Clinical response of human subjects to rear-end automobile collisions

Brault, John R.; Wheeler, Jeffrey B.; Siegmund, Gunter P.; Brault, Elaine J.

doi:10.1016/s0003-9993(98)90212-x

Cited by 122 publications

(59 citation statements)

References 19 publications

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“…Given ethical concerns with subjecting volunteers to injurious neck perturbations, most volunteer experiments have, for example, been conducted with military personnel and members of the research team. A few other experiments have been done with other volunteer groups but were necessarily limited to low-or very low-velocity collisions [1,3,4,7,9,10,14].…”

Section: Introductionmentioning

confidence: 99%

Cervical muscle response to whiplash-type right anterolateral impacts

2004

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Frontal impacts are a common cause of whiplash injury. Yet, volunteer studies of the cervical muscular response and head-neck kinematics to frontal impacts are uncommon, and specifically, the effect of an offset (anterolateral) frontal impact on the resultant muscle responses is unknown. The purpose of this study was to determine the response of the cervical muscles to increasing low-velocity frontal impacts offset by 45°to the right, and to compare the quantitative effects of expected and unexpected impact. Ten healthy volunteers were subjected to frontal impacts, offset by 45°to the subject's right, of 5.1-, 8.7-, 12-, and 13.7-m/s 2 peak acceleration at two levels of expectation: expected and unexpected. Bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis were recorded. Triaxial accelerometers recorded the acceleration of the chair, torso at the shoulder level, and head of the participant. At a peak acceleration of 13.7 m/s 2 , with an unexpected impact, the contralateral trapezius (i.e., left trapezius in a right anterolateral impact) generated 83% of its maximal voluntary contraction electromyogram, whereas all other muscles generated 50% or less of this variable. Although it generated less EMG, the splenius capitis muscle also tended to show an asymmetric EMG response, with the left (contralateral) splenius capitis generating a higher percentage (46%) of its maximal voluntary contraction electromyogram than the ipsilateral (right) splenius capitis. In comparison, the sternocleidomastoid muscles behaved symmetrically and generated 25% or less of this variable under all impact conditions. Similarly, the times to onset and times to peak electromyogram for the contralateral (left) splenius capitis and (left) trapezius progressively decreased with increasing levels of acceleration (p<0.01). Subjects exhibited lower levels of their maximal voluntary contraction electromyogram when the impact was expected (p<0.01). The kinetic variables and the electromyographic variables regressed significantly on the acceleration (p<0.01). In response to right anterolateral impacts, muscle responses were greater with higher levels of acceleration, and more specifically, when a frontal impact is offset to the subject's right, it results in not only increased EMG generation in the contralateral trapezius, but the splenius capitis contralateral to the direction of impact also bears part of the force of the neck pertubation. Expecting or being aware of imminent impact plays a role in reducing muscle responses in low-velocity anterolateral impacts.

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Section: Introductionmentioning

confidence: 99%

Cervical muscle response to whiplash-type right anterolateral impacts

2004

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“…26,30 Approximately one-third of subjects exposed to such a low-speed collision (where the speed change at impact was between 4 and 8 km/h) re- 26 However, so did one-quarter of subjects exposed to a sham collision. 30 …”

Section: Experimental Studiesmentioning

confidence: 99%

The Burden and Determinants of Neck Pain in Whiplash-Associated Disorders After Traffic Collisions

et al. 2008

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Study Design. Best evidence synthesis. Objective. To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions.Summary of Background Data. Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research. Methods.A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980 -2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis.Results. The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females.Conclusion. WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk, and better consideration of confounding factors, are needed.

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“…75 However, at 8 km/h, 38% of subjects exposed to controlled rear-end collisions experienced WAD symptoms. 13 At velocities of 32 km/h (20 mph), the head reaches a peak acceleration of 12g. In the course of the rear-ended impact, the neck is subjected to shear forces parallel to the direction of impact, 47,77 as well as compression, tension, flexion, and extension at different cervical levels and at different stages of the event.…”

Section: Forces Acting On the Head And Neck During An Mvamentioning

confidence: 99%

Whiplash: Pathophysiology, diagnosis, treatment, and prognosis

2004

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We have reviewed the literature relevant to pathophysiology, diagnosis, treatment, and prognosis of whiplash-associated disorder (WAD) since 1995 and provided a brief summary of literature pertaining to forces action on the head and neck during a motor vehicle accident. The scope of the current review is confined to the Quebec guidelines for WAD grades 1-3 but excludes grade 4 (neck complaints and fracture or dislocation). After excluding papers without scientific data and single case reports or case series with fewer than 20 patients, articles were reviewed for methodological quality. The diagnosis remains clinical. No imaging, physiological, or psychological study provides specific diagnostic criteria. In the acute period up to 2 weeks, soft collars or rest and work-leave do not shorten the duration of neck pain. Sick leave is reduced by high-dose methylprednisolone given within 8 h of injury, but confirmatory studies examining the cost-benefit relationship are needed. In the first 6 months, active as opposed to passive treatment results in improved outcomes. Specific exercise strategies have not been studied. For those with symptoms lasting more than 6 months, percutaneous radio-frequency neurotomy can provide pain relief for many months in those responding to blind local anesthetic facet blocks. Intra-articular corticosteroids are ineffective. Uncontrolled trials suggest that multimodal rehabilitation programs result in improved overall function. The overall prognosis for recovery has varied considerably across studies. Such variability is likely due to differences in case identification methods and whether outcome is assessed in terms of symptoms or the receipt of financial compensation for injury. The impact on prognosis of both collision- and patient-related factors is also reviewed.

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Clinical response of human subjects to rear-end automobile collisions

Cited by 122 publications

References 19 publications

Cervical muscle response to whiplash-type right anterolateral impacts

Cervical muscle response to whiplash-type right anterolateral impacts

The Burden and Determinants of Neck Pain in Whiplash-Associated Disorders After Traffic Collisions

Whiplash: Pathophysiology, diagnosis, treatment, and prognosis

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