Neck P! with Movement and Coordination Impairment (WAD) Flashcards
What is the proposed underlying cause of Whiplash Associated Disorder (WAD)? (7)
- Trauma often associated with a motor vehicle accident
- Central and Peripheral Nervous system sensitization are common (Nociplastic pain)
- Motor impairment
- Muscle strain and ligamentous sprain
- Fatty infiltration of the neck/extensors
- PTSD
- Concussion is possible
Differential diagnosis for WAD should include other impairment-based diagnoses. What are those different diagnosis?
- Neck pain with mobility deficit
- Neck pain with headache
- Neck pain with radiating pain
- Rotator cuff related shoulder
- Thoracic and/or rib pain with mobility deficit
What system, structure, pain mechanism (phenotype), and phase of healing are unique to WAD patients?
System
- Neuromuscular
Structure
- Ligaments, muscles, central/peripheral nervous system
Pain Mechanism
- Nociceptive (WAD I - WAD B){Minor injury},
- Nociplastic (WAD IIC),
- Nociplastic/Neuropathic (WADIII)
Phase of healing
- Muscle strain 2-4 weeks, ligament sprain 10-12 weeks
What are common subjective reports of patients with motor coordination impairments (WAD)?
(10) Get big picture
- History of trauma often involving MVA
- Neck pain with possible somatic referred pain in UE
- High pain and disability score
- Variable agg/ease factors and 24 hr pain behavior based on dominate pain mechanisms and Quebec classification
- Various nonspecific concussive S/S
- Dizziness/nausea
- Headache, concentration or memory difficulties
- Confusion
- Hypersensitivity to mechanical, thermal, acoustic, odor, light stimuli
- Heightened affective distress
What is the Pain Phenotype/Mechanism of pain for Movement Coordination impairments (WAD)
Nociceptive Pain
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD 0-1}
WAD 0
- No symptoms of neck pain
- No physical signs
WAD I
- Neck symptoms of pain, stiffness, or tenderness
- No physical signs
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD II}
WAD II
Neck Symptoms
- Pain, stiffness, or tenderness
Musculoskeletal signs
- Decreased ROM
- Point tenderness
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD III}
WAD III
Neck Symptoms
- Pain, stiffness, or tenderness
Musculoskeletal signs
- Decreased ROM
- Point tenderness
*Neurological
- Altered DTRs
- Weakness and sensory deficits
What are common findings for patients with movement coordination impairments (WAD) based on the Quebec Classification? {WAD IV}
WAD IV
Fracture or Dislocation
Neck Symptoms
- Pain, stiffness, or tenderness
Musculoskeletal signs
- Decreased ROM
- Point tenderness
*Neurological
- Altered DTRs
- Weakness and sensory deficits
What are common findings for patients with movement coordination impairments (WAD) based on the Sterling Subclassification? {WAD II A}
WAD II A {Flexor Endurance is Poor}
Neck Pain
Motor Impairment
- Decreased ROM
- Altered recruitment patterns (CCFT)
Sensory Impairment
- Local Cervical Mechanical Hyperalgesia
What are common findings for patients with movement coordination impairments (WAD) based on the Sterling Subclassification? {WAD II B}
WAD II B
Neck Pain
Motor Impairment
- Decreased ROM
- Altered recruitment patterns (CCFT)
Sensory Impairment
- Local Cervical Mechanical Hyperalgesia
Psychological Impairment
- Elevated psychological distress
What are common findings for patients with movement coordination impairments (WAD) based on the Sterling Subclassification? {WAD II C}
WAD II C
Neck Pain
Motor Impairment
- Decreased ROM
- Altered recruitment patterns (CCFT)
- Increased joint positioning errors
Sensory Impairment
- Local Cervical Mechanical Hyperalgesia
Generalized sensory hypersensitivity (Mechanical, thermal, bilateral upper lomb neurodynamics testing
Sympathetic nervous system disturbances
Psychological Impairment
- Elevated psychological distress
- Elevated levels of acute post-traumatic stress
In the Objective Examination, what you looking for when doing AROM and PIVM with the patient?
We are looking at the patients ability to move and for Pain Provocation
In the Objective Examination, What will you typically find with AROM with WAD?
- ROM limitations and symptoms provocation will depend on individual patient presentation
- Neck P! with mid-range motion worsens with end-range positions
- May see altered muscle recruitment and aberrant motions
In the Objective Examination, What will you typically find with PIVM (Passive Intervertebral Motion) with WAD?
- Spasm and/or local and/or referred pain reproduction at the involved segments
- Possible hyper-or hypomobility throughout the cerviothoracic spine
When doing Special Test and Measures for Pt. with WAD, What test will you conduct for Advanced Sensory Examination (WAD IIA-WAD IIC and WADIII), and what may you find?
- Pressure Algometry: Reduced pressure threshold (local and regional)
- Ice-Pain Test: Cold Hyperalgesia (Local and Regional)
- ULND 1 (Median N.): + for gross neurodynamics mechanosensitivity
When doing Special Test and Measures for Pt. with WAD, what may you find when you are doing Palpations on the Patient?
- Point tenderness may include myofascial trigger points; Increased muscle tone of superficial cervical muscles
In the Objective Examination for WAD, what special test and measures are you using for muscle performance examination?
- Craniocervical Flexion Test (CCFT)
- Deep Neck Flexor Endurance Test
- Deep Neck Extensor Endurance Test
- Cervical joint position sense test
- Parascapular muscle recruitment and endurance testing
What is the Prognosis for WAD?
- Risk stratification
–Mild disability/post-traumatic stress(45% of pt.)
–Initially moderate improving to mild (40% of pt.)
–Chronic severe problems (15% of pt.) - Recovery happens most rapidly in the 6-12 weeks post-injury
- 50% will fully recover within 1 year
- Considerable slowing to no recovery after 12 months
- No significant recovery between 12 and 24 months
When determining the Prognosis for WAD, what is the clinical prediction rule for this diagnosis?
- Pt. older age (>40)
- Initially higher levels of disability (NDI >40%)
- Hyperarousal symptoms (>6 on hyperarousal subscale)
–Posttraumatic Diagnostic Scale
Patients with this are at a higher risk for long-term disability
What factors may impact the Prognosis of WAD?
- High pain intensity (NPRA >/= 6/10)
- High self-reported disability (NDI >/= 30%)
- High Pain catastrophizing (PCS >/= 20)
- High PTSD Symptoms (IES >/= 33)
- Cold hyperalgesia (extremely sensitive to cold)
Strong association with long-term disability
How would a patient present with WAD in the Acute stage of condition? What is the intervention goal?
- Severity and Irritability are often high
- Pain at rest or with initial to mid-range spinal movement; before tissue resistance
- Pain control is often the intervention goal at this stage
How would a patient present with WAD in the Subacute stage of condition? What is the intervention goal?
- Severity and Irritability are often moderate
- Pain experienced with mid-ranged motions that often worsen with end-range spinal movement; At tissue resistance
- Movement control is often the intervention goal at this stage
How would a patient present with WAS in the Chronic stage of condition? What is the intervention goal?
- Severity and Irritability are often low
- Pain that worsens with sustained end-range spinal movements or positioned; overpressure into tissue resistance
- Functional optimization is often the intervention goal at this stage
