DECREASED PROPRIOCEPTION AND AFFECT ON BRAIN FUNCTION

Spine 1992, Feb. 17; (2): 127-31.  Evidence has been documented the post-traumatic whiplash syndrome results in cognitive disturbances as a consequence of altered cervical spine proprioception.  Undetectable physical injury of the cervical spine is probably the facet proprioceptors resulting in disturbance to the brain.

Gimse R, Tjell C, BjorgenIA, Sauntte C.   Disturbed eye movements after whiplash due to injuries to the posture control system.  J Clin Exp Neuorpsychol. 1996 Apr; 18 (2): 178-86.

Whiplash group deviated from the control group on measure of eye movements during reading, on smooth pursuit eye movements with the head in normal position, and with body turned to the left or to the right.  Clinical, caloric and neurophysiological tests showed no injury to the vestibular system or to the CNS.  Test results suggest that injuries to the neck due to whiplash can cause distortion of the posture control system as a result of disorganized neck and proprioceptive activity. 

Gimse R, Tjell C, BjorgenIA, Tyssedal JS, Bo K.  Reduced cognitive function in a group of whiplash patients with demonstrated disturbances in the posture control system.  J Clin Exp Neuorpsychol. 1997 Dec; 19(6): 838-49.  Smooth pursuit has been altered in patients with whiplash injuries.  It has been suggested that the neck muscle proprioceptive system can influence the oculomotor and vestibular system.  Suggests that cognitive interpretation can be influenced by neck proprioceptive input and other changes in the interacting postural control system.  Right parietal lesion with left neglect-patient localized body’s sagittal midplane 15 degrees to the right could compensate with left caloric stimulation or neck muscle vibration. 

Alexander MP.   In the pursuit of proof of brain damage after whiplash injury.  Neurology.  1998 Aug; 51(2): 336-40.  Chronic whiplash patients complain of cognitive deficits.  Parietal hypoperfusion identified on SPECT.  Medical treatment of whiplash (or mild traumatic brain injury) is towards psychological consequences (depression/anxiety) rather than at neurologic consequences.  Steadfast efforts to increase physical and mental activity comprise optimal management. 

Tjell C, RosenhallU.  Smooth pursuit neck torsion test: a specific test for cervical dizziness.   Am J Otol.  1998 Jan; 19(1): 76-81.  Control of body posture is integrated in the flocculus of the midcerebellum.  Alteration in pursuit is related to abnormal input from the neck proprioceptors. 

Mallinson AI, LongridgeNS.  Dizziness from whiplash and head injury: differences between whiplash and head injury.  Am J Otol.  1998 Nov; 19(6): 814-8.  The whiplash motion itself does not necessarily cause traumatic brain injury.  It may be the altered afferent stimulation from proprioceptors in the cervical spine rather than a blow to the head. 

Heikkila HV, Wenngren BI.   Cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury.  Arch Phys Med Rehabil.  1998 Sep; 79(9): 1089-94.  Active head repositioning was significantly less precise in whiplash subjects.  Restricted cervical movements and changes in the quality of proprioceptive information from the cervical spine affect voluntary eye movements.  Oculomotor dysfunction after neck trauma might be related to cervical afferent input disturbances. 

Radanov BP, Bicik I, Dvorak J, Antinnes J, Von Schulthess GK, Buck A.   Relation between neuropsychological and neuroimaging findings in patients with late whiplash syndrome.  J Neurol Neurosurg Psychiatry.  1999 Apr; 66(4): 485-9.  No structural damage identified by MRI/CT.  Brain damage in the frontal regions, parieto-occipital hypoperfusion may be explained by activation of nociceptive afferents from the upper cervical spine.  Patients averaged below normal performance levels on tasks of divided attention and working memory.  Significant correlation between pain intensity, emotional-psychological factors, and cognition. 

OmmayaAK, Faas F, Yarnel P.  Whiplash injury and brain damage: an experimental study.  JAMA. 1968 Apr 22; 204(4): 285-9.  It is matter of crucial importance that we investigate and manage the clinical problems of whiplash injuries in our patients not only with regard to the musculoskeletal system and peripheral nervous system but also with greater attention to the finer details of behavioral and neurological deficits. 

AndaryMT, Crewe N, Ganzel SK, Haines-Pepi C, Kulkani MR, Stanton DF, Thompson A, Yosef M.  Traumatic brain injury/chronic pain syndrome: a case comparison study.  Clin J Pain. 1997 Sep; 13(3): 244-50.  Patient’s who exhibit memory or concentration problems, who express confusion about their diagnosis, who were injured in an auto accident, or who complain of pain in the head, neck or arms should be questioned about the possibility of concurrent traumatic brain injury.  Most of these patients with TBI may require a longer treatment time.