<p>WAD betyder whiplash associated disorder och har sin grund i en whiplashskada, som är en svårdiagnostiserad skada på nackpartiet.Whiplashskador har i västvärlden blivit en av de vanligaste skadornatill följd av trafikolyckor. De vanligaste symptomen är smärta i huvudoch nacke samt domningar och stickningar i olika kroppsdelar. Syftet med denna studie var att undersöka huruvida det finns någon skillnad i kognitiva funktioner mellan personer med WAD och personer utan denna skada (n = 20). Detta undersöktes med hjälp av en enkät och ett kognitivt testbatteri. Resultaten tyder på en signifikant gruppeffekt för sekundärminne vid omedelbar fri återgivning, F(1, 19) =4.48, p<.05.De övriga resultaten var inte statistiskt säkerställda men visade klara tendenser till att kontrollgruppen presterade bättre på samtliga kognitiva test.</p>

<p>The aim of this study was to describe how persons with Whiplash associated disorder experience how the pain affects them in their daily life. The design of the study was descriptive with qualitative, individual interviews, questionnaire with background facts of the examination group, and diary notes from persons with pain of WAD. Method for selection was convenience. Through contact with the association of whiplash group in a county in middle of Sweden, the majority of the examination group for the study was found. Five persons where given information about the study, one of them choose not to take part of the study, and one of the persons did not complete the study. One further person was asked to participate in the study and did take part and completed. Four persons choose to take part and completed the study, all women and between the ages 31-60. The result is presented in categories: To live with pain of WAD, Loss of quality of life, Changes in life after injury, Consequences of activity, Relations and isolation, Pain and sleep. The legible emerge that could be seen in the study was that planning the days was necessary to handle the intensity of pain. The pain controlled the days and the social relations to friends and relatives experience deteriorated because the degree of experienced pain controlled the day. All persons in the examine group emphasized that their injury can not be seen, and because that the acceptance for their injury and pain is low from the society.</p>

The aim of this study was to describe how persons with Whiplash associated disorder experience how the pain affects them in their daily life. The design of the study was descriptive with qualitative, individual interviews, questionnaire with background facts of the examination group, and diary notes from persons with pain of WAD. Method for selection was convenience. Through contact with the association of whiplash group in a county in middle of Sweden, the majority of the examination group for the study was found. Five persons where given information about the study, one of them choose not to take part of the study, and one of the persons did not complete the study. One further person was asked to participate in the study and did take part and completed. Four persons choose to take part and completed the study, all women and between the ages 31-60. The result is presented in categories: To live with pain of WAD, Loss of quality of life, Changes in life after injury, Consequences of activity, Relations and isolation, Pain and sleep. The legible emerge that could be seen in the study was that planning the days was necessary to handle the intensity of pain. The pain controlled the days and the social relations to friends and relatives experience deteriorated because the degree of experienced pain controlled the day. All persons in the examine group emphasized that their injury can not be seen, and because that the acceptance for their injury and pain is low from the society.

WAD betyder whiplash associated disorder och har sin grund i en whiplashskada, som är en svårdiagnostiserad skada på nackpartiet.Whiplashskador har i västvärlden blivit en av de vanligaste skadornatill följd av trafikolyckor. De vanligaste symptomen är smärta i huvudoch nacke samt domningar och stickningar i olika kroppsdelar. Syftet med denna studie var att undersöka huruvida det finns någon skillnad i kognitiva funktioner mellan personer med WAD och personer utan denna skada (n = 20). Detta undersöktes med hjälp av en enkät och ett kognitivt testbatteri. Resultaten tyder på en signifikant gruppeffekt för sekundärminne vid omedelbar fri återgivning, F(1, 19) =4.48, p&lt;.05.De övriga resultaten var inte statistiskt säkerställda men visade klara tendenser till att kontrollgruppen presterade bättre på samtliga kognitiva test.

No description available.

Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whiplash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of traumatic and non-traumatic origin and compared the prevalence of, sociodemographic data, self-perceived health, workload and chronic lowback pain in these groups. In a ready-made questionnaire (MONICA study), we added questions about cervical spine and low-back complaints. 6,000 (72%) completed a self-administered questionnaire. 43% reported neck pain: 48% of women and 38% of men. Women of working age had more neck pain than retired women, a phenomenon not seen in men. 19% of the studied population suffered from chronic neck pain and it was more frequent in women. A history of neck trauma was common in those with chronic neck pain. Those with a history of neck trauma perceived their health worse and were more often on sick-leave. About 50% of those with traumatic and non-traumatic chronic neck pain also had chronic low-back pain. We assessed the subjective and objective neuropsychological functioning in 42 patients with chronic neck pain, 21 with a whiplash trauma, and 21 without previous neck trauma. Despite cognitive complaints, the WAD patients had normal neuropsychological functioning, but the WAD group especially had deviant MMPI results—indicating impaired coping ability and somatization.WAD patients had no alterations in cerebral blood-flow pattern, as measured by rCBF-SPECT and SPM analysis, compared to healthy controls. This contrasts with the non-traumatic group with chronic neck pain, which showed marked blood-flow changes. The blood-flow changes in the non-traumatic group were similar to those described earlier in pain patients but— remarkably enough—were different from those in the WAD group. Chronic neck pain of whiplash and non-traumatic origin appears to be unique in some respects. A better understanding of the underlying pathological mechanisms is a prerequisite for prevention of the development of such chronic pain syndromes and for improvement of the treatment of patients with severe symptoms.

Pain from the musculoskeletal system is very common in the modern society. Chronic musculoskeletal pain syndromes causes not only individual suffering but also dysfunctions of movements and postural control, as large costs for the society. In spite of significant efforts, there is a shortage of knowledge on effective prevention, diagnoses and rehabilitation of different chronic musculoskeletal pain syndromes. The general aims of this thesis was to investigate the predictive value of physical, sociodemographic, and psychosocial-behavioural variables for pain reduction after multimodal rehabilitation in patients with chronic low back or neck pain, and to develop and evaluate tests for objective and quantitative evaluation of characteristic sensorimotor disturbances in chronic neck pain. Logistic regression models revealed that unchanged pain intensity could be predicted with good precision while reduced pain intensity after rehabilitation was poorly predicted by the baseline variables. Altered pain intensity in chronic low back pain was predicted by high pain intensity, low levels of pain severity and high affective distress, while reduced pain intensity for patients with chronic neck pain were predicted by high endurance, low age, high pain intensity, low need of being social along with optimistic attitudes on how the pain will interfere with daily life, and few vegetative symptoms. One of the conclusions was that objective measures of specific sensorimotor disturbances should improve the precision by which treatment-induced effects can be assessed and predicted. A study was designed to objectively and quantitatively evaluate a large numbers of different sensorimotor characteristics in a small group of patients with chronic neck pain of different aetiology (whiplash-related and insidious). Kinematic data was recorded during different motor tasks, involving cervical rotations, arm movements and standing. In comparison to a group of asymptomatic control subjects, patients with chronic neck pain was characterised by slower movements, poor balance, reduced cervical stability during perturbations, altered smoothness of movement (jerk index), and reduced movement precision (variable error and variability in range of motion). The sensorimotor variables velocity of arm movements and cervical stability, could correctly classified nearly 90% of the subjects as having chronic neck pain or being asymptomatic. There was a large diversity of sensorimotor disturbances among the individual patients. This was confirmed in a regression model that failed to separate the groups insidious neck pain (sensitivity 44%) and WAD (sensitivity 67%). By investigating associations between the different sensorimotor variables, close relations was found between the repositioning acuity and variability in range of motion, and between standing balance and cervical stability/ standing balance during perturbation. These two groups of variables were only weakly related to each other and to smoothness of movement and movement velocity. The results indicate that chronic neck pain is characterised by specific sensorimotor deficits, and that there are common pathophysiological mechanisms in chronic neck pain of different aetiology. However, the lack of associations between several sensorimotor disturbances indicates that different mechanisms are involved. The thesis indicates that objective sensorimotor tests should be used to improve the quality of functional assessments in chronic neck pain. Methods that objectively and quantitatively measure e.g. movement precision, balance and cervical stability are also needed in order to evaluate current treatment methods and to develop new rehabilitation programs for specific sensorimotor deficits.

By adopting the Policy for Global Development (PGD) in 2003 the Swedish parliament established gender mainstreaming as a goal in development cooperation policy, thereby emphasizing women’s role as agents of empowerment in development. This has not always been the case. During most of the history of Swedish foreign aid women issues have been handled separately and development policy mainly based on a male perspective. A lot of research has focused on trends in the global debate over how to better integrate women in development process, but much less academic attention has focused on how Swedish development policy has addressed the issue and how women have been referred to in development policy since the origin of Swedish foreign aid. According to the theories of critical discourse analysis (CDA) our written and spoken language influence our view of the reality and how we understand society. Following that logic, how women are referred to in Swedish development policy influence how women are perceived by the actors of development cooperation. Through a critical discourse analysis of official Swedish governmental documents concerning foreign aid, such as government bills and letters of appropriation, this study aims to detect discourses of Swedish development policy regarding women in developing countries. Furthermore it aims to understand how these discourses have related to the global debate about women’s role in development. This study observes six discourses of women in developing countries in the material: Women as passive recipient, agent of empowerment, the savior, motherhood-women as mothers, the other woman, and the man as the norm. The analysis shows Sweden’s development policies following the global discussions fairly coherently during much of the period, with 80s as the only possible exception.

The main aim of this project was to encircle the subtype of temporomandibular disorders (TMD) present in patients with chronic whiplash-associated disorders (WAD) and study the debut of TMD symptoms, the provoking factors and the outcome of conservative TMD treatments. The results could add to the aetiological discussion about TMD mainly as being part of chronic WAD pain or not. The subjects were referred patients with chronic WAD at a specialized rehabilitation centre where they were diagnosed using a standardized classification of WAD diagnosing that resulted in approximately 20% WAD grade 2 and 80% WAD grade 3. In Studies I and II, a total 136 individuals with chronic WAD were found to have a significantly higher prevalence of pain associated with TMD compared to a control group of 66 general dental patients. The symptoms debuted approximately six months after the whiplash injury and were most often provoked by stress. In Study III, the effect of a therapeutic jaw exercise (TJE) program on TMD was studied over six months in patients with chronic WAD and TMD, randomized to TJE (25 subjects) or not (30 subjects). TJE had no effect on TMD. In Study IV, patients with chronic WAD and TMD were found to have a mainly myogenous origin of TMD pain. Five months of stabilisation appliance therapy (SAT) equally resulted in an almost complete perceived reduction of jaw pain and frontal headache in patients with chronic WAD and TMD (n=14) and TMD patients without WAD (n=10). In the long-term, TMD was significantly lower in patients with chronic WAD who were treated compared to patients with chronic WAD and TMD who were not treated (n=9). TMD in patients with chronic WAD grades 2 or 3 may be the same kind of musculoskeletal disorder as in TMD patients without WAD, and not primarily part of the WAD pain. A functional TMD examination as well as assessment of perceived stress can be recommended as part of the standardized screening procedure for patients with chronic WAD grades 2 and 3. Patients with symptoms and signs of TMD could be recommended SAT. Patients with symptoms of frontal headache alone should also be considered as candidates for SAT.

Background: Whiplash associated disorders (WAD) account for a large proportion of the overall impairment and disability from traffic injuries and causes substantial bio psychosocial consequences for some individuals. Aims: To increase the knowledge about factors described in terms of either function /impairment, activity/disability and life satisfaction in acute and chronic WAD as well as possible implications for rehabilitation. Within this aim the incidence and recovery rate of whiplash injury and prognostic factors of interest for early rehabilitation have been studied. Subjects and Methods: Fifty-five healthy controls and 34 WAD subjects were analysed within and between groups concerning a) biomechanical out put, endurance, fatigue and muscle tension (EMG activity of trapezius, infraspinatus and deltoideus) during repetitive shoulder forward flexion b) impairments and activity/disability and life satisfaction.356 subjects seeking medical attention due to whiplash trauma, 296 were available at follow up, mean 16 months post injury. Incidence and odds ratio of accident and other background factors on disability were determined. Thirty-four out of 43 patients with whiplash injury were investigated through quantitative sensory tests at six weeks and 71 months after injury. 62 WAD participated in an interdisciplinary rehabilitation program (a pilot study) designed to evaluate such rehabilitation program for patients with chronic (in relatively early stage) WAD. Program evaluation of impairment, disability and life satisfaction (prospective and retrospective) was carried out before and after program and at 6 months. Results: No significant effects of sex or age on the ability to relax between repetitive r muscle contractions (SAR) were found in healthy subjects (study I). Significantly higher inability to relax between contractions was found for the two portions of trapezius and infraspinatus in the WAD group compared to the healthy group (study II). Significantly lower levels of activity preferences were noted for three out of five indices in females with WAD The WAD group had significantly higher prevalence of neropsychological and emotional symptoms. Both pain related symptoms and neropsychological symptoms were of significant importance for aspects of disability and life satisfaction in this group (study IV). Sensory disturbances over the trigeminal skin area persisted over the years. At follow-up a significant correlation was found between the sensory disturbances and the symptoms related to the central nervous system while no significant relationship was found with the musculoskeletal symptoms (study HI) .The annual incidence according to the grading of the Quebec Task Force on Whiplash-Associated Disorders (WAD 1-3) was 3.2/1000 and 4.2/1000 when WAD 0 was included. Sixty-eight percent of the patients recovered during the follow-up Pre-traumatic neck pain, low educational level, female gender and WAD grade E-Ill were significantly associated with a poor prognosis (study IV). . Participants in the rehabilitation program reported increased coping ability. Stress reactions seemed rather frequent (32 %). Pain intensity in the neck and upper back were significantly decreased at 6 months follow-up. However, for most of the functional and psychological markers, no significant changes were found (study V). Conclusion: The higher prevalence of musculoskeletal complaints of the neck shoulder region in females cannot be explained by higher muscle tension and clinical assumption of increased muscle tension seems correct in whiplash patients Results indicate heterogeneity among WAD subjects. Females are at risk after a whiplash trauma but the severity of initial symptoms and signs also affect outcome as well as low education. High levels of neuropsychological symptoms and pain, signs of posttraumatic stress, fear and avoidance, loss of control, anxiety, bio-mechanical and psychosocial factors at work (studies) and social support are potential factors to be aware of. Extensive and costly investigations are in most cases not necessary. However most persons will recover a whiplash injury. Multidisciplinary/interdisciplinary assessment should be considered at three months if substantial negative effect on the person’s ability to function and health situation exists. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 2001, härtill 6 uppsatser.</p> / digitalisering@umu