New Concept of Whiplash Injuries Rehabilitation

Whiplash injuries are a global health problem and a significant financial burden for both health care systems, and for insurance providers. The diverse symptomatology after whiplash injury both in the somatic, emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders (WAD) as a separate category of diseases. The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological, emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction. As a result, the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent. Based on the prsesnted here of Head Neutral Reference Point (HNRP), the objective of central desensitization is to restore valid somatosensory output from Cranio - cervical Junction (CCJ). This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.

The detection of malingering in whiplash-related injuries: a targeted literature review of the available strategies

Objective The present review is intended to provide an up-to-date overview of the strategies available to detect malingered symptoms following whiplash. Whiplash-associated disorders (WADs) represent the most common traffic injuries, having a major impact on economic and healthcare systems worldwide. Heterogeneous symptoms that may arise following whiplash injuries are difficult to objectify and are normally determined based on self-reported complaints. These elements, together with the litigation context, make fraudulent claims particularly likely. Crucially, at present, there is no clear evidence of the instruments available to detect malingered WADs. Methods We conducted a targeted literature review of the methodologies adopted to detect malingered WADs. Relevant studies were identified via Medline (PubMed) and Scopus databases published up to September 2020. Results Twenty-two methodologies are included in the review, grouped into biomechanical techniques, clinical tools applied to forensic settings, and cognitive-based lie detection techniques. Strengths and weaknesses of each methodology are presented, and future directions are discussed. Conclusions Despite the variety of techniques that have been developed to identify malingering in forensic contexts, the present work highlights the current lack of rigorous methodologies for the assessment of WADs that take into account both the heterogeneous nature of the syndrome and the possibility of malingering. We conclude that it is pivotal to promote awareness about the presence of malingering in whiplash cases and highlight the need for novel, high-quality research in this field, with the potential to contribute to the development of standardised procedures for the evaluation of WADs and the detection of malingering.

Frequency of Formication Symptoms in Injured Motorists and in Normal Controls

Background: Formication is the sensation or feeling as if insects were crawling on or under the skin. It is observed in a variety of clinical situations including drug intoxications, multiple sclerosis, and diabetic neuropathy, among many others. Furthermore, it can be associated with injuries incurred during motor vehicle accidents (MVAs). We examined the frequency of reports of formication in a normal control sample as well as in a sample of motorists who sustained concussive and whiplash injuries following high impact MVAs. We also evaluated the correlations of the formication to measures of pain, insomnia, and of various post-accident neuropsychological symptoms. Method: De-identified data on 23 injured motorists (mean age=38.0 years, SD=12.8) and on 20 normal controls (mean age 42.8 years, SD=19.9) were available. All motorists responded to the following True/False item: “I have pain in my body which seems to feel like bugs crawling under the surface of my skin.” Their data were also available on the Brief Pain Inventory, Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, and on the Rivermead Post-Concussion Symptoms Questionnaire. The data of normal controls included responses to the following specific item of the formication questionnaire: “Do you sometimes have an annoying feeling in some of your limbs or in some other part of your body as if insects were crawling on or under your skin?” The participants were to circle one of the following responses: “never, very rarely, sometimes, often, or almost constantly.” Results and Discussion: Almost a third (30.4%) of the motorists who sustained whiplash trauma in their MVA reported the formication. In contrast, only one of the 20 normal controls (i.e., 5%) reported formication (this was an elderly man with MRI documented pathology in lumbosacral spine). Notably, formication correlated significantly with the ratings of “reduced feeling in the limbs” (r=.55, p=.010), but not with ratings of “tingling in the limbs” (r=.21, p>.05). Conclusion: The painful form of formication has been reported by almost a third of motorists who sustained whiplash injuries in their accident.

Whiplash Injuries. Current State of Knowledge

Due to the rapid development of transport and a significant increase in the number of road users, whiplash injuries are a global health problem and a significant financial burden for both health care systems and insurance systems. The rich symptomatology of whiplash injuries with their impact on the somatic and emotional-behavioral sphere prompts us to define a new disease entity, namely Whiplash Associated Disorders (WAD). The mechanism of whiplash injury is still under debate and theories explaining the pathogenesis of WAD are very diverse, ranging from purely biomechanical and hydrostatic to neurophysiological, emphasizing sensitization and dysfunctional neuromodulation of pain after whiplash injuries. WAD syndrome should be understood more broadly than just cervical trauma, as problems specific to local legal cultures often determine both epidemiological indicators, the course of treatment and prognosis of the disease. There is a need for further research on the issue of whiplash considering inconsistent literature data about optimal rehabilitation after such injuries.