Week 2 Whiplash P1

Whiplash Associated Disorder (WAD)

is a term used to describe a variety of symptoms that can occur following a whiplash injury, commonly associated with rear-end vehicle collisions. Symptoms may include neck pain, headaches, dizziness, and cognitive difficulties.

Understanding WAD

Classification of Trusted Factors Affecting Level of Injury

  • Factors affecting injury severity in whiplash:

    • Gender: May influence the risk and severity of symptoms due to physiological differences.

    • Awareness

    • Age

    • Head restraint position

    • Impact velocity

    • Seat or occupant positioning

Signs and Symptoms

General Symptoms

  • Pain is prevalent in nearly all patients, often accompanied by neck stiffness.

  • Neck pain found in 92% of referred patients (Radinov et al, 1995).

  • Headaches reported in 50-90% of patients (Sterling, 2011).

  • Shoulder and arm pain experienced by 40-70% of patients (Sterling, 2011).

  • Thoracic and lumbar back pain reported in 35% of patients (Sterling, 2011).

  • Paraesthesia/Anaesthesia (primarily in upper limbs) reported by 20% of patients (Sterling, 2011).

Additional Symptoms- Neurological

  • Balance and postural changes

  • Unsteadiness and clumsiness

  • Dizziness

  • Visual disturbances

  • Auditory disturbances (e.g., tinnitus)

  • Temporomandibular joint pain

  • Photophobia

  • Fatigue

  • Cognitive difficulties: loss of concentration and memory impairment.

  • Possible link to underlying brain injury as cause is still unclear.

Quebec Task Force Classification of WAD

Grading System (1995)

  • Grade 0: No neck pain or physical signs.

  • Grade I: Muscle tightness, Neck pain, stiffness, tenderness; no physical signs.

  • Grade II: Strain, Neck pain with musculoskeletal signs such as decreased range of motion or tenderness.

  • Grade III: Disc injury, neck pain with neurological signs including reflex changes, muscle weakness, sensory deficits.

  • Grade IV: Neck pain with fracture or dislocation.

Psychological Symptoms

Associated Mental Health Effects

  • Symptoms may include:

    • Anxiety

    • Post-Traumatic Stress Symptoms (PTSD) (Dunne-Proctor, 2015)

  • Study findings:

    • 40% of whiplash patients demonstrate psychological resilience.

    • 43% have moderate PTSD symptoms initially, with 17% experiencing persistent moderate symptoms for over 12 months (McCarthy S.).

Patterns of Recovery

Symptom Onset and Longevity

  • Symptoms can manifest immediately or be delayed by 12-15 hours (Sterling, 2011).

  • 50% of individuals may experience ongoing symptoms and not fully recover within one year post-injury (Sterling, 2011).

  • Evidence shows limited improvement for symptoms persisting beyond three months (Kamper et al, 2008).

  • Chronic WAD symptoms may include sensitivity to cold and are often associated with poor prognosis (Marcuzzi et al, 2015).

Chronic WAD and Rehabilitation

Cervical Dysfunctions in Chronic Cases

  • Common cervical dysfunctions involve:

    • Increased cervical tone, including myofascial trigger points (Nijs et al, 2009).

    • Impaired cervical movement control (various studies).

  • Note: Improvements in cervical function do not guarantee enhancement in overall patient health status, which complicates care.

Initiation and Maintenance of WAD

Contributing Factors

  • Various factors linked to WAD include:

    • Sensorimotor disturbances (Treleaven, 2008)

    • Augmented central nociceptive processing (Jull Sterling et al, 2011)

    • Stress system responses and PTSD (Jull Sterling et al, 2011)

    • Psychosocial and sociocultural factors (Jull Sterling et al, 2011)

  • The role of compensation in WAD recovery is debated in literature.

  • Evidence suggests that mild traumatic brain injury may contribute to WAD (Findling et al, 2011; Cassidy et al, 2014; Hartvigsen et al, 2014).

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