1
|
Gill-Lussier J, Saliba I, Barthélemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med 2023; 12:jcm12051884. [PMID: 36902670 PMCID: PMC10003866 DOI: 10.3390/jcm12051884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Proprioceptive cervicogenic dizziness (PCGD) is the most prevalent subcategory of cervicogenic dizziness. There is considerable confusion regarding this clinical syndrome's differential diagnosis, evaluation, and treatment strategy. Our objectives were to conduct a systematic search to map out characteristics of the literature and of potential subpopulations of PCGD, and to classify accordingly the knowledge contained in the literature regarding interventions, outcomes and diagnosis. A Joanna Briggs Institute methodology-informed scoping review of the French, English, Spanish, Portuguese and Italian literature from January 2000 to June 2021 was undertaken on PsycInfo, Medline (Ovid), Embase (Ovid), All EBM Reviews (Ovid), CINAHL (Ebsco), Web of Science and Scopus databases. All pertinent randomized control trials, case studies, literature reviews, meta-analyses, and observational studies were retrieved. Evidence-charting methods were executed by two independent researchers at each stage of the scoping review. The search yielded 156 articles. Based on the potential etiology of the clinical syndrome, the analysis identified four main subpopulations of PCGD: chronic cervicalgia, traumatic, degenerative cervical disease, and occupational. The three most commonly occurring differential diagnosis categories are central causes, benign paroxysmal positional vertigo and otologic pathologies. The four most cited measures of change were the dizziness handicap inventory, visual analog scale for neck pain, cervical range of motion, and posturography. Across subpopulations, exercise therapy and manual therapy are the most commonly encountered interventions in the literature. PCGD patients have heterogeneous etiologies which can impact their care trajectory. Adapted care trajectories should be used for the different subpopulations by optimizing differential diagnosis, treatment, and evaluation of outcomes.
Collapse
Affiliation(s)
- Joseph Gill-Lussier
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
- Collège d’Études Ostéopathique de Montréal (CEOM), Montréal, QC H3G 1W7, Canada
| | - Issam Saliba
- Division of Otolaryngology, Head and Neck Surgery—Otology and Neurotology, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC H2X 3E4, Canada
- Correspondence:
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
| |
Collapse
|
2
|
Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. J Clin Med 2022; 11:jcm11216293. [DOI: 10.3390/jcm11216293] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 01/17/2023] Open
Abstract
Basic science and clinical evidence suggest that cervical spine disorders can lead to dizziness. The cervical spine has highly developed proprioceptive receptors, whose input information is integrated with the visual and vestibular systems in the central nervous system, acting on the neck and eye muscles to maintain the coordinative motion of the head, eyes, neck, and body through various reflex activities. When the cervical proprioceptive input changes due to the mismatch or conflict between vestibular, visual, and proprioceptive inputs, cervicogenic dizziness may occur. The diagnosis of cervicogenic dizziness can be determined based on clinical features, diagnostic tests, and the exclusion of other possible sources of dizziness. The cervical torsion test appears to be the best diagnostic method for cervicogenic dizziness. Based on the available evidence, we first developed the diagnostic criteria for cervicogenic dizziness. Treatment for cervicogenic dizziness is similar to that for neck pain, and manual therapy is most widely recommended.
Collapse
|
3
|
Monaro M, Bertomeu CB, Zecchinato F, Fietta V, Sartori G, De Rosario Martínez H. The detection of malingering in whiplash-related injuries: a targeted literature review of the available strategies. Int J Legal Med 2021; 135:2017-2032. [PMID: 33829284 PMCID: PMC8354940 DOI: 10.1007/s00414-021-02589-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Merylin Monaro
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy.
| | - Chema Baydal Bertomeu
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain
| | - Francesca Zecchinato
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy
| | - Valentina Fietta
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy
| | - Giuseppe Sartori
- Department of General Psychology, Università degli Studi di Padova, via Venezia 8, 35131, Padova, Italy
| | - Helios De Rosario Martínez
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain
- CIBER de Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| |
Collapse
|
4
|
Mazaheri M, Abichandani D, Kingma I, Treleaven J, Falla D. A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder. PLoS One 2021; 16:e0249659. [PMID: 33831060 PMCID: PMC8031393 DOI: 10.1371/journal.pone.0249659] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account. DATA SOURCES PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed. STUDY SELECTION Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected. DATA EXTRACTION Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version). DATA SYNTHESIS Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24-0.62]) and extension (0.33 [95%CI: 0.08-0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05-0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22-0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37-0.88] and 0.78 [0.56-0.99], respectively) and EC (0.69 [0.46-0.91] and 0.80 [0.58-1.02]) conditions. CONCLUSION The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.
Collapse
Affiliation(s)
- Masood Mazaheri
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deepa Abichandani
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Lecturer in Physiotherapy, Institute of Health and Social Care, London South Bank University, London, United Kingdom
| | - Idsart Kingma
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Julia Treleaven
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| |
Collapse
|
5
|
Monaro M, De Rosario H, Baydal-Bertomeu JM, Bernal-Lafuente M, Masiero S, Macía-Calvo M, Cantele F, Sartori G. A model to differentiate WAD patients and people with abnormal pain behaviour based on biomechanical and self-reported tests. Int J Legal Med 2021; 135:1637-1646. [PMID: 33774707 PMCID: PMC8205908 DOI: 10.1007/s00414-021-02572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/11/2021] [Indexed: 11/12/2022]
Abstract
The prevalence of malingering among individuals presenting whiplash-related symptoms is significant and leads to a huge economic loss due to fraudulent injury claims. Various strategies have been proposed to detect malingering and symptoms exaggeration. However, most of them have been not consistently validated and tested to determine their accuracy in detecting feigned whiplash. This study merges two different approaches to detect whiplash malingering (the mechanical approach and the qualitative analysis of the symptomatology) to obtain a malingering detection model based on a wider range of indices, both biomechanical and self-reported. A sample of 46 malingerers and 59 genuine clinical patients was tested using a kinematic test and a self-report questionnaire asking about the presence of rare and impossible symptoms. The collected measures were used to train and validate a linear discriminant analysis (LDA) classification model. Results showed that malingerers were discriminated from genuine clinical patients based on a greater proportion of rare symptoms vs. possible self-reported symptoms and slower but more repeatable neck motions in the biomechanical test. The fivefold cross-validation of the LDA model yielded an area under the curve (AUC) of 0.84, with a sensitivity of 77.8% and a specificity of 84.7%.
Collapse
Affiliation(s)
- Merylin Monaro
- Department of General Psychology, University of Padova, via Venezia 8, 35131, Padova, Italy.
| | - Helios De Rosario
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain.,CIBER de Bioingeniería, Biomateriales Y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - José María Baydal-Bertomeu
- Instituto de Biomecánica de Valencia, Universitat Politècnica de Valencia, Ed. 9C. Camino de Vera s/n, 46022, Valencia, Spain
| | - Marta Bernal-Lafuente
- MAZ, Academia General, Mutua Colaboradora con la Seguridad Social nº 11. AvenidaMilitar 74, 50015, Zaragoza, Spain
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 5, 35128, Padova, Italy
| | - Mónica Macía-Calvo
- MAZ, Academia General, Mutua Colaboradora con la Seguridad Social nº 11. AvenidaMilitar 74, 50015, Zaragoza, Spain
| | - Francesca Cantele
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 5, 35128, Padova, Italy
| | - Giuseppe Sartori
- Department of General Psychology, University of Padova, via Venezia 8, 35131, Padova, Italy
| |
Collapse
|
6
|
Fraix M, Badran S, Graham V, Redman-Bentley D, Hurwitz EL, Quan VL, Yim M, Hudson-McKinney M, Seffinger MA. Osteopathic manipulative treatment in individuals with vertigo and somatic dysfunction: a randomized, controlled, comparative feasibility study. J Osteopath Med 2021; 121:71-83. [PMID: 33125033 DOI: 10.7556/jaoa.2020.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context There is a paucity of research assessing the efficacy of osteopathic manipulative treatment (OMT) in patients with vertigo. Objective To assess the feasibility of conducting a randomized, controlled trial comparing OMT and vestibular rehabilitation therapy (VRT), alone or in combination, in patients with vertigo and somatic dysfunction. Methods Volunteers with vertigo who were also diagnosed with somatic dysfunction (SD) were prospectively enrolled in a blinded, randomized, controlled cohort comparative effectiveness study and assigned to 1 of 4 groups: OMT alone, VRT alone, a combination of OMT and VRT (OMT/VRT), or a nonintervention control group. Participants between 18 and 79 years of age were included if they had experienced symptoms of vertigo for at least 3 months' duration, demonstrated somatic dysfunction, and could participate in computerized dynamic posturography (CDP) testing, tolerate manual therapy and exercises, and communicate effectively in English or Spanish. A total of 3 treatments lasting 45 minutes each were administered 1 week apart to each participant. OMT in this study consisted of counterstrain, myofascial release, balanced ligamentous tension, soft tissue, HVLA, and articulatory techniques. Comparisons were made between composite scores (CS) assessed with computerized dynamic posturography (CDP), dizziness handicap inventory (DHI), optometric evaluation, and osteopathic structural examinations collected before the first treatment, after the third/final treatment, and 3 months after the final treatment. (ClinicalTrials.gov number NCT01529151). Results A total of 23 patients were included in the study: 7 in the OMT group, 5 in the VRT group, 6 in the OMT/VRT group, and 5 in the control group. The OMT/VRT group demonstrated significant improvement in DHI score (P=0.0284) and CS (P=0.0475) between pre- and 3-month posttreatment measures. For total severity, improvements were significant in the OMT group both from pretreatment to immediate posttreatment measures (P=0.0114) and from pretreatment to 3-month posttreatment measures (P=0.0233). There was a statistical difference between the OMT and control groups from pretreatment to 3-month posttreatment DHI scores (P=0.0332). Also, there was a statistical difference in DHI score between VRT and control from pre- to 3-month posttreatment scores (P=0.0338). OMT/VRT statistically and clinically improved visual acuity in patients' right eyes from pre- to posttreatment (P=0.0325). In all participants, vergence dysfunction was prevalent (5; 21.7%) in addition to vertical heterophoria (15; 65.2%). Conclusion A combination of OMT and VRT significantly reduced vertigo and improved balance 3 months after treatment (P<0.05). There was a high prevalence in vergence and vertical heterophoria, which are not typical screening measurements used by physical therapists and physicians to assess vertigo patients. With a small sample size, this study demonstrated the feasibility of an interdisciplinary team evaluating and treating patients with vertigo in a community setting. A larger study is needed to assess the efficacy of OMT/VRT in vertigo patients.
Collapse
Affiliation(s)
- Marcel Fraix
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | - Sondos Badran
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | | | - Donna Redman-Bentley
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | | | - Valerie L Quan
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | - Michelle Yim
- The Dignity Health California Hospital Medical Center , Los Angeles , CA , USA
| | - Mary Hudson-McKinney
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | - Michael A Seffinger
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| |
Collapse
|
7
|
Puerta de Diego R, Elia Martinez JM, Gallart Úbeda V, Meliá Casado B, Tenias Burillo JM. [Posturographic and oculomotor findings in the first 24 hours after whiplash]. Rehabilitacion (Madr) 2020; 55:89-97. [PMID: 32674926 DOI: 10.1016/j.rh.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVES Instability is a frequent symptom after whiplash (WL) with alterations in postural control in chronic phases. The main objective of our study was to evaluate if there were objective alterations in postural control in the acute phases after a WL, as well as to determine the presence or absence of oculomotor alterations in early phases. MATERIAL AND METHODS A posturographic study was carried out using the NedSVE/IBV system, as well as an oculomotor assessment, in a sample of 44 patients with WL in the first 24h after the accident. RESULTS More than half of the patients had a global assessment below normal. The predominant sensory pattern was vestibular. The main parameters of the Romberg test (total displacement, swept area, average speed, anteroposterior and mediolateral displacement and anteroposterior force) increased following the sequence Romberg open eyes, Romberg foam rubber open eyes, Romberg closed eyes, and Romberg foam rubber closed eyes. Concerning the comparison with normality and using the reference values of the Institute of Biomechanics of Valencia, the data from the WL patients showed significant differences in all the parameters analysed, except for gait assessment and the mediolateral directional rhythmic control. CONCLUSIONS Our data confirm that patients in the acute phase of WL have worse postural control than non-injured persons. The results suggest that patients with WL have greater visual dependence. Only a minority of patients had oculomotor abnormalities during early examination.
Collapse
Affiliation(s)
| | | | | | - B Meliá Casado
- Hospital Universitario de La Ribera, Alzira, Valencia, España
| | | |
Collapse
|
8
|
Zheng S, Muheremu A, Sun Y, Tian W, Wu CA. Preoperative imaging differences of patients with cervical spondylosis with cervical vertigo indicate the prognosis after cervical total disc replacement. J Int Med Res 2019; 48:300060519877033. [PMID: 31640443 PMCID: PMC7607185 DOI: 10.1177/0300060519877033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between the preoperative imaging differences and prognosis in patients with cervical spondylosis with cervical vertigo who underwent total disc replacement (TDR). METHODS This was a retrospective study of patients with cervical spondylosis with cervical vertigo treated with single-segment TDR. The severity of pre- and postoperative cervical vertigo was evaluated separately. Paired samples t-tests were used to compare the severity of the symptoms before and after surgery. Characteristics of plain films, computed tomography myelography and magnetic resonance imaging were compared between patients with different outcomes by analysis of variance and Fisher's exact tests. RESULTS The severity of cervical vertigo was significantly different after single-segment TDR. Three groups with different treatment outcomes were not significantly different with regard to gender, age, type of the cervical spondylosis, follow-up time, segment of surgery, cervical curve, range of motion, T2WI high signal in the spinal cord, and location of compression. The type of compression was significantly different between the three groups. CONCLUSIONS Cervical vertigo was improved in patients with cervical spondylosis through the TDR procedure. Those in whom a herniated disc was the main source of compression may have a better prognosis following TDR.
Collapse
Affiliation(s)
- Shan Zheng
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | | | - Yuqing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Cheng-Ai Wu
- Department of Molecular Orthopaedics, Beijing Institute of Traumatology and Orthopaedics, Beijing, China
| |
Collapse
|
9
|
Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. Eur Arch Otorhinolaryngol 2018; 275:2421-2433. [PMID: 30094486 DOI: 10.1007/s00405-018-5088-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients. However, most of these studies have studied the cervicogenic dizziness in general without separating the constitute conditions. Since the aetiopathological mechanism of dizziness varies between these cervicogenic causes, one cannot rely on the universal conclusions of these studies unless the constitute conditions of cervicogenic dizziness are separated and contrasted against each other. METHODS This narrative review of recent literature revisits the pathophysiology and the management guidelines of various conditions causing the cervicogenic dizziness, with an objective to formulate a practical algorithm that could be of clinical utility. The structured discussion on each of the causes of the cervicogenic dizziness not only enhances the readers' understanding of the topic in depth but also enables further research by identifying the potential areas of interest and the missing links. RESULTS Certain peculiar features of each condition have been discussed with an emphasis on the recent experimental and clinical studies. A simple aetiopathological classification and a sensible management algorithm have been proposed by the author, to enable the identification of the most appropriate underlying cause for the cervicogenic dizziness in any given case. However, further clinical studies are required to validate this algorithm. CONCLUSIONS So far, no single clinical study, either epidemiological or interventional, has incorporated and isolated all the constitute conditions of cervicogenic dizziness. There is a need for such studies in the future to validate either the reliability of a clinical test or the efficacy of an intervention in cervicogenic dizziness.
Collapse
Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India.
| |
Collapse
|
10
|
Sensorimotor Control in Individuals With Idiopathic Neck Pain and Healthy Individuals: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:1257-1271. [DOI: 10.1016/j.apmr.2016.09.121] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/25/2022]
|
11
|
Bianco A, Pomara F, Petrucci M, Battaglia G, Filingeri D, Bellafiore M, Thomas E, Paoli A, Palma A. Postural stability in subjects with whiplash injury symptoms: results of a pilot study. Acta Otolaryngol 2014; 134:947-51. [PMID: 25012056 DOI: 10.3109/00016489.2014.906749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Posturographic tests can be used to assess and confirm the body's imbalance in subjects with whiplash injury. Further studies with larger cohorts are necessary to confirm this pilot study. OBJECTIVES To verify through a posturographic exam the qualitative and quantitative alterations of postural stability in subjects with previous cervical trauma in comparison with healthy subjects. METHODS A total of 42 subjects were analysed for the study; 22 as the control group (NM) and 20 (WM) with a positive anamnesis of whiplash injury from 3 to 12 month from diagnosis through a force platform. Centre of pressure (CoP) movements of the two groups with their eyes open and closed were recorded. RESULTS During the closed eye test, the subjects with cervical injuries displayed a significant increase in the anterior-posterior oscillation velocity (p < 0.05) compared with the control group, with a significant reduction (p < 0.01) of the ratio between the shifting length (SL) of CoP on the polygon support and the total envelope area (EA, mm(2)) of CoP movements in the polygon support (SL/EA-ratio, mm(-1)).
Collapse
Affiliation(s)
- Antonino Bianco
- Sport and Exercise Science Research Unit, University of Palermo
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Zuo J, Han J, Qiu S, Luan F, Zhu X, Gao H, Chen A. Neural reflex pathway between cervical spinal and sympathetic ganglia in rabbits: implication for pathogenesis of cervical vertigo. Spine J 2014; 14:1005-9. [PMID: 24291360 DOI: 10.1016/j.spinee.2013.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 09/25/2013] [Accepted: 11/21/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A functional association between cervix and vertigo has been observed in patients with cervical vertigo, implicating correlation between cervical spinal and sympathetic ganglia. However, it is unclear where there is an anatomic connection between those two groups of ganglia. PURPOSE This study aimed to investigate the existence of the neural connections between cervical spinal and sympathetic ganglia. STUDY DESIGN/SETTING FluoroGold staining patterns in cervical spinal and sympathetic ganglia were evaluated using FluoroGold retrograde tracing in New Zealand rabbits. METHODS New Zealand rabbits were randomly divided into superior cervical spinal ganglion injection groups, inferior cervical spinal ganglion injection groups, superior cervical sympathetic ganglion injection group, and inferior cervical sympathetic ganglion injection group. Four percent FluoroGold solution was injected into these ganglia. Distribution of FluoroGold in cervical spinal and sympathetic ganglia was observed under a microscope. RESULTS When FluoroGold solution was injected into C2 and C3 superior cervical spinal ganglia or C5-C6 inferior cervical spinal ganglia, fluorescence was only observed in the ipsilateral superior or inferior cervical sympathetic ganglia, respectively. When FluoroGold solution was injected into superior or inferior cervical sympathetic ganglia, fluorescence was found mainly in the ipsilateral C3-C4 superior or C5-C8 inferior spinal ganglia. No fluorescence was observed in contralateral ganglia of experimental animals and all ganglia of matched control animals injected with physiological saline. CONCLUSIONS Bidirectional nerve fiber connections between cervical spinal and sympathetic ganglia were observed, and these connections are arranged in a segmental distribution. This observation may provide a possible neuroanatomic basis for the pathogenesis of cervical vertigo.
Collapse
Affiliation(s)
- Jinliang Zuo
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China.
| | - Jianlong Han
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Siqiang Qiu
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Fanghai Luan
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Xinwei Zhu
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Haoyuan Gao
- Department of Orthopedics, The 4th Hospital of Jinan, 50 Shifan Rd, Jinan, Shandong Province 250031, China
| | - Anmin Chen
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, Hubei Province 430030, China
| |
Collapse
|
13
|
Giacomello M, Bertella L, Perego S, Zorzella P, Caccianiga G. The Stomatognathic System's Role in the Postural Stabilization in Subjects Suffering from Whiplash Injury Part 1: Patients with Physiological Occlusion. EUR J INFLAMM 2012. [DOI: 10.1177/1721727x120100s216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim of this study is analyze the effects of dental occlusion on postural stability in patients with previous whiplash and normal occlusion. Materials and methods: 36 adult patients with previous whiplash and normal occlusion (good alignment, 1st class or mild 2nd class deep bite for mandibular retrusion) were selected. The patients were suffering from masticatory muscles pain caused by clenching during sleep. Exclusion criteria: use of psych drugs. To simulate the conditions of sleep (with a reduction of proprio-and esteroceptive inputs for postural management performed by CNS), we used postural Romberg analysis (feet together, closed eyes)on stabilometric platform changing occlusal parameters only, under the following conditions: 1) in occlusal rest position, 2) in centric occlusion, 3) in clenching, 4) with occlusal disengage with cotton rolls and 5) in clenching on cotton rolls. Time of each test: 15 seconds. It was performed a statistical analysis with T-test comparing between them the mean of all tests. Results: stabilometry data (postural ball and ellipse) show better postural performances in centric occlusion and clenching in centric occlusion, and a worsening in all tests with occlusal disengage (with statistically significant difference - p<0.05). Conclusions: postural instability caused by whiplash increases muscles tone and dental clenching as compensatory effects, with onset of facial pain. An occlusal disengage (like an occlusal splint to reduce clenching)induces a postural worsening in patients with normal occlusion, while centricocclusion increases the stability. These results suggest that stomatognathic organ has a new physiological function: the posture stabilization.
Collapse
Affiliation(s)
- M.S. Giacomello
- University of Milano-Bicocca, Department of Neurosciences, Dental Clinic, Milano, Italy
| | - L. Bertella
- University of Milano-Bicocca, Department of Neurosciences, Dental Clinic, Milano, Italy
| | - S. Perego
- University of Milano-Bicocca, Department of Neurosciences, Dental Clinic, Milano, Italy
| | - P. Zorzella
- University of Milano-Bicocca, Department of Neurosciences, Dental Clinic, Milano, Italy
| | - G. Caccianiga
- University of Milano-Bicocca, Department of Neurosciences, Dental Clinic, Milano, Italy
| |
Collapse
|
14
|
Silva AG, Cruz AL. Standing balance in patients with whiplash-associated neck pain and idiopathic neck pain when compared with asymptomatic participants: A systematic review. Physiother Theory Pract 2012; 29:1-18. [PMID: 22515180 DOI: 10.3109/09593985.2012.677111] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Neck proprioception is one of the information sources that helps regulate postural balance. However, it is believed to be impaired as patients with both idiopathic neck pain (INP) and whiplash-associated disorders (WAD) have been shown to have a more unstable balance than healthy controls. This systematic review aims to determine if there are significant differences in balance between patients with INP and healthy controls and between patients with WAD and healthy controls. Studies were sought from PubMed, Cinahl, Physiotherapy Evidence Database, Web of Science, Academic Search Complete, Science Direct, and Scielo. Two reviewers independently screened titles and abstracts, assessed full reports for potentially eligible studies, and extracted information on participants' characteristics, pain characteristics, study methods, study results, and study quality. Twelve studies were included in this systematic review. Of these, six compared INP and healthy controls and eight compared WAD and healthy controls. All but one study (11/12) found a statistically significant difference for at least one measurement between patients with INP and WAD and healthy controls. The results of this systematic review suggest that both patients with INP and patients with WAD have poorer balance than healthy controls.
Collapse
Affiliation(s)
- Anabela G Silva
- Adjunct Professor, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal.
| | | |
Collapse
|
15
|
Larrosa F, Durà MJ, Menacho J, González-Sabaté L, Cordón A, Hernández A, García-Ibáñez L. Aphysiologic performance on dynamic posturography in work-related patients. Eur Arch Otorhinolaryngol 2012; 270:93-7. [DOI: 10.1007/s00405-012-1930-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
|
16
|
Ruhe A, Fejer R, Walker B. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain? BMC Musculoskelet Disord 2011; 12:162. [PMID: 21762484 PMCID: PMC3146912 DOI: 10.1186/1471-2474-12-162] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/15/2011] [Indexed: 11/10/2022] Open
Abstract
Background Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between pain intensity and postural sway in adults (aged 50 or less) with non-specific low back pain. Methods Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11), an equal number of patients (n = 11) was enrolled per pain score. Results Generally, our results confirmed increased postural instability in pain sufferers compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were reached with an incremental change in NRS scores of two to three points. Conclusions COP mean velocity and sway area are closely related to self-reported pain scores. This relationship may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation.
Collapse
Affiliation(s)
- Alexander Ruhe
- Murdoch University, Praxis fuer Chiropraktik Wolfsburg, Wolfsburg, Germany.
| | | | | |
Collapse
|
17
|
Ruhe A, Fejer R, Walker B. Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder - A systematic review of the literature. Chiropr Man Therap 2011; 19:13. [PMID: 21609469 PMCID: PMC3121601 DOI: 10.1186/2045-709x-19-13] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 05/24/2011] [Indexed: 12/12/2022] Open
Abstract
Study design Systematic literature review. Objectives To assess differences in center of pressure (COP) measures in patients suffering from non-specific neck pain (NSNP) or whiplash-associated disorder (WAD) compared to healthy controls and any relationship between changes in postural sway and the presence of pain, its intensity, previous pain duration and the perceived level of disability. Summary of Background data Over the past 20 years, the center of pressure (COP) has been commonly used as an index of postural stability in standing. While several studies investigated COP excursions in neck pain and WAD patients and compared these to healthy individuals, no comprehensive analysis of the reported differences in postural sway pattern exists. Search methods Six online databases were systematically searched followed by a manual search of the retrieved papers. Selection Criteria Papers comparing COP measures derived from bipedal static task conditions on a force plate of people with NSNP and WAD to those of healthy controls. Data collection and analysis Two reviewers independently screened titles and abstracts for relevance. Screening for final inclusion, data extraction and quality assessment were carried out with a third reviewer to reconcile differences. Results Ten papers met the inclusion criteria. Heterogeneity in study designs prevented pooling of the data and no direct comparison of data across the studies was possible. Instead, a qualitative data analysis was conducted. There was broad consensus that patients with either type of neck pain have increased COP excursions compared to healthy individuals, a difference that was more pronounced in people with WAD. An increased sway in antero-posterior direction was observed in both groups. Conclusions Patients with neck pain (due to either NSNP or WAD) exhibit greater postural instability than healthy controls, signified by greater COP excursions irrespective of the COP parameter chosen. Further, the decreased postural stability in people with neck pain appears to be associated with the presence of pain and correlates with the extent of proprioceptive impairment, but appears unrelated to pain duration.
Collapse
Affiliation(s)
- Alexander Ruhe
- Murdoch University, Praxis fuer Chiropraktik Wolfsburg, Porschestrasse 1, 38440 Wolfsburg, Germany.
| | | | | |
Collapse
|
18
|
Madeleine P, Nielsen M, Arendt-Nielsen L. Characterization of postural control deficit in whiplash patients by means of linear and nonlinear analyses – A pilot study. J Electromyogr Kinesiol 2011; 21:291-7. [DOI: 10.1016/j.jelekin.2010.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/27/2010] [Accepted: 05/17/2010] [Indexed: 11/30/2022] Open
|
19
|
Baydal-Bertomeu JM, Page AF, Belda-Lois JM, Garrido-Jaén D, Prat JM. Neck motion patterns in whiplash-associated disorders: quantifying variability and spontaneity of movement. Clin Biomech (Bristol, Avon) 2011; 26:29-34. [PMID: 20858573 DOI: 10.1016/j.clinbiomech.2010.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 08/24/2010] [Accepted: 08/24/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND whiplash-associated disorders have usually been explored by analyzing changes in the cervical motor system function by means of static variables such as the range of motion, whereas other behavioural features such as speed, variability or smoothness of movement have aroused less interest. METHODS whiplash patients (n=30), control subjects (n=29) and a group of people faking the symptoms of whiplash-associated-disorders (Simulators, n=30) performed a cyclical flexion-extension movement. This movement was recorded by means of video-photogrammetry. The computed variables were: range of motion, maxima angular velocity and acceleration, and two additional variables that quantify the repeatability of a motion and its spontaneity. Two comparisons were made: Control vs. Patients and Patients vs. Simulators. At each comparison we used ANOVA to detect differences between groups and discriminant analysis to evaluate the ability of these variables to classify individuals. FINDINGS comparison between Controls and Patients showed significant reductions in the range of motion, and both the maximum of angular velocity and acceleration in the Patients. The most efficient discriminant model only included the range of motion and maximum angular velocity. Comparison between Patients and Simulators showed a significant reduction in all measured variables in the Simulators. The best classification model was obtained with maximum angular velocity, spontaneity and repeatability of motion. INTERPRETATION our results suggest that the pathological patterns differ from those of Controls in amplitude and speed of motion, but not in repeatability or spontaneity of movement. These variables are especially useful for detecting abnormal movement patterns.
Collapse
Affiliation(s)
- José M Baydal-Bertomeu
- Instituto de Biomecánica de Valencia, Universidad Politécnica de Valencia, Edificio 9C, Camino de Vera s/n. 46022, Valencia, Spain
| | | | | | | | | |
Collapse
|