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If you happen to be looking left or right when your car is rear-ended, you could be lucky enough to avoid the headache of whiplash. A new study at the University of Alberta shows that whiplash injuries in low-speed accidents are much less likely if the victim’s head happens to be turned to either side instead of facing front when the vehicle is struck.

The research involving neck muscles is giving a solid scientific definition to whiplash that may help identify and establish soft tissue injuries–if any are actually suffered in the course of an accident.

Results from the study appear in the November, 2004 issue of Clinical Biomechanics. The findings, based on research begun at the university in 1999, will help clear up the murky definition of whiplash–injuries to the head and neck most commonly suffered in rear-end vehicle collisions, said Dr. Shrawan Kumar, a professor of physical therapy and neuroscience at the University of Alberta.

“Having a scientific framework for whiplash injects a great deal of objectivity into a subjective realm where there are a lot of legal claims and counter-claims. It clears up some of the mystery surrounding the condition,” said Dr.Kumar, lead author on the paper.

Using 20 healthy volunteers and a special sled equipped with a rotating chair (complete with a seatbelt) and a pneumatic piston, the researchers measured the response of six different neck muscles to gradually increased low-velocity impacts from eight different directions. The muscle responses were measured using surface electrodes.

Each volunteer was fitted at the forehead and top of the back with accelerometers–devices which measured the effect of impact on the head-neck motion. The acceleration of the chair was also recorded.

The tests revealed that there was less risk of injury when the subjects had their heads turned either to the right or to the left at the time of low-velocity impact (up to 10 km/h). “The act of turning the head tenses the muscles, which prevents movement of the neck and decreases the chances of soft tissue injury,” Dr. Kumar said.

Low-velocity whiplash is one of the most contentious injuries in the legal arena. The effects of low-speed, rear-end collisions have not previously been extensively researched, and that has left a gray area in diagnosing soft-tissue injuries, Dr. Kumar said. The muscles and ligaments of the neck–not the bones–are more at risk in low-speed accidents, he noted.

The findings will indirectly benefit people who claim questionable whiplash injuries, he added. “This should prevent a person, if rear-ended, from assuming a ’sick role’, disabling oneself psychologically and socially, hoping to gain something.”

The information gathered from the research can also be used in developing safety features to protect drivers even in low-velocity collisions.

This study is the latest in a series conducted on whiplash since 1999 by Dr. Kumar and his fellow researchers, Dr. Robert Ferrari and Yogesh Narayan.

In an earlier research project using similar test methods, Dr. Kumar and his colleagues determined that in a low-speed rear-end collision, it is the front ligatures of the neck, not the back ones, that are at greater risk of injury, and that the opposite is true for front-end collisions. This contradicts a common assumption that a rear-end collision will do the most damage to the back of the head and neck, Dr. Kumar said.

They also found that mere awareness of an impending impact reduces the head-neck acceleration by 40 per cent, mitigating the risk of injury.

“Based on scientific evidence, we can now show there is a certain degree of safety built into the human system which needs to be exceeded before injury can be precipitated.”

The source of this article is http://www.sciencedaily.com/releases/2004/11/041123104315.htm

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Researchers are calling for the creation of a collaborative registry to assess the risk of serious injuries when treating children using spinal manipulation. A recent study done in part by the University of Alberta in Edmonton, Canada, concludes that although serious adverse events have been identified when spinal manipulation is used to treat children, their true incidence remains unknown, and these events must be better reported. Patient safety demands a greater collaboration between the medical community and other health care professionals, the study suggests.

A team of researchers representing multiple professions that provide spinal manipulation conducted the study, the results of which were published in a recent issue of the journal Pediatrics.

They reviewed data drawn from 13 international studies conducted over a period of more than 40 years and found that adverse reactions in children appeared to be rare compared to the numbers of spinal manipulations performed. But those injuries that occurred, such as stroke and paraplegia, were serious enough to warrant further investigation and the development of an active surveillance registry to gather data about the quantity and quality of adverse events so that precise risk estimates can be made.

“Despite the fact that spinal manipulation is commonly used on children, exceedingly few serious injuries or adverse events have been reported,” said Dr. Kim Humphreys, one of the study authors and dean of Graduate Education and Research at the Canadian Memorial Chiropractic College.

“We are unclear if that is because they do not occur, or because they are not reported,” added lead author Dr. Sunita Vohra, an associate professor in the Department of Pediatrics at the University of Alberta and a pediatrician with the Capital Health Authority in Alberta.

In the data reviewed worldwide, 14 identified cases of direct adverse reactions following spinal manipulation in children 18 and younger were found. Nine were serious, resulting in hospitalization, permanent disability or death. Three of the nine cases involved misdiagnosed underlying pathology such as cancer of the spinal cord. Two involved moderately adverse events such as severe headache requiring medical attention, and three involved minor events such as back soreness.

An additional 20 cases were identified as delayed diagnosis and/or inappropriate delivery of spinal manipulation for serious medical conditions requiring the care of a physician. Eight of the cases involved delayed treatment of cancer and two of meningitis. Three of the eight cases resulted in death. All of the most serious adverse events occurred in children 13 and younger.

Spinal manipulation may be provided by a variety of health care providers such as physicians and physical therapists, but is most often provided by chiropractors. Children made an estimated 30 million visits to U.S. chiropractors in 1997, according to the study. While there is little Canadian data on the percentage of children receiving chiropractic care, a more recent survey of 1,800 participants in a Canadian pediatric hospital showed that 31 per cent of children had at some time received treatment from a chiropractor.

“Safety begins with communication,” said Dr. Vohra. “Improved dialogue between parents and their child’s doctor, about all of their child’s health care practices, as well as between health care providers, is key.”

The source of this article is  http://www.sciencedaily.com/releases/2007/04/070426111316.htm

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Anybody who’s tried to concentrate on work while suffering a headache knows that pain compellingly commands attention–which is how evolution helped ensure survival in a painful world. Now, researchers have pinpointed the brain region responsible for pain’s ability to affect cognitive processing. They have found that this pain-related brain region is distinct from the one involved in cognitive processing interference due to a distracting memory task.

Ulrike Bingel and colleagues at the University Medical Center Hamburg-Eppendorf published their discovery in the July 5, 2007 issue of the journal Neuron.

To search for the region responsible for pain’s ability to usurp attention, the researchers asked volunteers to perform a cognitive task involving distinguishing images, as well as a working memory task involving remembering images. The researchers asked the volunteers to perform the tasks as they experienced different levels of pain caused by the zapping of their hands by a harmless laser beam.

During these tests, the volunteers’ brains were scanned using functional magnetic resonance imaging (fMRI). In this widely used analytical technique, harmless magnetic fields and radio waves are used to scan the brain to determine blood flow across regions, which reflects brain activity.

The researchers’ experiments identified a brain region called the lateral occipital complex (LOC) as the cognitive-related area affected by both “working memory load” and pain. This finding was expected, since the LOC is known to be involved in processing images.

The researchers next sought to identify the brain region by which pain affects the functioning of the LOC. They theorized that the best candidate for this region was one called the rostral anterior cingulate cortex (rACC). This region is known to be involved in the brain’s processing of pain, and it is part of the anterior cingulate cortex, which plays an important role in “executive” functions such as attentional control. These structures are located deep in the brain in the region of connection between the two hemispheres.

Indeed, the researchers’ fMRI scans indicated that the rACC is, indeed, the brain center through which pain influences the LOC. By contrast, they found a working memory load affects the LOC through a different region, the inferior parietal cortex.

The researchers noted that the modulation of visual processing by pain that they observed in their fMRI studies is behaviorally relevant, because as their fMRI scans showed pain affecting the LOC, they also observed a parallel impairment of accuracy in subjects’ recognition of the images.

The source of this article is http://www.sciencedaily.com/releases/2007/07/070705121857.htm 

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Middle-aged men and women with a history of migraine and other headaches are more likely to have retinopathy, damage to the retina of the eye which can lead to severe vision problems or blindness, than those without a history of headaches, according to a study from the University of North Carolina at Chapel Hill.

For the study, published in the May 15, 2007, issue of Neurology, researchers reviewed the headache history and eye health of 10,902 men and women who participated in the Atherosclerosis Risk in Communities (ARIC) study. Participants, who were from communities in Maryland, Minnesota, Mississippi and North Carolina, were black and white and between the ages of 51 and 71 at the time of their examination.

Twenty-two percent of the participants had a history of migraine or other headaches. Those with a history of headaches were slightly younger, more likely to be female, and more likely to be white than those without a history of headaches.

The study found people with headaches were between 1.3 and 1.5 times more likely to have retinopathy than those without headaches. Among participants who did not have a history of diabetes or hypertension, the association was stronger and limited to those with migraine headaches and other headaches with aura (visual disturbances).

“Middle-aged people with a history of migraine and other headaches are more likely to have retinopathy,” said the study’s lead author Kathryn M. Rose, research assistant professor of epidemiology at the UNC School of Public Health. “This association persisted after controlling for diabetes, glucose levels, cigarette smoking, blood pressure and use of blood pressure medications.”

“Our findings suggest that problems in the circulatory system of small blood vessels may be an underlying factor. This is possible given that anatomically and physiologically small blood vessels in the retina and brain are similar,” said Rose. “Our findings are also consistent with previous studies linking migraine and retinopathy with the occurrence of stroke.”

Other study authors are: Dr. Tien Yin Wong, professor of ophthalmology, Centre for Eye Research Australia, University of Melbourne; April P. Carson, former postdoctoral fellow, and David Couper, biostatistics associate professor, UNC School of Public Health; Dr. Ronald Klein, professor of ophthalmology and visual sciences, University of Wisconsin Medical School; Dr. A Richey Sharrett, adjunct professor of epidemiology, Johns Hopkins University Bloomberg School of Public Health.

The ARIC study was supported by the National Heart, Blood, and Lung Institute of the National Institutes of Health.

The source of this article is http://www.sciencedaily.com/releases/2007/05/070514162230.htm 

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BOSTON – Researchers from Brigham and Women’s Hospital (BWH) have found that patients who suffer from chronic rhinosinusitis (CRS), a long term viral or bacterial sinus infection, can find relief from symptoms which include nasal obstruction, discolored nasal drainage, loss of smell, facial pressure or pain, fatigue and headache, through endoscopic sinus surgery (ESS), a noninvasive outpatient procedure. In addition, study results suggested that ESS helps reduce dependence on antibiotics and antihistamines to mange these symptoms.

CRS is a debilitating form of sinusitis whose symptoms can lead to substantial physical and emotional impairment. According to the Sinus and Allergy Health Partnership (SAHP), approximately 31 million Americans are believed to have a sinus infection each year with approximately 20 million Americans experiencing CRS at some point during their lifetime. Sinusitis is more prevalent than arthritis and hypertension and, when chronic, sinusitis can be as equally debilitating as diabetes and chronic heart disease. In addition, according to the National Center for Health, Americans make 545,000 emergency department visits annually for CRS at significant costs to themselves. CRS sufferers have several treatment options but few that reduce symptoms to the same degree as ESS, a minimally invasive procedure that lasts approximately one to three hours with patients typically returning home that day. ESS allows a surgeon to delicately remove diseased tissue without having to make more radical facial incisions. According to study’s lead researcher Neil Bhattacharyya, MD, division of Otolaryngology at BWH and assistant professor of Otology and Laryngology at Harvard Medical School (HMS), “Patients suffering from CRS symptoms experience a significant negative impact on their quality of life including missed days at work and medical costs associated with frequent treatments. This research demonstrates the clinical effectiveness of ESS to specifically address these symptoms allowing patients to take advantage of a straightforward, noninvasive medical procedure to reduce their symptoms to a point where medication dependence is lessened and quality of life is improved.”

In a nonrandomized clinical trial with 100 adult patients, researchers first conducted a rhinosinusitis symptom inventory, or a listing of the major and minor symptoms associated with CRS, within the study population. After following patients for an average of 19 months, researchers found that following ESS, patients experienced a statistically significant decrease in both major and minor symptoms associated with CRS as compared to the initial inventory. Specifically, researchers noted large size effects for reductions in facial pressure and nasal obstruction in addition to headache and fatigue. And, patients also demonstrated a 50 percent decrease in the number of workdays missed due to physician appointments. Findings also suggested that while use of topical nasal steroids did not appear to lessen after ESS, usage of antibiotics and antihistamines were reduced by 33 percent and 20 percent respectively.

“Prior to this study, the success of ESS to address individual symptoms such as facial pain, smell loss and fatigue, has been questioned, with many medical professionals believing that it provided only an incomplete relief of symptoms and, patients still experienced a high recurrence rate post-surgery,” Bhattacharyya said. “Clearly, this study provides compelling evidence that this may not be the case. Although ESS is not appropriate for every patient with CRS, if significant symptoms persist after appropriate medical treatment, CRS sufferers should talk to their physicians about surgical options that could help improve their quality of life as well as lessen their dependence on antibiotics.”

The source of this article is http://www.sciencedaily.com/releases/2004/03/040323071722.htm

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