Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.

Development of a symptom expectation questionnaire for whiplash injury

Background:Expectations and beliefs appear to be important predictors of outcome following whiplash injury.Instruments for measuring these expectations in the general population have not been well studied.The objective of this study was to develop a simple symptom expectation questionnaire for whiplash injury for use in future research studies. Methods:An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for whiplash injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter(a subject who expected at least one of these symptoms would remain chronic following whiplash injury).A total of seven of the 56 items were found to be discriminatory.The identified, discriminatory items were then tested in additional subject groups against the original questionnaire. Results:From the original database of 179 subjects completing a 56-item symptom expectation checklist,119 expected at least one of the 56 symptoms would be chronic following whiplash injury.The 119 expecters.however,all chose at least one of seven items:headache,anxious or worried,depressed,neck pain,problems sleeping,back pain,or jaw pain.Using these seven items,in two new groups of subjects given the 56- item symptom expectation checklist and then a new shortened(7-item) symptom expectation checklist one week later(and the same done for another group of 100 subjects in reverse order),all those who endorsed one of the 56 symptoms as likely to be chronic following whiplash injury (expecters) could also be identified on the 7-item checklist. Conclusion:A shortened(7-item) symptom expectation checklist of commonly reported symptoms following whiplash injury(headache, anxious or worried,depressed,neck pain,problems sleeping,back pain,and jaw pain) correctly identifies subjects who expect at least one symptom will be chronic following minor head injury(i.e.,an expecter).This shortened(7-item) symptom expectation checklist can be used in future population-based studies to understand the prevalence of belief patterns and expectations for whiplash injury.

Evaluation of the test-retest repeatability of the Injury Severity Perception score in patients with acute whiplash-associated disorder

Objective： To determine the test retest repeatability of the Injttry Severity Perception （ISP） score in participants with acute whiplash-associated disorders （WADs）. Methods： Consecutive patients with WAD, presenting in the acute stage to a primary care center, were asked to complete the 1SP score. ISP was measured with a numerical rating scale that ranged from 0 to 10, on which subjects were asked to rate how severe （in terms of damage） they thought their injury was. The anchors were labeled ＂no damage＂ （0） and ＂severe, and maybe permanent damage＂ （10）. The ISP questionnaire was administered to the participants at the time of recruitment and again 7 days later. Repeatability was evaluated by calculating percentage agreement and Cohen kappa statistic between the two time points of measurement. Results： A total of 94 subjects （34 males, 60 females, mean age 40.6 ± 10.0 years, range 19-60 years） were included. The mean 1SP score was 4.9 ± 1.7 （range 2-9 out of 10） at the time of recruitment and 5.1 ± 2.1 （range 2-9 out of 10） 7 days later. The percentage agreement between the two repeat measures of the ISP was 86% and the kappa coefficient was 0.79. Conclusion： This study suggests that the test-retest repeatability for the ISP is high and that it is thus likely to have a low risk of classification bias in prognostic studies. The ISP likely has adequate reliability for use in epidemiological research of WADs.

Correlation between self-reported recovery and central sensitization in whiplash patients

Central sensitization has been associated with chronic pain in whiplash patients.Methods:Consecutive whiplash patients were assessed at 3 months post-whiplash injury with the brachial plexus provocation test(BPPT)as a sign of central sensitization.Self-reported recovery was assessed by the response to the question ‘Do you feel you have recovered fully from your accident injuries?'Results:Sixty-nine subjects(32 males,37 females,age 37.5±13.0 years(mean±SD),range 18-71)were included.Of these,34 reported a lack of recovery,and 35 reported recovery at 3 months post-injury.The mean BPPT elbow extension(from 180°)was 41.5±23.0°,and the mean VAS score for the BPPT was 2.2 ± 1.2(out of 10).Those who reported recovery had a mean BPPT elbow extension angle of 25.1±15.8 while those who did not report recovery had a mean BPPT angle of 58.4 ± 15.9(P＜0.05).The visual analogue scale(VAS)score for recovered subjects was 1.8 ± 1.1 and 2.7 ± 1.1(P＜0.05)for non-recovered.There was a moderate correlation between self-reported recovery and BPPT elbow extension angle(-0.44)and a lower correlation between self-reported recovery and VAS score(-0.30).Conclusion:Self-reported recovery correlates well with a lower likelihood of signs of central sensitization.Copyright(c)2012,Shanghai University of Sport.Production and hosting by Elsevier B.V.All rights reserved.

Assessment of the Biological Damage in Whiplash Syndrome: Role of Digital Infrared Thermal Imaging (DITI) and Ultrasonography (US)

Objectives: To compare DITI vs US in a cohort of patients with whiplash syndrome for assessing soft tissues injuries of the cervical and dorsal spine. Methods: 70 patients presenting to clinic with traumatic cervical and/or dorsal spine injury and with a clinical diagnosis of whiplash syndrome underwent both DITI (AVIO TVS 2000) and US (GE Logic 5) of the following muscles: sternocleidomastoid, splenius, trapezius, longus colli and paravertebral muscles. DITI considered positive in the region with the most altered temperature among the injured area examinated (normal range 0℃ - 0.8℃). US valued the cervical and dorsal region with a comparative examination of the soft tissues. The images taken with DITI were compared with the clinical and the sonographic outcomes respectively. US and DITI were considered a) congruent whether both had a positive outcome for the same muscle clinically injured;b) not congruent whether one of the two instruments had a different outcome then the clinical evidence. Wilcoxon paired test was used for statistical analysis. Results: DITI and US matched 153 of 233 (65%) injured muscles. The association between DITI and US in the evaluation of the injured muscles was statistically significant for the following muscles: left trapezius (p Conclusions: According to our preliminary study, DITI and US were both helpful for assessing soft tissues injuries in patients with whiplash syndrome, defining the extent of the biologic damage for a correct clinical-therapeutical management.

Predictive Factors for Persistent Pain and Poor Recovery of Health Status 1 Year after Whiplash Injury (Quebec Grade 1 and 2): Results from the ESPARR Cohort

Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors;the implicated processes, however, remain a matter of debate. The present study used data from the ESPARR cohort (an on-going prospective study of a representative cohort of road accident victims in the Rh?ne administrative département of France). The objectives were to describe the consequences of whiplash injury and to determine prognostic factors for poor recovery and persistent pain at 1 year post-accident. Methods: The cohort included 255 “pure” whiplash victims, 173 of whom responded to the 1-year follow-up questionnaire. Correlations between explanatory variables and health and pain status were explored by modified Poisson regression to provide adjusted relative risk (RR) values. Results: Half of the victims had not fully recovered health status by 1 year. The main factor associated with non-recovery was pain (RR = 1.3;1.0-1.7). A birth in the family preceding the accident emerged as another factor (RR=1.5;1.2-1.9). Victims responsible for their accident were twice as likely to report being free of pain as those not responsible (RR = 0.5;0.3-0.8). No correlation emerged with accident-related characteristics or PTSD. Conclusions: The present results extend our understand- ing of whiplash injury. Residual pain is the fundamental factor causing whiplash victims to feel that they have not recovered good health. Our findings suggest this may be bound up with physical factors (gender susceptibility);external factors such as having to carry weights (such as a baby) and with perceiving oneself as a victim are not incompatible with this hypothesis.

New Concept of Whiplash Injuries Rehabilitation

Whiplash injuries are a global health problem and a significant financial burden for both health care systems,and 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 presented 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.

Postmortem MSCT Diagnosis of Whiplash Injuries in a Traffic Accident：A Case Report and Review of the Literature

A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway.He was found to have died after a respiratory and cardiac arrest at the scene.No sign of skin injuries was observed from the external inspection.The autopsy was not permitted by the family members because of the local culture.Multislice computed tomography(MSCT)was applied to the current case,showing dislocation of C3~4cervical vertebrae withⅡdegree,C4vertebral plate fractures,and spinal stenosis.Post-mortem MSCT confirmed the diagnosis as whiplash injuries.MSCT was verified to be effective in showing the severity of whiplash injuries,thus providing certain objective evidence for medicolegal expertise.

基于骨架几何位置调整的座椅抗鞭打性能优化

为了减小鞭打试验伤害评估中普遍较高的颈部损伤指标(Neck Injury Criterion,NIC)和上颈部伸张弯矩,基于某汽车座椅的LS-DYNA有限元模型和物理试验结果,首先对其基本结构和后碰撞下的运动响应进行分析,使用多体动力学分析软件(Mathematical Dynamic Model,MADYMO)建立座椅鞭打试验的多体动力学模型.然后,通过伤害机理分析和对座椅主要设计参数的灵敏度分析,确定座椅结构中的主要几何结构参数,并据此建立数值模型.最后,利用多目标优化算法,获得相应的座椅抗鞭打性能优化方案.结果表明,通过调整座椅骨架横梁及头枕位置,提高乘员头部和下颈部运动一致性,使NIC降低58.5%,上颈部伸张弯矩满足最高性能限值.

某座椅鞭打试验仿真与优化

针对某款座椅在鞭打试验中假人挥鞭伤较为严重,鞭打得分较低的问题,利用HyperMesh软件建立座椅有限元模型,并进行鞭打仿真分析,得到对鞭打伤害影响较大的因素分别为调角器刚度系数、头枕杆直径、靠背左侧支撑板厚度、靠背右侧支撑板厚度、靠背后部支撑板厚度、座垫右侧支撑板厚度和座垫左侧支撑板厚度,利用哈默斯雷试验设计方法对上述7个设计变量进行样本点采集,并利用移动最小二乘法进行近似模型拟合,采用全局响应面法对近似模型进行多目标优化,验证结果表明,优化模型的精度满足要求,优化后鞭打得分提高,座椅抗挥鞭伤性能显著提升。

冥想应用于颈椎病的研究进展

随着社会节奏的加快,颈椎病已经成为城市人群的常见病、多发病。颈椎病患者时常遭受着颈痛,久而久之造成焦虑、抑郁等负面情绪,严重影响患者的生活质量,给个人、家庭带来巨大的经济及精神负担。近年来,冥想作为一种具有强大生理调节功能的心理训练方式受到了越来越多的关注。冥想可以通过调节机体的神经-内分泌-免疫网络等机制,达到有效去除抑郁、焦虑和缓解压力等作用。冥想有机整合了祖国医学中经络学说、脏象学说、五行学说以及天人合一的理论、情志理论、扶正理论;并结合了现代心身医学、心理治疗和正念冥想中的重要理论与实践;充分利用了传统医学中的自然疗法和音乐疗法。本文将从冥想的概念、冥想对颈椎病的研究成果、冥想对颈椎病的干预策略等方面进行综述。

基于文献计量学分析挥鞭样损伤的研究热点及趋势

目的 基于文献计量学分析挥鞭样损伤(WI)的研究热点及趋势。方法 检索Web of Science^(TM) Core Collection数据库,检索时限为1999年1月1日至2022年12月31日,搜集WI的相关文献,采用CiteSpace6.1.R6软件分析年度发文量变化趋势、国家/地区发文量、研究机构发文量、作者发文量,并进行关键词共现分析、关键词聚类分析、关键词突现分析。结果 1999—2022年Web of Science^(TM) Core Collection数据库收录的WI相关文献共2 790篇,年度发文量总体呈现波动上升的趋势。发文量排名前三的国家为美国、澳大利亚、加拿大。发文量排名前三的研究机构是昆士兰大学、阿尔伯塔大学、悉尼大学。发文量排名前三的作者为Sterling M、Cote P、Nijs J。关键词共349个,出现频次最高的关键词是颈痛、挥鞭样损伤、损伤。关键词可形成8个聚类,分别为颈痛、颈椎、本体感觉、挥鞭样损伤、恢复、效度、中枢敏化、核磁共振。生活质量、慢性挥鞭伤、创伤性脑损伤、中/重度残疾、心理测量特性、震荡等为WI研究领域未来的研究趋势。结论 WI研究热度总体呈现波动上升趋势,研究热点集中于颈痛、挥鞭样损伤、本体感觉、中枢敏化、核磁共振成像等方面,改善患者生活质量、关注患者心理状态、促进慢性WI患者康复、尽早识别合并颅脑损伤的WI患者或将是该领域未来的研究趋势。

复杂钢混组合线下式高铁站房结构设计与抗震分析

钢-混凝土不规则组合框架体系对于线下式高铁站房具有良好的适用性。依托济南至莱芜高速铁路历城站结构设计,研究了钢-混凝土不规则组合线下站房结构设计的关键技术。研究结果表明:采用民用建筑规范与铁路规范相协调的设计方法,能较好地满足线下式站房的要求;钢-混凝土不规则组合结构中的侧向组合能够有效减少上下组合结构中的鞭梢效应;超长门厅钢拱组合桁架采取“抗放结合”的处理措施,可有效解决温度应力的影响;钢混锥台过渡转换节点能确保混凝土与钢结构转换的可行性与可靠性。通过对结构进行动力弹塑性分析,验证了该组合结构满足了既定的性能目标,安全可靠。

Correlation between expectations of recovery and injury severity perception in whiplash-associated disorders

Objective:To assess the correlation between expectations of recovery and whiplash patients' perceptions of injury severity using a simplified instrument.Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies.The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis.Methods:Consecutive patients with whiplash-associated disorder grade 1 or 2,presenting in the acute stage to a primary care centre,were asked "do you think that your injury will…" with response options "get better soon;get better slowly;never get better;don't know." Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0-10,on which subjects were asked to rate how severe (in terms of damage) they thought their injury was.The anchors were labeled "no damage" (0) and "severe,and maybe permanent damage" (10).The primary outcome measure was the correlation between the subject's ISP score and expectation of recovery.Results:A total of 94 subjects (34 males,60 females,and mean age (40.6±10.0) years,range 19-60 years) were included.The initial responses to expectation of recovery were:get better soon (29/94);get better slowly (22/94);never get better (11/94);don't know (32/94).The mean ISP score was 4.9±1.7 (range 2-9 out of 10).There was a high correlation between expectations and ISP scores (Spearman's rank correlation coefficient 0.68).Those who expected to recover soon and those who expected to get better slowly had the lowest ISP scores.Conclusions:The more slowly whiplash patients expect to recover,or the less sure they are of recovery,the more severe their initial perceptions of injury.

Biomechanics of whiplash injury

Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics,facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3)The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury,potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in the impact. (5) There are several possible injury criteria to correlate with the duration of symptoms during reconstructions of actual crashes. These results form the biomechanical basis for a hypothesis that the facet joint capsule is a source of neck pain and that the pain may arise from large strains in the joint capsule that will cause pain receptors to fire.

Distribution Characteristics of Meridian Sinew(Jingjin) Syndrome in 313 Cases of Whiplash-Associated Disorders

Objective：To investigate and analyze the characteristics of Meridian Sinew（Jingjin） syndrome in patients with whiplash-associated disorders（WAD）.Methods：From August 2010 to September 2011,313 WAD cases from New York and California states were collected.The survey mostly collects the information of ＂Sinew Knotted Points＂ and symptoms of four types of Meridian Sinew differentiation—Taiyang,Shaoyin,Shaoyang and Yangming.Results：Among the cases which are on the average of medium injury level,the higher frequency of ＂Sinew Knotted Points＂ tenderness were found on Jianwaishu（SI 14）,Jianzhongshu（SI 15）,Tianchuang（SI 16）,C3-6 Spinous Process,Dazhui（GV 14）,Fengchi（GB 20）,Tianliao（SJ 15） and Tianding（LI 17）.The most commonly presented symptoms were widespread spasm and tenderness in the neck（Taiyang）,difficulty in lateral flexion（Shaoyang）,problems of extension and flexion（Taiyang）,and stiffness and pain during neck movement（Yangming）.Among the cases,237 cases（75.72%） were related to Taiyang Meridian Sinew syndrome,82 cases（26.20%） to Shaoyin syndrome and 175（55.91%） and176（56.23%） cases to Shaoyang and Yangming syndrome respectively.The most of cases presented in a combination format.The syndrome distribution under Grade Ⅰ,Ⅱ and Ⅲ reflected that more combination of the Meridian Sinew syndromes in the whiplash injury patients which is resulted from more severity of injury.Conclusion：It is practical to identify the location of abnormality through Meridian Sinew differentiation,considering both ＂Sinew Knotted Points＂ tenderness and corresponding symptoms,for the local neck symptoms of WAD.

Effect of a pain diary use on recovery from acute whiplash injury: a cohort study

Previously,it was shown that the use of a symptom diary for two weeks,even in generally healthy subjects,results in increased recall of daily symptoms and increased perception of symptom severity(Ferrari and Russell,2010).In that study,generally healthy female subjects were asked to recall symptoms experienced in the previous two weeks,after keeping a symptom diary for two weeks,while a control group was asked to recall symptoms experienced in the previous two weeks without having kept a symptom diary.While both groups had

软头枕对某款座椅鞭打损伤的影响分析

佩戴软头枕会改变座椅在追尾事故中的保护效果,但是目前针对佩戴软头枕时的鞭打性能研究几乎没有。为探索软头枕在追尾事故中的作用,设计并完成了佩戴软头枕和未佩戴软头枕两种工况下的鞭打对比试验。结果表明,座椅佩戴软头枕会使假人头部较早的接触座椅,支撑并缓冲假人的头部运动,减缓假人头部向后甩动的剧烈程度;并使假人各部位的损伤减小,颈部伤害峰值明显降低;同时,具有提高座椅鞭打得分的作用。研究成果作为追尾事故的一种预研数据积累,将服务于后续新版鞭打规程的制修订工作。

Extended Impact of Cold Air Invasions in East Asia in Response to a Warm South China Sea and Philippine Sea

During boreal winter,the invasion of cold air can lead to remarkable temperature drops in East Asia which can result in serious socioeconomic impacts.Here,we find that the intensity of strong synoptic cold days in the East China Sea and Indochina Peninsula are increasing.The enhanced synoptic cold days in these two regions are attributed to surface warming over the South China Sea and Philippine Sea(SCSPS).The oceanic forcing of the SCSPS on the synoptic cold days in the two regions is verified by numerical simulation.The warming of the SCSPS enhances the baroclinicity,which intensifies meridional wind and cold advection on synoptic timescales.This leads to a more extended region that is subject to the influence of cold invasion.

某车型座椅鞭打试验性能优化方案研究

本文着重分析了某车型驾驶员座椅在CNCAP2021版Whiplash试验中得分较低的原因,探讨了相关影响因素,并结合仿真分析手段确定了减少靠背后倾、提高靠背侵入量等优化方案,验证表明更改后的座椅鞭打性能得到了提高,为后续项目的座椅开发和改进提供了参考。