Soft tissue cervical spine (neck) injuries, known as ‘whiplash’, are a leading cause of injury in motor vehicle collisions. A detailed finite element (FE) model of the cervical spine that is able to predict local tissue injury is a vital tool to improve safety systems in cars, through understanding of injury mechanisms at the tissue level and evaluation of new safety systems. This is the motivation for the formation of the Global Human Body Models Consortium, which is a collective of major automotive manufacturers with the goal of producing a detailed FE human body model to predict occupant response in crash. This work builds on an existing detailed cervical spine model, with a focus on improved validation in terms of kinematics and tissue level response. The neck model used in this research represents a 50th percentile male and was developed at the University of Waterloo. The model includes both passive and active musculature, detailed nucleus and annulus models of the discs, rate dependent non-linear ligaments, facet capsules with a squeeze film model of the synovial fluid, and rigid vertebrae with the geometry derived from CT scans. The material properties were determined from published experimental testing and were not calibrated to improve the model response. The model was previously validated at the segment level. In this study, the model was validated for tension loading, local tissue response during both frontal and rear impacts, and head kinematic response during frontal and rear impact. The whole neck model without musculature was exposed to a tensile load up to 300N and the predicted response was within the experimental corridors throughout. The ligament strains and disc shear strains predicted by the model were compared to bench-top cadaver tests. In frontal impact, the ligament and disc strains were within a standard deviation of the experiments 26/30 and 12/15 times respectively. In rear impact, the strains were within a standard deviation of the experiments 9/10 and 12/15 times for the ligaments and discs respectively. All of the ligament strains were within two standard deviation of the experimental average and the disc strains were all within three standard deviations. The global kinematic response of the head for 4g and 7g rear impacts and 7g and 15g frontal impacts was generally a good fit to the experimental corridors. These impact loads are relevant to the low speed impacts that generally cause whiplash. In the global kinematic validation, the model was shown to oscillate more, which is likely due to the lack of soft-tissues such as the skin and fat or the lack of high-rate material data for the intervertebral discs. In rear impact, the head over extended by 17° and 6° for 4g and 7g impacts respectively; this is likely due to difficulties defining the facet gap or lack of uncovertebral joints. Even with these limitations the model response for these varied modes of loading was considered excellent. A review of organic causes of whiplash revealed the most likely sources of whiplash include the capsular ligament, other ligaments, and the vertebral discs. The model was exposed to frontal and rear impacts with increasing severities until the soft tissue strains reached damage thresholds. In frontal impact, these strains started to reach damage values at a 15g impact. The disc annulus fibres were likely injured at 10g in a rear impact, and the ligaments were likely injured at 14g in a rear impact. These impact severities agree with findings from real-life accidents where long term consequences were found in rear impacts from 9g to 15g. The model was used to show that bench-top cadaver impacts under predict strain because they lack active musculature. A number of recommendations have been proposed to improve the biofidelity of the model including perform in-vivo measurement of human facet gaps, incorporate the uncovertebral joints, measure rate-dependent properties for the annulus fibrosus of the disc, include non-structural soft tissues for increased damping, determine a muscle activation strategy that can maintain head posture in a gravity field, and continue to develop relationships between prolonged painful injury and strain in structures of the neck other than the capsular ligaments. Furthermore, it was recommended that the model should be developed further for whiplash injury prediction with out of position occupants.

The diagnosis of a whiplash injury is a very subjective process. A claim of this type of injury is usually made on the basis of pain, which may or may not be accompanied by clinical signs of trauma. This study was aimed at providing a more objective, quantitative approach to identifying the potential for whiplash injury in a directfront-or-rear-end automobile collision. The Whiplash Injury Severity Estimator (WISE Index) was created using data obtained from Dr. Schneck's personal library of case files, including the collisionacceleration of the vehicle, and the height, weight, and sex of the occupant. Some extrapolated data was also used representing the low and high ranges of height, weight, and collision acceleration to increase the range of the WISE Index. Data was analyzed by the Dynaman computer program in conjunction with the Articulated Total Body Model, to calculate the response of the body to external forces and impacts. The dynamic response of the occupant, combined with preexisting medical statistics provided the information necessary to perform a regression analysis in MINITAB and thus construct the WISE Indices shown below. Male WISE Index (R&#178 = 0.993) &#163 = 0.2643 &#177 0.4071 |(accel,g)| -0.01428(PI) <1.1g<=accel<=5g; 22.4<=PI<=25.0 Female WISE Index (R&#178 = 0.978) &#163 = 0.6214 &#177 0.3429 |(accel,g)| -0.02929(PI) 0.8g<=accel<=5g 22.3<=PI<=31.0 Acceleration: Use the negative sign if it is a rear-end collision and the positive sign if it is a head-on collision. &#163 : A negative value means that potential injury results from backward head rotation, as in a rear-end collision. A positive value means that potential injury results from forward head rotation, as in a head-on collision. |&#163 | < 1 = &#34 Safe &#34 |&#163 | > 1 = &#34 Dangerous &#34 The WISE Index allows one to predict the potential for a whiplash injury, as well as the intensity of the injury, based solely on collision acceleration, height, weight, and sex of the occupant. It is anticipated that this work and future efforts in this area will provide the information base necessary for anyone to effectively evaluate the validity of an alleged whiplash injury. / Master of Science

Title: Whiplash syndrome-evaluation of the therapy effect through various physiotherapeutic approaches Objectives: The aim of this diploma thesis is to find out which treatment method is the best suited for the reduction of the convalescence period in an acute whiplash syndrome and how the treatment can the most effectively affect chronic whiplash syndrome. This thesis also summarizes the most recent knowledge regarding this issue. Methods: The diploma thesis is processed in the form of a literary review, it has an analytic descriptive character. The thesis is divided into two parts, the first part deals with the theoretical point of view and the second part deals with the thesis methodology together with results. The theoretical part is dedicated to the problematic itself and physiotherapeutic methods used in the treatment of whiplash syndrome in the form of passive and active approaches. The second part describes a criteria methodology for studies which are included in the thesis. Conclusions of the studies are discussed together with their effects. Results: A total of 23 studies have been selected for this thesis. The recommended threatment for the acute whiplash syndrome is a form of the active approach. From the physiotherapeutical methods perspective - The McKenzie Method and therapeutic...

ABSTRACT: Whiplash-associated disorders are a common occurrence. Physiotherapy rehabilitation of such disorders include, among others, improving the recruitment ability of the deep cervical flexor muscles. Cervical proprioception, which has recently gained attention, is not commonly addressed. Evidence points to a possible link between cervical proprioception and deep cervical flexor recruitment ability. This study aimed to determine whether such a correlation exists. This is significant as it highlights the role that recruitment training of the deep cervical flexors has on cervical proprioception. A correlation study design was employed that involved 29 patients with whiplashassociated disorders. They were tested in their ability to perform the cranio-cervical flexion test and Revel’s test for proprioception. Linear regression was employed to interpret the results. This study concluded that a correlation exists between the ability to perform the craniocervical- flexion test and cervical proprioception.

<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>

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.

The purpose of this study is to quantify the dynamic mechanical properties of human cervical ligaments following whiplash. Cervical ligaments function to provide spinal stability, propioception, and protection during traumatic events to the spine. The function of cervical ligaments is largely dependant on their dynamic biomechanical properties, which include force and energy resistance, elongation capability, and stiffness. Whiplash has been shown to injure human cervical spine ligaments, and ligamental injury has been shown to alter their dynamic properties, with potential clinical consequences such as joint degeneration and pain. In this study we quantified the dynamic properties of human lower cervical ligaments following whiplash and compared their properties to those of intact ligaments. Whiplash simulation was performed using biofidelic whole cervical spine with muscle force replication (WCS-MFR) models. Next, ligaments were elongated to failure at a fast elongation rate and peak force, peak elongation, peak energy, and stiffness values were calculated from non-linear force-elongation curves. Peak force was highest in the ligamentum flavum (LF) and lowest in the intraspinous and supraspinous ligaments (ISL+SSL). Elongation was smallest in middle-third disc (MTD) and greatest in ISL+SSL. Highest peak energy was found in capsular ligament (CL) and lowest in MTD. LF was the stiffest ligament and ISL+SSL least stiff. These findings were similar to those found in intact ligaments. When directly comparing ligaments following whiplash to intact ligaments in a prior study it was found that the anterior longitudinal ligament (ALL) and CL had altered dynamic properties that were statistically significant, suggesting that whiplash may alter the dynamic properties of cervical ligaments. These findings may contribute to the understanding of whiplash injuries and the development of mathematical models simulating spinal injury.

Whiplash-related injuries and manifestations, typically neck pain, following car collisions are known to potentially disable individuals with a high and increasing cost to society. There is limited knowledge regarding the temporomandibular joint (TMJ) sequelae following whiplash trauma. Previous studies are typically based on retrospective data and few follow-ups are prospective and controlled in design. Furthermore, previous follow-ups have not included magnetic resonance (MR) imaging, which is a prerequisite for verification of TMJ status. The aims of this prospective long-term study were (i) to determine frequency of inaccurate recall of TMJ symptoms in patients with a history of whiplash trauma, and (ii) to evaluate incidence, prevalence and progression of TMJ pathology, verified with MR imaging, and TMJ symptoms in patients after whiplash trauma, compared with the natural course in matched volunteers. We studied 60 consecutive patients who had neck symptoms following a rear-end car collision and were seen at a hospital emergency department. Bilateral TMJ MR imaging and clinical examination were performed at inception and at follow-up on average 15 years later. A self-administered questionnaire regarding TMJ symptoms (pain, dysfunction, or both) and a subsequent interview were performed at inception, at the one-year, and 15-year follow-up. Fifty-seven patients (95%) participated in all three examinations (85% for MR imaging examinations). Concurrently, 53 volunteers matched by age and sex followed the same protocol. Fifty volunteers (94%) participated in all three examinations (89% for MR imaging examinations). Ethics approval of the study protocol and informed consent from all participants was obtained. The calculated agreement between each patient’s inceptive and retrospective reports on TMJ symptoms yielded a kappa value of 0.41 (95% CI 0.18-0.64). Sixteen patients (40%) had inaccurate recall one year after whiplash trauma. There was no statistically significant difference in TMJ symptoms reported by the patients to be present before whiplash trauma compared with matched volunteers at inception. Prevalence of TMJ symptoms increased significantly with whiplash trauma and the increase remained stable throughout the 15-year study period, which contrasted to the natural course in volunteers. After one year the difference in prevalence between patients and volunteers was 54% versus 21% (p=0.0003) and after 15 years 49% versus 18% (p=0.0017). There was no statistically significant difference between patients and volunteers in prevalence of TMJ disc displacement either at inception (63% versus 53%) or at 15-year follow-up (63% versus 55%). TMJ disc displacement was significantly more prevalent in symptomatic volunteers compared with asymptomatic volunteers (89% versus 31%, p=0.0002). Incidence or progression of MR imaging verified TMJ pathology did not differ between patients and volunteers. This prospective 15-year follow-up concludes - that future studies on TMJ sequelae following whiplash trauma should be prospective in study design with examinations conducted in close proximity to whiplash trauma. This allows for reliable baseline status and potential bias of inaccurate recall of symptoms is minimized. - that future controlled studies on TMJ pathology in patients should include control groups of not only asymptomatic but also symptomatic volunteers in order to avoid potentially biased conclusions. - that one of three patients exposed to whiplash trauma can be expected to develop TMJ symptoms beyond that which corresponds to the natural course in volunteers. This finding and previously reported impairment of jaw function in patients with symptoms after whiplash trauma points to the need for including TMJs and related muscles in routine medical examinations of patients with symptoms following whiplash trauma. - that adult individuals presenting with no or mild TMJ symptoms seldom show development or aggravation of TMJ pathology and there is no or little indication for TMJ treatment of these adult individuals. This is in contrast to the higher progression of TMJ pathology previously reported for adult patients with TMJ symptoms, which requires treatment.

Proefschrift Maastricht. / Lit. opg. - Met samenvatting in het Nederlands.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 5 uppsatser.