Whiplash is nonimpact injuries involving soft-tissue damage to the neck area that can occur during a front-end or rear-end collision, resulting in hyperflexion or hyperextension of the neck muscles. The injuries are caused during accelaration or deceleration in rear-end and front-end collisions. Patients suffering from whiplash injuries report a variety of physical and neurocognitive complaints, particularly memory and attentional problems. Symptoms commonly associated with depression and anxiety are also reported. In fact, as many as 25% or more also endorse signs and symptoms of post-traumatic stress disorder. Despite evidence to the contrary, there is still much debate as to whether or not whiplash or the motion that causes whiplash is sufficient force to cause brain lesions. Due to lack of findings on structural neuroimaging (CT and MRI), some clinicians and researchers believe that whiplash injuries are non-existent at low speeds and that whiplash symptoms merely reflect psychological problems or a means of gaining attention and financial compensation. However, recent research has challenged these claims, reporting that most articles that refute the validity of whiplash syndrome are methodologically flawed (Freeman et al., 1999). In addition, new findings also indicate that although MRI studies are not sensitive in detecting brain damage, quantitative electroencephalography (QEEG) shows significant wide range circuitry dysfunction, particularly increased spike wave activity and frontocentral slowing (Henry et al., 2000).
Previous research predicting recovery after whiplash has found that initial neck pain and headache intensity, impaired neck movement, prior history of headaches or head trauma, older age, problems with attention, and high levels of anxiety and neuroticism are all predictors for poor outcome at one year after injury (Radanov & Sturzenegger, 1996). Socio-demographic factors (i.e., female gender, older age, lack of full-time employment, and being responsible for dependents), as well as crash-related factors (i.e., being the passenger, colliding with a moving object, and head-on or perpendicular collision) have been correlated with a poorer prognosis and thus, a slower and more costly recovery (Harder et al., 1998).
Stress has a negative effect on the overall recovery after whiplash. A study in Sweden (Smed, 1997) found that patients who reported having stressful events in their lives unrelated to the accident itself express more overall symptoms and distress than their counterparts without the added stress. In addition, the stressed patients faired worse in terms of stress and subjective cognitive functioning several months after the date of injury. This research suggests that clinicians should not only assess the patients’ cognitive abilities and accident related symptomatology, but should also evaluate global functioning.
What to do with patients who may have whiplash injuries? The research confirms what most of us who assess these patients already know; comprehensive assessment soon after injury is crucial to provide a cognitive and psychological baseline in order to track any changes that may occur and to identify those patients who are at risk of poor recovery. A neuropsychological consultation is recommended to differentiate cognitive complaints due to pain or psychological factors versus acquired traumatic brain injury. In addition, an initial consultation also serves to educate the patient about their injuries and to develop a rehabilitation treatment program, which may include the implementation of compensatory strategies and psychotherapy. By providing immediate interventions to whiplashed patients, one may reduce the likelihood of further symptomatology and secondary accidents.