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Summary of November 2017 Topic: Whiplash Associated Disorder (WAD)

The November Topic was Whiplash Associated Disorder (WAD). The five articles ranged in focus including oculomotor control, cervical spine proprioception, dizziness, and balance. Common to all of the articles was that the subjects had a whiplash injury.

One systematic review examined oculomotor control after whiplash injury. Overall the results varied but a main finding was that compensatory eye movements were common, especially in smooth pursuits. Based on this finding, it was proposed that this could negatively affect head and eye coordination. (1)

Four articles looked at the efficacy of physical therapy on reducing symptoms from WAD. The first suggested that neck exercises including a behavioral approach could reduce pain, dizziness and improve balance compared to just performing neck exercises. However, this intervention did not resolve these impairments fully. The authors suggested that the effect of specific exercises for the neck, dizziness and balance should be studied. (2)

An article examined the effect of vestibular physical therapy on neck pain and cervical spine range of motion. Vestibular therapy did not decrease pain intensity nor improve range of motion but it clearly did not worsen either of these. (4) Another article examined the potential benefits of vestibular physical therapy on balance and self-perceived dizziness and balance handicap, using the Dizziness Handicap Inventory. Both of these measures improved after six weeks of vestibular PT. (5)

Finally, an article summarized that known mechanisms for dizziness, imbalance, impaired oculomotor control, cervical spine proprioception exist due to cervical afferent dysfunction following a whiplash injury. This article recommended the examination and targeted treatment of these impairments. (3)

Overall, these articles verify the association between dizziness, imbalance and visual disturbances following a whiplash injury and suggest that targeted assessment and treatment of these impairments is important in the rehabilitation of these patients.

1) Ischebeck BK, de Vries J, Van der Geest JN, Janssen M, Van Wingerden JP, Kleinrensink GJ, Frens MA. Eye movements in patients with Whiplash Associated Disorders: a systematic review. Man Ther. 2016 Apr;22:122-30. doi: 10.1016/j.math.2015.10.017.

2) Treleaven J, Peterson G, Ludvigsson ML, Kammerlind AS, Peolsson A. J Orthop Sports Phys Ther. Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs. 2017 Jul;47(7):492-502. doi: 10.2519/jospt.2017.7052.

3) 3) Treleaven J. Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain. J Orthop Sports Phys Ther 2017;47(7):492-502. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7052

4) Hansson EE, Persson L, Malmström EM. Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: a randomized controlled trial. J Rehabil Med. 2013 Sep;45(9):906-10. doi: 10.2340/16501977-1197.

5) 5) Ekvall Hansson E, Månsson NO, Ringsberg KA, Håkansson A. Dizziness among patients with whiplash-associated disorder: a randomized controlled trial. J Rehabil Med. 2006 Nov;38(6):387-90.

 

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