Whiplash is a bodily injury, where the person that is injured is subjected to force towards the neck, mainly in traffic accidents. Even low speed accidents can cause severe damage due to the complicated muscle and nerve structure of the neck. Symptoms range from neck aches and headaches to numb fingers and this makes the Whiplash injury difficult to diagnose. Whiplash is also a treacherous injury due to the fact that the symptoms can not be objectively verified. The principal symptom of the injury is pain, which is to its nature highly subjective. One problem that is fairly unique for Whiplash is that it can take several years for the injury to expose itself. The starting point for the essay is to examine what kind of problems that might, given the unique character of Whiplash, present themselves to the victim of Whiplash. The problem of verifying the symptoms objectively, and the fact that more than 90% of the people subjected to this kind of injury manage to recover, means that the remaining 10% are viewed sceptically by the insurance companies. These persons often claim that the injury of Whiplash is due to a different, competing incident. The right to compensation, in case of an accident, is a fundamental pillar of the Swedish welfare society. Few people would object to this, but the general perception is also that compensation should not be paid to anyone that has not been subjected to an injury. However, this pose a problem to the Whiplash victim, where a significant amount of time often passes before the pain caused by the injury reveals itself. The requirements placed by the courts on the burden of proof, and whom is responsible for obtaining this evidence, are questions that naturally arises in Whiplash related dis-putes. The verdict of the courts is often based on the medical evaluation provided by the arguing parties. Unfortunately the opinions of the various doctors involved are often contradictory. A consequence caused by the fact that a long time may pass before the Whiplash related pains reveal themselves is that the statute of limitation may have expired before the injured person has a possibility to pursue a claim of compensation in court. The 31 § (ex 28 §) of the Swedish traffic regulation is not very clear on this issue and only states that the statute of limitations relating to traffic accidents are three and ten years respectively. The start of the limitation period occurs when the person wishing to file a claim has sufficient knowledge to do so. What is meant by sufficient knowledge is not further specified in paragraph 31 TSL; this has been left in the hands of the court to decide. Until recently the verdicts of the court have often been in favour of the in-surance companies. This in the sense that the statute of limitation was considered to start at the time of the accident; a point in time that could easily be objectively verified. This had the unfortunate consequence of often leaving Whiplash victims in a position where they would be facing a fait accompli, i.e. of having their claims rejected due to the statute of limitation. One could say that a conflict existed between the injured person’s need for compensation and the insurance companies’ need of settling insurance claims in a quick an orderly fashion. However, in recent years the Swedish Supreme Court has made several rulings to specify what is meant by “sufficient knowledge”. Unfortunately these problems show no signs of becoming less relevant, with the amount of accidents resulting in Whiplash injuries estimated to amount to more than half of the 60 000 cases of personal injuries reported to the Swedish insurance compa-nies in 2003.

The aims of the present thesis were to evaluate the management of acute WAD and to develop, describe and evaluate a cognitive behavioural approach for the physiotherapy management of long-term WAD as well as to study the predictors and mediating factors for long-term disability and pain after a whiplash injury. Two approaches for acute and chronic WAD were evaluated in experimental studies. Fifty-nine patients with acute whiplash injury (study I) and 33 patients with chronic WAD (study V), were randomised into experimental and control groups. In addition, three chronic WAD patients participated in an experimental single case study (study IV). Home exercise programmes for patients with acute WAD were used in study I. In study IV a physiotherapy management with integrated components of cognitive-behavioural origin was tried for chronic WAD patients. In study V physiotherapy treatment in primary care units and a physiotherapy management with integrated components of cognitive-behavioural origin was tried for chronic WAD patients. Study I showed that a home exercise programme including training of neck and shoulder range of motion (ROM), relaxation and general advice, appears to be a sufficient treatment for most acute WAD patients. Further, the results of study IV and V suggest that cognitive behavioural components m be useful in physiotherapy treatment for patients with chronic WAD, but its contribution is not yet fully understood. Study III showed that the significance of coping as an explanatory factor for disability increased during the one-year period after a whiplash injury. In study V it was concluded that self-efficacy is related to patients' use of different coping styles. A model to study coping as a mediator between self-efficacy and disability was therefore introduced. In a path-analytic framework, data from subjects in study I were re-analysed to illustrate a theoretical standpoint that emphasises the process of coping. With regard to disability, the proportion of explained variance increased from 39% at three weeks after the accident, to 79% at one-year follow-up. These results also show that coping has a crucial and mediating role between self-efficacy and disability. Positive long- term outcomes in WAD-patients would therefore be improved by, shortly after an accident, boosting self- efficacy and teaching patients to use active, adaptive coping strategies to manage their problems.

Syftet med denna examensrapport är att ta fram ett eftermonterbart whiplashskydd till BMW 5-serie. Detta eftersom att denna modell, jämfört med modeller i samma prisklass, har fått mycket dåliga resultat i två oberoende whiplashtest. Projektet resulterade i ett skydd som enkelt och tryggt kan monteras på nackstöden i bilen. Skyddet reducerar risken för en whiplashskada genom att minska det kritiska avståndet mellan huvud och nackstöd. Konstruktionen av skyddet är okomplicerad men designad så att den inte kan röra sig ur läge vid en kollision. För att nå fram till detta resultat har en designmetodik använts som är lämpad för just detta ändamål. Designmetodiken innefattar olika processer så som brainstorming och evalueringsmatris. Resultatet i denna rapport är endast ett koncept, så vidare utveckling krävs för att nå fram till en färdig produkt. / The objective of this master thesis is to develop a post-mountable whiplash protection device for the BMW 5 Series. The reason for this is that the model has, in comparison to other models in the same price range, performed porely in two independent whiplash tests. The outcome of the project is a protection device that can be mounted in an easy and safe way on the headrests in the car. The protection device will reduce the risk of a whiplash injury by decreasing the critical distance between the head and the headrest. The protection device's design is simple, but engineered to prevent the device from moving out of position in case of a collision. In order to reach the result, a design method suitable for this kind of work has been used. The design method involves different processes like brainstorming and the use of an evaluation matrix. The result of the thesis is only conceptual, and further development is necessary to reach a final product.

<p>Whiplash is a bodily injury, where the person that is injured is subjected to force towards the neck, mainly in traffic accidents. Even low speed accidents can cause severe damage due to the complicated muscle and nerve structure of the neck. Symptoms range from neck aches and headaches to numb fingers and this makes the Whiplash injury difficult to diagnose. Whiplash is also a treacherous injury due to the fact that the symptoms can not be objectively verified. The principal symptom of the injury is pain, which is to its nature highly subjective. One problem that is fairly unique for Whiplash is that it can take several years for the injury to expose itself.</p><p>The starting point for the essay is to examine what kind of problems that might, given the unique character of Whiplash, present themselves to the victim of Whiplash. The problem of verifying the symptoms objectively, and the fact that more than 90% of the people subjected to this kind of injury manage to recover, means that the remaining 10% are viewed sceptically by the insurance companies. These persons often claim that the injury of Whiplash is due to a different, competing incident. The right to compensation, in case of an accident, is a fundamental pillar of the Swedish welfare society. Few people would object to this, but the general perception is also that compensation should not be paid to anyone that has not been subjected to an injury. However, this pose a problem to the Whiplash victim, where a significant amount of time often passes before the pain caused by the injury reveals itself. The requirements placed by the courts on the burden of proof, and whom is responsible for obtaining this evidence, are questions that naturally arises in Whiplash related dis-putes. The verdict of the courts is often based on the medical evaluation provided by the arguing parties. Unfortunately the opinions of the various doctors involved are often contradictory.</p><p>A consequence caused by the fact that a long time may pass before the Whiplash related pains reveal themselves is that the statute of limitation may have expired before the injured person has a possibility to pursue a claim of compensation in court. The 31 § (ex 28 §) of the Swedish traffic regulation is not very clear on this issue and only states that the statute of limitations relating to traffic accidents are three and ten years respectively. The start of the limitation period occurs when the person wishing to file a claim has sufficient knowledge to do so. What is meant by sufficient knowledge is not further specified in paragraph 31 TSL; this has been left in the hands of the court to decide. Until recently the verdicts of the court have often been in favour of the in-surance companies. This in the sense that the statute of limitation was considered to start at the time of the accident; a point in time that could easily be objectively verified. This had the unfortunate consequence of often leaving Whiplash victims in a position where they would be facing a fait accompli, i.e. of having their claims rejected due to the statute of limitation. One could say that a conflict existed between the injured person’s need for compensation and the insurance companies’ need of settling insurance claims in a quick an orderly fashion. However, in recent years the Swedish Supreme Court has made several rulings to specify what is meant by “sufficient knowledge”.</p><p>Unfortunately these problems show no signs of becoming less relevant, with the amount of accidents resulting in Whiplash injuries estimated to amount to more than half of the 60 000 cases of personal injuries reported to the Swedish insurance compa-nies in 2003.</p>

A biomechanical study of intervertebral foraminal narrowing during simulated automotive head-forward and head-turned rear impacts. The objective of this study was to quantify foraminal width, height and area narrowing during head-forward and head-turned rear impacts, and evaluate the potential for nerve root and ganglion impingement. Muscle weakness and paresthesias, documented in whiplash patients, have been associated with neural compression within the cervical intervertebral foramen. Rotated head posture at the time of rear impact has been correlated with increased frequency and severity of chronic radicular symptoms, as compared to facing forward. No studies have quantified dynamic changes in foramen dimensions during head-forward or head-turned rear impacts. Six whole cervical spine specimens with muscle force replication and surrogate head underwent simulated whiplash at 3.5, 5, 6.5 and 8 g, following non-injurious baseline 2 g acceleration. Continuous dynamic foraminal width, height and area narrowing were recorded, and the peaks were determined during each impact and statistically compared to baseline narrowing. During head-forward rear impacts, significant increases (P<0.05) in average peak foraminal width narrowing above baseline were observed at C5-C6 beginning with 3.5 g impact. No significant increases in average peak foraminal height narrowing were observed, while average peak foraminal areas were significantly narrower than baseline at C4-C5 at 3.5, 5 and 6.5 g. During head-turned rear impacts, significant increases (P<0.05) in average peak foraminal width narrowing above baseline of up to 1.8 mm in the left C5-C6 foramen at 8 g were observed. Average peak dynamic foraminal height was significantly narrower than baseline at right C2-C3 foramen at 5 g and 6.5 g, while no significant increases in foraminal area were observed. Extrapolation of the present head-forward rear impact results indicated that the greatest potential for ganglia compression injury was at the lower cervical spine, C5-C6 and C6-C7. The present head-turned rear impact results indicated that the greatest potential ganglia compression injury exists at C5-C6 and C6-C7. Greater potential for ganglia compression injury exists at C3-C4 and C4-C5 due to head-turned rear impact, as compared to head-forward rear impact. Acute ganglia compression may produce a sensitized neural response to repeat compression leading to chronic radiculopathy following head-forward and head-turned rear impacts. Dynamic ganglion or nerve root compression may also lead to chronic radiculopathy.

Recorded on July 27, 2007 by Eugene Barsky, Physiotherapy Outreach Librarian, UBC / N/A

No description available.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 6 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 134-139).