AMA Guides® Newsletter - Issue Archive

Articles

1. Cervical Whiplash: Assessment, Treatment, and Impairment Rating

   Alan L. Colledge, Roger Pack, Christopher R. Brigham, Charles N. Brooks

   Pages 1–3, 8-15

   DOI: 10.1001/amaguidesnewsletters.2007.MayJun01

   Abstract

   Whiplash-associated disorder (WAD) refers to complaints attributed to a shear-hyperextension then hyperflexion cervical injury, typically following a rear-end motor vehicle collision. Research suggests that chronic whiplash symptoms should be the exception rather than the rule, and the surge of chronic whiplash symptoms probably reflects the focus on biological treatment of WAD, ignoring the cultural, psychological, and sociological influences. The physician evaluating and/or treating a whiplash patient needs to have a solid understanding of the complexities and controversies associated with this disorder. Evaluation should be prompt and thorough, but, unless indicated, evaluators should avoid sophisticated diagnostic studies (eg, magnetic resonance imaging studies correlate poorly with whiplash symptoms). Treatment generally should be simple and consists primarily of reassurance and home exercise. Disability, both occupational and avocational, should be avoided or minimized. As with other impairment evaluations, the clinical assessment (history, physical examination, and review of diagnostic studies) must be thorough. If there are ratable findings, examiners must determine their reliability and whether the examinee has achieved maximal medical improvement. Most cases of WAD do not result in permanent impairment, but when there is ratable impairment it usually falls in DRE Cervical Category II, with a rating of 5% to 8% whole person permanent impairment. Managing patients’ beliefs and expectations following motor vehicle injury can help guide them to continue or promptly return to normal activities. {223}
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2. Case Exercise: Biomechanics in Rearend Motor Vehicle Collisions

   Charles N. Brooks, Christopher R. Brigham

   Pages 4–7

   DOI: 10.1001/amaguidesnewsletters.2007.MayJun02

   Abstract

   Multiple factors determine the likelihood, type, and severity of bodily injury following a motor vehicle collision and, in turn, influence the need for treatment, extent of disability, and likelihood of permanent impairment. Among the most important factors is the change in velocity due to an impact (Δv). Other factors include the individual's strength and elasticity, body position at the time of impact, awareness of the impending impact (ie, opportunity to brace, guard, or contract muscles before an impact), and effects of braking. Because Δv is the area under the acceleration vs time curve, it combines force and duration and is a useful way to quantify impact severity. The article includes a table showing the results of a literature review that concluded, “the consensus of human subject research conducted to date is that a single exposure to a rear-end impact with a Δv of 5 mph or less is unlikely to result in injury” in most healthy, restrained occupants. Because velocity incorporates direction as well as speed, a vehicular occupant is less likely to be injured in a rear impact than when struck from the side. Evaluators must consider multiple factors, including the occupant's pre-existing physical and psychosocial status, the mechanism and magnitude of the collision, and a variety of biomechanical variables. Recommendations based solely on patient history and physical findings (and, perhaps, imaging studies) may be ill-informed.
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