Development of motor system dysfunction following whiplash injury.
Dysfunction in the motor system is a feature of persistent whiplash associated disorders. Little is known about motor dysfunction in the early stages following injury and of its progress in those persons who recover and those who develop persistent symptoms. This study measured prospectively, motor system function (cervical range of movement (ROM), joint position error (JPE) and activity of the superficial neck flexors (EMG) during a test of cranio-cervical flexion) as well as a measure of fear of re-injury (TAMPA) in 66 whiplash subjects within 1 month of injury and then 2 and 3 months post injury. Subjects were classified at 3 months post injury using scores on the neck disability index: recovered (<8), mild pain and disability (10-28) or moderate/severe pain and disability (>30). Motor system function was also measured in 20 control subjects. All whiplash groups demonstrated decreased ROM and increased EMG (compared to controls) at 1 month post injury. This deficit persisted in the group with moderate/severe symptoms but returned to within normal limits in those who had recovered or reported persistent mild pain at 3 months. Increased EMG persisted for 3 months in all whiplash groups. Only the moderate/severe group showed greater JPE, within 1 month of injury, which remained unchanged at 3 months. TAMPA scores of the moderate/severe group were higher than those of the other two groups. The differences in TAMPA did not impact on ROM, EMG or JPE. This study identifies, for the first time, deficits in the motor system, as early as 1 month post whiplash injury, that persisted not only in those reporting moderate/severe symptoms at 3 months but also in subjects who recovered and those with persistent mild symptoms.
The Whiplash Research Unit, Department of Physiotherapy, The University of Queensland, 4072 Brisbane, Australia. m.sterling@shrs.uq.edu.au
Michele
M
Sterling
Gwendolen
G
Jull
Bill
B
Vicenzino
Justin
J
Kenardy
Ross
R
Darnell
D000328:Adult; D018771:Arthralgia / Q000503:physiopathology; D002574:Cervical Vertebrae / Q000293:injuries / Q000503:physiopathology; D004185:Disability Evaluation; D004576:Electromyography; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000209:etiology* / Q000523:psychology; D009068:Movement; D009334:Neck Muscles / Q000503:physiopathology; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014911:Whiplash Injuries / Q000150:complications* / Q000523:psychology