Whiplash är en skada som uppstår efter ett nacktrauma och besvär som uppstår pga denna skada benämns whiplashrelaterade besvär (WAD). Alla som råkar ut för ett nacktrauma får inte bestående men, men för de 10% där besvären kvarstår påverkas livsituationen avsevärt. Skadan går inte att påvisa med den medicintekniska apparatur som finns idag. De kroniska besvären är många och omfattande, ofta diffusa och kan inte alltid logiskt kopplas till nacktraumat. Patienten känner att skadan ideligen måste ”bevisas” eftersom den inte syns. Läkarvetenskapen står dessutom oenig om vad whiplash verkligen är, och om hur tillståndet ska behandlas. Den som lider av WAD söker ofta vård och vårdpersonal tycks ha bristande kunskaper om, och förståelse för, whiplashproblematiken och detta leder till ett ökat lidande för den drabbade. För att kunna förstå och stödja dessa patienter på ett optimalt sätt är det nödvändigt att skaffa sig kunskaper om hur den som lider av whiplashrelaterade besvär upplever sin livssituation och det är syftet med detta arbete. Metoden som använts är en litteraturbaserad studie av biografier. Elva berättelser om hur det är att leva med whiplashrelaterade besvär ingick i analysen. Sex teman framkom efter att de meningsbärande enheterna satts samman utifrån innebörd, skillnader och likheter. Känsla av otrygghet och ovisshet, känsla av att inte bli trodd och inte bli förstådd, känsla av sorg och saknad, behov av stöd och uppmuntran, känsla av att inte ha kontroll, och acceptans och känsla av att kunna gå vidare, var de teman som sammanfattade de upplevelser de elva whiplashskadade berättade om i sina biografier. Diskussionen tar upp betydelsen av att sjuksköterskan har en förståelse för patientens situation. En djupare diskussion förs runt temat ”känsla av att inte bli trodd och inte bli förstådd” eftersom det temat är centralt och interagerar med de andra kategorierna. / Program: Fristående kurs

Introduction: Little is known about the effect of beliefs on whiplash-associated disorders. Objective: To assess population beliefs regarding whiplash injury, to assess expectation as a predictor of recovery; to explore symptom attribution (Study III); and, assess the relationship between the Whiplash Disability Questionnaire (WDQ) and self-assessed recovery. Materials and Methods: Canadian residents were surveyed about whiplash injury; a whiplash cohort was assessed for association between expectations of recovery and recovery; whiplash patients were examined to correlate auditory symptoms and cerumen occlusion; and, Whiplash patients were asked a global recovery question and results compared to the whiplash Disability Questionnaire (WDQ). Results: Beliefs about whiplash injury were more negative. Expectations of recovery from injury increases the recovery rate. Cerumen explains auditory symptoms in whiplash patients. Patients responding yes to the recovery question had a low WDQ score. Conclusions: Population beliefs, expectations of recovery and symptom attribution are important in whiplash-associated disorders. / Experimental Medicine

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.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / Whiplash injuries are thought to occur in as many as one-fifth of all MVA’s in the United States and Canada. South Africa may have a higher incidence of whiplash injuries due to the exceptionally high road accident rate when compared with international norms (Burger 1996:478). The incidence rate is higher among female subjects and people aged 20-24 years (Teasell and Shapiro 1998: 72, Spitzer et al. 1995). Whiplash injuries or whiplash-associated disorders (WAD) often result in chronic pain with a poor response to conventional therapeutics. Manipulation, exercise and anti-inflammatories have been identified as the options with scientifically established validity in the management of WAD (Spitzer et al. 1995) Patients with WAD have a distortion of the posture control system as a result of disorganised neck proprioceptive activity. It would therefore appear that proprioceptive rehabilitative exercises would benefit WAD sufferers (Revel et al. 1994, Gimse et al. 1996). Spinal manipulation has also been shown to have a significant effect on proprioceptive-dependent abilities in subjects with chronic neck pain (Rogers 1997). This suggests that a combination of manipulation and proprioceptive rehabilitation may offer an improved treatment protocol for WAD (Fitz-Ritson 1995). The purpose of this investigation is to evaluate the relative effectiveness of proprioceptive exercises and cervical spine manipulation compared to manipulation alone, in terms of subjective and objective measures, in the treatment of whiplash-associated disorders. / M

The syndrome commonly referred to as whiplash injury" resulting from motor vehicle accidents is complex and remains a challenge to clinicians, as is evidenced by the recent report of the Quebec task force on the "whiplash syndrome". The main objective of this prospective randomised study was to evaluate two conservative treatment regimens (early immobilisation-experimental group-1, early active mobilisation experimental group-2) which are based on accepted physiological rationale and then to compare their effectiveness with existing treatment regimens that are commonly practiced (control group) in the management of "whiplash" type of injuries. To this stage, the current study is the only prospective randomised clinical trial of its type conducted with a sufficiently large sample size and over a long study period. The results of the current study clearly demonstrated that the subjects in the immobilised group recovered from their pain-related symptoms and returned to their normal duties sooner than those in the other two treatment groups. In addition to this, those subjects who received the immobilisation regimen did not show adverse effects on either the range of motion or the strength of the neck muscles. Thus, the immobilisation regimen was clearly shown to be the preferred option when compared to the other two treatment methodologies investigated in the current study.Although the primary interest of the current study was to compare the efficacy of three different treatment regimens, a series of statistical analyses were performed to establish the prognostic significance of several factors associated with "whiplash" injury. This showed that factors such as gender, age, speed of the vehicles involved, paraesthesia, intensity of pain at the time of the initial examination, interscapular pain, blurred vision and difficulty in focusing, all had prognostic value. ++ / Similarly, the type of collision, seating position, presence of headache within 24 hours post injury, pre-existing degenerative changes in the cervical spine, loss of lordosis and litigation factors had no prognostic significance. Another major emphasis of the current study has been to concentrate on the pain related symptoms of the neck which are of major concern to "whiplash" subjects and to those clinicians treating them. A paucity of such information is considered to be one of the most notable causes of difficulties encountered in the management of "whiplash" injuries.As an adjunct to the main study, the morphology of the deep pre- and post vertebral muscles of the neck region using embalmed cadavers and fresh post-mortem specimens was investigated, as the literature is deficient in--this regard. Similarly, a longitudinal study of 45 subjects was also performed using Magnetic Resonance Imaging (MRI) technology. The longitudinal nature of the M.R.I. study provided for the first time an account of the details associated with the progressive pathological changes that occurred in some disc lesions, at defined points in time following a MVA. The observations made from the adjunct studies help develop a better understanding of the pathoanatomy associated with the deep muscles of the neck region and the pathological changes that occur following a traumatic disc lesion as evidenced within 2 weeks, after 3 months and 12 months post- injury. On the basis of the observations made in the current study, a classification of the "whiplash" injury has been proposed for the consideration of clinicians. Similarly, the questionnaire used for data collection in the current study, can be readily modified and utilised in a clinical situation for establishing documentation, planning treatment strategies and for evaluation of the treatment outcomes of "whiplash" type of injuries.

<p>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.</p><p>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.</p><p>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.</p><p>Resultatet i denna rapport är endast ett koncept, så vidare utveckling krävs för att nå fram till en färdig produkt.</p> / <p>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.</p><p>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.</p><p>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.</p><p>The result of the thesis is only conceptual, and further development is necessary to reach a final product.</p>

<p>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. </p><p>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. </p><p>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. </p>