How we can help with prognosis, diagnosis and effective treatment of whiplash injuries
Learn how a combination of physical and psychological measures has been shown in the recent scientific literature to accurately predict prognosis and aid in clinical decision making. This presentation includes a substantial proportion of the assessment and treatment sections of the Whiplash: The Endemic presentation described below.
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Whiplash: The Endemic
Who can benefit from learning the facts about whiplash injuries? Attorneys who litigate personal injury cases, legislators, physicians, physiotherapists, patients and the lay public.
The purpose of Whiplash: the Epidemic is to educate and inform. Whiplash today affects a huge segment of society. In the U.S. there are approximately 3 million new injuries each year, with 35-50% of these victims suffering long-term pain, and about 14% becoming disabled. Our research has shown that 45% of all persons suffering from chronic neck pain attribute it to a motor vehicle crash injury in their past. And, despite the many advances in automotive safety technology, the incidence of whiplash has been on the rise over the past decade. The overall cost to society or "harm" (a term that considers medical costs, legal costs, emergency services costs, the costs of lost wages, costs to employers, the loss of tax base, etc.) is more than a quarter of a billion dollars each year. Most importantly, and unlike many of the other diseases we cope with today, this injury is largely preventable. Yet the gradual increase in the incidence of this tremendous public health burden makes it clear that the lack of progress is largely the result of general ignorance as well as the targeted misinformation campaigns mounted by those whose interests are served by it.
In short, it is a problem that cannot change without public education and enlightenment. Whiplash: the Epidemic is designed to tell the real story of the modern epidemic of whiplash using a scientific and evidence-based format. Following is an outline of the subject matter covered.
History of whiplash
From the 19th century train injuries to present day motor vehicle injuries, this often maligned condition has been the subject of unending debate. Fortunately, there has been a great surge of new interest in the condition among the scientific community in recent years.
Epidemiology of whiplash
We take a critical look at the problem and present the real statistics; from incidence and risk to prevalence. The size of the problem is growing worldwide and the real reasons for this unexpected growth are revealed.
Current challenges for patients, physicians, and attorneys This section explores the myths and misconceptions promoted by groups wishing to marginalize the whiplash problem as insignificant or even non-existent. This section contains three optional expansion modules (Red Boxes) that allow presenters to explore the commonly held belief that injuries are unlikely or impossible in certain kinds of crashes in greater detail, as well as to take a closer look at the current state of low speed auto crash reconstruction and its limitations. We discuss the recent research with bumper systems and event data recorders (EDR) - the vehicleís black box. We explore the known relationships between vehicle damage and injury risk. This section also contains slow motion footage of crash tests which juxtapose non-destructive bumper-to-bumper collisions with the relatively violent occupant kinematics occurring in the same crashes.
Biomechanics of whiplash
After an introduction to key terminology (delta V, closing velocity, etc.) we explore the relationships between crash speed, crash duration, and acceleration as a way of understanding how some occupants of a vehicle can escape injury - even in crashes with large amounts of damage - while others can be injured in collisions with little or no vehicle damage. This section contains crash test footage contrasting a very high speed crash with a low speed crash in which the subjects, nevertheless, experienced similar head acceleration. Close-up occupant footage also highlights a number of important phenomena, such as ramping, the effects of varying head restraint geometry, variances between male and female occupants, and much more. The sequence of events in typical crashes is covered, as well as important vehicle and occupant variables affecting risk.
Soft tissue injuries
As regards injury, the key tissues are now known to be disc, ligament, and the facet joints. End plates can also be damaged during whiplash injury, as our research has shown. This section also details the potential range of other spinal area lesions. Important symptom patterns, such as dermatomal and scleratomal patterns are explained. Mild traumatic brain injuries (MTBI) are not uncommon in whiplash trauma and are detailed in this section as well. New research findings have also shown a connection between whiplash and allergy, breathing disorders, low back pain, cardiac problems, and digestive disorders.
The traditional approach to diagnosis is plain radiography, but even CT and MRI may fail to disclose the soft tissue lesions attributable to whiplash trauma. Other forms of evaluation include QST, Sedated overpressure flexion X-Rays and Sensori-Motor testing. Other tests (diagnostic facet joint injections) can also be useful in some cases and these are discussed as well.
The program touches on the goals of guideline-based treatment, emphasizing multimodal treatment, co-management with appropriate health care providers when required, and stresses the importance of supportive management, which might include the use of cervical pillows, home cervical traction, exercise, and advice regarding activities of daily living. Other treatments such as RadioFrequency Neurotomy and Prolotherapy are also discussed.
Risk assessment is a critically important component of those cases that are associated with legal action. The most meaningful evaluation, i.e., the one with the greatest construct validity from a medicolegal standpoint, is one in which a trained and experienced physician has interviewed the victim, performed a detailed physical examination, reviewed other available documents and tests, and considered all of these within the overall framework of known risk factors (age, gender, stature, awareness of the crash, the numerous crash parameters, and so on). Dozens of risk factors have been identified in clinical and epidemiological research in recent years and are presented here in the context of risk for acute injury and risk for poor outcome. As always, these facts are fully referenced.
Comes complete with a reference list of all cited literature.
(Developed by Dr. A. Croft: SRISD)