Monthly Archives: March 2013

Why Does Some Whiplash Become Chronic?

Why Does Some Whiplash Become Chronic? Scientists continually work to solve the mystery of why some whiplash symptoms become chronic and others do not.

A new study investigated how various factors affect the progression to chronic whiplash symptoms. The researchers looked into pre-injury mental symptoms, self-rated health, use of health services and medications, and health behaviors. They also sought to find if there was a connection between socio-demographic variables and the development of chronic whiplash.

Participants who reported chronic whiplash reported worse baseline health than non-chronic participants. The study found that poor self-rated health was a big risk factor for chronic whiplash. Additionally, musculoskeletal pain increased the risk of chronic whiplash.

Other factors that seemed to be connected to subsequent chronic whiplash included poor somatic health, use of different health services, high medication use, and anxiety.

Socio-demographic variables were not associated with whiplash severity.

Researchers of this study concluded that chronic whiplash is not exclusively an “organic disorder,” but is also affected by patient expectations and feelings about their symptoms. Several former studies have also linked chronic whiplash to patients’ thinking and understanding, such as a lack of patient education and psychosocial factors.

Reference

Makalani Mytveit S, Wilhelmsen I, et al. What characterizes individuals developing chronic whiplash?: The Nord-Trondelag Health Study (HUNT). Journal of Psychosomatic Research; available online 13 March 2013.

 

 

How Much Physical Therapy Do You Need After Whiplash?

How Much Physical Therapy Do You Need After Whiplash?Experts continue to debate the level of physiotherapy care considered optimal for whiplash-associated disorders (WAD) resulting from motor-vehicle collisions. Recent research sought to add to the debate by developing a profile to identify potential high users of physiotherapy services.

The Australian research team attempted to identify predictors for high use of physiotherapy services from claimant information. The research utilized data from Motor Accident Commission claims in Australia for whiplash injuries between 2006 and 2009. This data included 2,818 claimants with WAD.

Of the 2,818 claimants whose data was included in the study, a total of 1,688 (or 59.9%) utilized at least one physiotherapy treatment. The median number of per-claimant physiotherapy services was 15, with a range from one to 194. High users of physiotherapy tended to be female, aged 25-59, living in a high-income area, and with legal representation.

Most people in the study delayed seeking physiotherapy treatment for at least four weeks following the initial injury. Delaying treatment may worsen whiplash; if symptoms go on too long unaddressed, patients may develop muscle degeneration, further injury, or decreased mobility. Attorneys and health professionals could help claimants avoid chronic whiplash by educating patients about the benefits of early treatment.

 Reference

Grimmer-Somers K, Milanese S, Kumar S, Brennan C, Mifsud I. Number and frequency of physiotherapy services for motor vehicle-induced whiplash: Interrogating motor accident insurance data 2006–2009. J Rehabil Med 2012; 44: 774–780.

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Cervical Dysfunction Linked to Long-term Disability in Whiplash Patients

Cervical Dysfunction Linked to Long-term Disability in Whiplash Patients Whiplash trauma is caused by sudden acceleration-deceleration which transfers energy to the cervical region, or neck. This sudden trauma may cause injuries to the bones, joints, ligaments, muscles, and nerves of this region. It’s not surprising then that many patients suffer from cervical motor dysfunction after whiplash, . But little research has been done on whether having these symptoms initially impacts prognosis from whiplash injury. Better insight into this process and its potential predictive value could help to develop more efficient interventions for patients with acute whiplash.

A recent literature review adds to our understanding of cervical motor dysfunction and acute whiplash-associated disorder (WAD). The researchers examined studies of cervical motor dysfunction following whiplash trauma in order to study the presence of such dysfunction, evaluate its course, and assess its predictive value for long-term prognosis. The literature review involved ten studies, each of which investigated cervical motor dysfunction in patients with acute WAD.

The researchers found reduced cervical mobility, altered muscle activity, and disturbed kinaesthesia in patients with acute WAD. Reduced cervical range of movement was demonstrated in all groups of whiplash patients. According to one study, people with an initial reduced cervical range of motion had a 4.6 times greater risk of developing long-term disability. However, the course and predictive value of the initially reduced cervical mobility was inconsistent between studies.

While cervical motor dysfunction appears to be a key clinical finding in acute whiplash, there seems to be conflicting evidence regarding its progression. The researchers concluded that the predictive value of cervical motor dysfunction was limited, and may not explain long-term symptoms. Further research is needed to understand the underlying mechanisms and complex nature of cervical motor dysfunction.

Other recent research has examined whether initial symptoms can predict the prognosis of whiplash.

Reference

Daenen L, Nijs J, Raadsen B, Roussel N, Cras P, Dankaerts W. Cervical motor dysfunction and its predictive value for long-term recovery in patients with acute whiplash-associated disorders: a systematic review. Journal of Rehabilitation Medicine 2013.45(3): 113-122.

Drug Users More Likely To Die in Car Crashes

Drugs Increase Risk of Mortality in Car Crashes “I drive better when I’m high” is common refrain for some pot smokers. But a new study shows that drug use, regardless of what drug you chose, increases your risk of dying from an auto collision.

Previous research has shown that alcohol elevates the risk of mortality due to motor vehicle collisions but it was unknown whether using drugs was riskier than alcohol in terms of mortality.  A new study from the journal Accident Analysis Prevention is the first major population-based study to analyze the effects of drug use on fatalities from auto collisions.

The study included over a million drug users who were hospitalized in California between 1990 and 2005. The researchers followed up with these participants for up to 16 years after the start of the study, and tracked the mortality ratios due to motor-vehicle collisions.

Alcohol was the number one source of fatalities from auto accidents, followed by cocaine, pain killers, methamphetamine, cannabis, and polydrug. Women and men had similar mortality ratios.

The authors pointed out that drug users often underestimate the impact of drug use on safe driving. “It may be important for health-service or public-health interventions to address such biases and improve road safety,” they concluded.

Reference

Callaghan RC, et al. Alcohol- or drug-use disorders and motor vehicle accident mortality: A retrospective cohort study. Accident Analysis Prevention 2013; 53:149-55. doi: 10.1016/j.aap.2013.01.008.

Risks of Driving After Brain Injury

Risks of Driving After Brain Injury It’s hard to know when you can resume normal activities like driving after a brain injury. While an estimated 40-60% of patients eventually return to driving after a moderate to severe brain injury, studies show they’re also more likely to get in car crashes. New research suggests that this increased accident rate may be a result of specific attention disorders caused by brain injury.

In a study published in the journal Brain Injury, researchers had ten patients and ten controls conduct specific tests to simulate the attention required while driving. Participants were told to watch a speedometer but ignore sudden changes in their environment. The patients with TBI had attention difficulties during complex situations.

“These difficulties may have a negative impact on real driving situations,” the authors concluded.

But attention disorders aren’t the only factor influencing driving behavior after brain injury. Another new study examined the driving behavior of 184 patients with mild to severe injury within five years of sustaining a TBI.

Women and older adults were more likely to avoid challenging or complex driving scenarios. This sense of caution did not translate to all TBI patients however. Young men and patients with a poorer performance on cognitive tests at the time of rehabilitation did not avoid challenging driving situations. The researchers suggested that patients with more severe injuries and young men may require additional guidance when returning to driving.

References

Labbe DR, et al. Predictor s of driving avoidance and exposure following traumatic brain injury. Journal of Head Trauma Rehabilitation 2013; [E-pub ahead of print.]

Masson M, et al. Specific attention disorders in drivers with traumatic brain injury. Brain Injury 2013; [E-pub ahead of print].

Jaw Disorders Common in Fibromyalgia Patients

Jaw Disorders Common in Fibromyalgia Patients Fibromyalgia is a chronic pain condition with many varied symptoms. Temporomandibular joint disorders are one potential symptom. A recent study sought to add to the understanding of TMJ disorders in patients with fibromyalgia. The study compared TMD features in 40 women with fibromyalgia with TMD in 40 healthy participants.

Facial pain was reported by 85% of the patients with fibromyalgia and 77.5% were diagnosed with myofascial TMD. Patients with fibromyalgia reported significantly higher levels of muscle pain while moving the jaw, bruxism/clenching during the day, and limited mouth opening. No difference was found in bruxism/clenching while sleeping or in joint noises.

Classic signs of TMD, such as clenching at night and joint noise, do not appear to be associated with fibromyalgia. However, daytime clenching, muscle pain during jaw movements, and limited mouth openings do appear to be features of fibromyalgia. This study revealed that the specific muscle involvement of TMD is also present in fibromyalgia.

Studies show that patients with whiplash are also more likely to suffer from temporomandibular joint disorders.

Reference

Pimentel MJ, Gui MS, Martins de Aquino LM, Rizzatti-Barbosa CM. Features of temporomandibular disorders in fibromyalgia syndrome. Cranio 2013; 31(1):40-5.

Heading a Soccer Ball Could Impair Players’ Thinking

Heading a Soccer Ball Could Impair Players' ThinkingSoccer coaches commonly encourage players to use their heads to direct a soccer ball during play. Doing so is legal in the game and often impressive for bystanders and fans.

However, a new study shows that this maneuver could be dangerous for players. Researchers tested the cognitive function of a girls’ high school varsity soccer team in the Houston area. They were looking for evidence whether or not the slight and repeated impact of the soccer ball to the head was impacting the players’ thinking abilities.

The research team used a simple iPad touch-screen edition of a cognition test, which they gave to the players immediately following soccer practice sessions that included heading the ball. The research team also subjected a group of girls who were not currently involved in a contact sport to the same tests.

The soccer players were significantly slower in the cognition test than the control group. And the more times a girl had headed the ball in the practice before the test, the worse her cognitive scores were.

Researchers also found that the more years and the more hours per week a girl had played soccer, the slower she tended to be on the iPad test.

While the results of the study may trouble players and their parents, it is important to note that the study was small and the level of impairment shown was slight. The researchers also point out that further research would be helpful to determine whether the negative effects are short-lived or long-lasting.

The innovation is exciting of using iPad tablets in the study, because they offer portability and convenience, allowing scientists to do tests on a field rather than in a lab. The research team from this study is currently working on studies involving how other sports, including football, affect cognition in players.

Reference

Zhang M, Red S, Lin A, Patel S, Sereno A. Evidence of cognitive dysfunction after soccer playing with ball heading using a novel tablet-based approach. PloS one 2013; 8(2): e57364. doi: 10.1371/journal.pone.0057364.

 

 

 

Football Concussions Can Be Deadly

Football Concussions Can Be Deadly New attention on brain injuries in football has sparked growing concern among  high school and college football programs.  Although athletes can recover from mild brain injuries in a matter of weeks, studies show that even minor injuries can cause lasting brain damage.

And for some athletes, concussions can be deadly. A new study from The American Journal of Sports Medicine found that brain injuries were the second most common cause of death among college and high-school football players.

The study included an analysis of 243 football fatalities reported to the National Center for Catastrophic Sports Injury Research between 1990 and 2010.  Every year, an average of 12.2 players died as result of their participation in football, with a rate of 1 per 100,000. The vast majority of deaths were caused by indirect (systemic) events like cardiac events, heat illness, and sickle-cell trait fatalities. These indirect events occurred most frequently in intense preseason training while brain fatalities were more likely to occur during the actual game.

The primary cause of death was cardiac failure (causing 41% of fatalities), followed by brain injuries (25.5%) and heat illness (15.6%). Additionally, college athletes had double the risk of fatalities from football than high-school players.

While  brain fatalities in football remain relatively rare, an increasing number of high-school players are suffering from severe brain injuries. In the last decade alone, there’s been a 25.5% jump in the number of catastrophic brain injuries sustained by high-school football players, according to another recent study from National Center for Catastrophic Sports Injury Research.

This research reminds of the seriousness of sports-related concussions. Rather than view a concussion as a minor injury that doesn’t require medical attention, athletes should seek guidance from health professionals before returning to play.

Reference

Boden BP, et al. Fatalities in High School and College Football Players. The American Journal of Sports Medicine 2013; doi: 10.1177/0363546513478572. [E-pub ahead of print].

Hypothermia Treatment Unsafe for Kids

Hypothermia Treatment Unsafe for KidsYou may not think of hypothermia as a good thing, but studies show that inducing moderate hypothermia may actually benefit brain-injury patients.

Immediately after a brain injury, the brain fires a series of metabolic responses that can actually worsen brain damage. Cooling the body temperature forces the body to slow down these responses which could limit the extent of the damage. Therapeutic hypothermia reduced mortality in animal studies and led to significantly better outcomes for patients in another recent study.

But while the treatment has been successful in many adults with brain injuries, it’s use in children is controversial.

A new  literature review suggests that children respond differently to hypothermia than adults, and may actually suffer more as result of the treatment. The review included 366 pediatric patients from six clinical trials who received therapeutic hypothermia.  The researchers discovered that children treated with hypothermia had more unfavorable outcomes than kids who under usual care. While hypothermia wasn’t linked to pneumonia, it did slightly increase the risk of mortality and cardiac arrhythmia.

Until more research is done to make the treatment safer for kids, experts recommend that therapeutic hypothermia not be used for children with severe brain injuries.

References

Hutchison J, et al. Hypothermia Therapy after Traumatic Brain Injury in Children. The New England Journal of Medicine 2008; 358:2447-2456.

Ma C, et al. Is therapeutic hypothermia beneficial for pediatric patients with traumatic brain injury? A meta-analysis. Child’s Nervous System 2013; [Epub ahead of print].

Whiplash Impairs Balance and Posture in Women

Whiplash Stresses Neck Muscles and Impairs Balance in WomenResearch about whiplash-associated disorder helps us understand the long-term effects of whiplash and how the daily lives of victims of whiplash are affected by the injury.

A recent cross-sectional study investigated the neck muscle activity and postural control of women who suffer from whiplash compared to healthy women. Researchers measured the activity of four different neck muscles and subjected both the whiplash group and the control group to three balance tasks.

The study’s findings showed that muscle activity in all four neck muscles increased during balance tasks with closed eyes and a one-legged stance for the women with whiplash-associated disorder. Compared to the healthy controls, this group also had increased postural sway.

The researchers concluded that these symptoms indicate disturbed sensory feedback patterns in people with whiplash-associated disorders. They also stated that whiplash injury can harm a victim’s ability to perform daily activities.

Reference

Juul-Kristensen B, et al. Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain: a cross-sectional study. Journal of Rehabilitation Medicine 2013; March 6 [Epub ahead of print]: doi: 10.2340/16501977-1120.