Chronic Whiplash Syndrome: Associated Disorders and Physiotherapy Management – A Literature Review

Purpose: The purpose of the current literature review is to present the Whiplash Associated-Disorders through diagnosis, scales, physical examination and to identify the most suitable physiotherapy management of these conditions. The long-term effectiveness of physiotherapy interventions is also examined. Methods: Sixteen randomized controlled trials (RCTs) and seven case-control and cohort studies related to chronic WAD fulfilled the inclusion and exclusion criteria. The design, diagnosis, population, methodology, results, methodological quality and physiotherapy management were examined. The PEDro Scale and the Newcastle-Ottawa Scale were used for the examination of the methodological quality. Results: The methodological quality of the studies used, were high. Significantly important on minimizing the symptoms of chronic WAD were the combination of Exercise therapy & Advice both at 6 and 12 months follow up. Other interventions such as Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not equally effective in the long-term. Conclusion: The most suitable intervention for the physiotherapy management of chronic WAD, with long-term effectiveness was the combination of Exercise & Advice, which was established with various outcome measures, such as NDI, VAS, NRI and SF-36. On the contrary, Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not that effective on minimizing the symptoms of chronic WAD in the long-term.

Novel treatment with percutaneus electrolysis in cervical whiplash syndrome

Introduction and Aims Cervical whiplash syndrome (CWS) commonly occurs because of the rear impact of motor vehicle collisions, producing a forced passive extension of the neck, followed by a rapid flexion in the form of a whip. This violent flexion can lead to an enthesopathy of the levator scapulae muscle (LS). The aim of this study was to evaluate the effectiveness of the percutaneous needle electrolysis (PNE) technique on the enthesopathy of the LS after a CWS and to compare this with a conventional physical therapy protocol. Material and Methods In a physical therapy center specialized in traffic accidents, we arranged to interview a sample of 100 voluntary patients, providing subjects with the inclusion-exclusion criteria and an informed consent form. Participants recruited to the study had their pain quantified using the visual analog scale (VAS) for pain, the validated neck pain questionnaire (NPQ), and an algometer. Two groups were created. One received the PNE technique and the other received the conventional physiotherapy protocol. Once treatments were completed, pain was quantified once again and the results were obtained. Results The most important findings are highlighted, regarding the comparison of variables of pain quantification in both groups and regarding the cost per treatment session. Conclusions 1. The conventional physiotherapy protocol used is effective for the reduction of pain in the SLC in the enthesopathy of the LS.2. Treatment with the PNE technique is effective for the reduction of pain in the CWS for LS enthesopathy.3. Physiotherapy treatment which includes the PNE technique is more effective in the algometry variable than treatment performed with conventional physiotherapy techniques by 16.8%.3. The PNE technique is superior to the protocol of conventional physiotherapy in the cost/effectiveness relationship by 85%.4. The PNE technique, without combining the same with any other physiotherapy technique, is effective for the reduction of pain in cases of enthesopathy.

Whiplash Syndrome

Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms. Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.

Impedance Adaptive Controller for a Prototype of a Whiplash Syndrome Rehabilitation Device

The objective of this study was to design of an output based impedance adaptive controller for a special class of cervical orthoses, a class of biomedical devices for the rehabilitation of neck illnesses. The controller used the adaptive sliding mode theory to enforce the tracking of the reference trajectory if the patient was not resistant to the therapy. If the patient rejects the orthosis activity, a second impedance-based controller governs the orthosis movement allowing the patient to take the leading role in the orthosis sequence of movements. The proposed controller considers a weighted controller combining the tracking and the impedance controls in a single structure. The monitoring of the external force was evaluated on a novel weighting function defining on-line the role of each controller. The proposed orthosis was motivated by the prevalence of whiplash, which is a syndrome that is produced by forced hyperextension and hyperflexion of the neck. This study included the development of a technological prototype of the orthotic type to support the recovery of patients diagnosed with whiplash. The sections that make up the orthotic device are two independent systems that move the patient’s head in the sagittal and frontal planes. For this purpose, the mechanical structure of the cervical orthosis was made up of 7 pieces printed in 3D with polylactic acid (PLA). The operation of the cervical orthosis was evaluated in two sections: (a) using a simulation system, which consists of a spring with an artificial head and the development of a graphic interface in Matlab, and (b) evaluating the controller on the proposed orthosis. With these elements, the follow-up of the trajectory proposed by the actuators was evaluated, as well as its performance in the face of the opposition that a patient generates. The superiority of the proposed controller was confirmed by comparing the tracking efficiency with proportional-integral-derivative and first-order sliding variants.