzer PM, et al. Trauma-associated tinnitus: audiological, demographic and clinical characteristics. PLoS One 2012; 7(9): e45599.

All-Terrain Vehicles Pose Risks for Rural Kids

Riding in all-terrain vehicles is a popular pastime among young rural people, but the activity is frequently the source of severe auto injuries. A new study sought to inform community prevention efforts by analyzing data on ATV injuries among children who visited a clinic in Tennessee. The researchers found that most injuries were moderate to severe in nature and that boys were more likely than girls to obtain ATV injuries (66% versus 34%).

Only 33% of kids wore helmets while riding in ATVs. But kids who did use helmets were less likely to obtain injuries to the head, neck, and face. The research suggests more needs to be done to promote helmet use and safety awareness among families with ATVs.

Causes of Occipital Neuralgia Headache After Auto Collisions

Occipital neuralgia is a type of headache caused by inflammation or injury to the occipital nerves, which run from the top of the spinal cord – at the base of the neck – upwards, through the scalp. This can cause a sharp pain in the back of the neck and head. Often, the symptoms are very similar to a migraine.

The occipital nerves may become compressed or irritated as the result of trauma, such as that sustained in an auto collision. Many medical conditions are also associated with occipital neuralgia. There are a number of pain relief methods used to treat the symptoms of occipital neuralgia, including medications, chiropractic care, and surgery. Proper treatment depends on accurate diagnosis of this condition, which is often confused with migraine-type headaches.

These inflamed nerves typically have an increase in crosssectional area when compared with asymptomatic nerves. A recent study sought to measure both symptomatic and asymptomatic occipital nerves, and to correlate occipital nerve size with sex, body mass index, and headache severity.

A total of 53 patients with suboccipital headaches underwent sonographic scans to measure the cross-sectional area and circumference of the greater occipital nerve. The researchers found significant differences in size between symptomatic and asymptomatic occipital nerves. This finding is consistent with typical swelling of peripheral neuropathy, but to the researchers’ knowledge, had not been reported previously. There was also a significant correlation between body mass index and both symptomatic and asymptomatic occipital nerve areas. No difference existed in nerve measurements between male and female patients, and no correlation between nerve measurements and headache severity.

Further research could include examining the sonographic crosssectional area of the occipital nerve in other types of headaches, such as migraines. In addition, studies monitoring the response of the nerve to treatments could lead to refinement in the diagnosis and treatment of occipital neuralgia.

Reference

Chin-Suk Cho J, and et al. Sonographic evaluation of the greater occipital nerve in unilateral occipital neuralgia. Journal of Ultrasound Medicine 2012; 31: 37-42.

Positive People May Have Better Recovery from Brain Injuries

People with a positive outlook and a sense of resilience tend to have more favorable outcomes while recovering from brain injuries, a new study suggests. Researchers analyzed patients moods, anxiety levels, and psychological resilience one week and one month post injury. They also generated estimates of pre-injury mood and resilience using questionnaires that measured stress and PTSD symptoms. Patients with a more depressed mood and lower resilience experienced more postconcussive symptoms and severe anxiety, regardless of age, gender, and education level.

The study confirms the importance of addressing the psychological component of brain-injury recovery.