Abstract
Whiplash injuries may disrupt normal cervical afferent and efferent projections. Oculomotor abnormalities have been reported in chronic whiplash cases, but there is limited knowledge of their presence in acute whiplash and how acute assessment may target early intervention. We present a literature review and case study of a 22-year-old female presenting with an acute concussion and whiplash secondary to a high-speed motor vehicle collision. Smooth pursuit eye-movement abnormalities were observed in relative cervical rotation in the setting of clinical examination of cervicogenic dysfunction. Treatment was focused on cervical manual therapy. While concussive symptoms resolved after seven days, eye-tracking showed a mild improvement and continued to exist in relationship with cervicogenic dysfunction. After completing physical therapy twice weekly for two weeks and in-home exercises, clinical signs and symptoms of whiplash-associated cervicogenic dysfunction and abnormal smooth pursuit eye-movement resolved across all cervical positions. This case highlights the need for ocular-motor impairment assessment following acute whiplash, specifically during cervical rotation. Early intervention should focus on cervical manual therapy and may be important in supporting altered cervical afferents causing oculomotor dysfunctions following acute whiplash.
Highlights
Traumatic cervical strain, including whiplash, may result in altered sensorimotor control secondary to mechanisms involving pathophysiologic afferent input related to pain and inflammation and the extensive integration of cervical afferents and efferents within the central nervous system [1]
This case report illustrates the use of eye-tracking in conjunction with physical examination for the diagnosis of cervical dysfunction after acute whiplash, and highlights the need for assessment in both concussion and Whiplash-associated disorders (WADs)
Intervention of manual therapy allowed the patient to make a full recovery and return to sport in two weeks, significantly decreasing incidence of chronic neck pain and/or chronic WAD and the sequelae of further symptoms commonly seen after a high-speed motor vehicle accident
Summary
Traumatic cervical strain, including whiplash, may result in altered sensorimotor control secondary to mechanisms involving pathophysiologic afferent input related to pain and inflammation and the extensive integration of cervical afferents and efferents within the central nervous system [1]. The following day, the patient was evaluated by her team’s sports medicine physician, diagnosed with a concussion and cervical strain secondary to WAD, and referred to physical therapy for vestibular and cervical evaluation Her management plan, to begin that day, included supervised, sustained cardiovascular exercises for 20-30 minutes with heart rate greater than 140 beats per minute. The patient was cleared of concussion by the athletic team’s neurologist and sports medicine physician and was allowed to continue progressing through a stepwise return to activity protocol supervised by the team’s athletic trainer At this time, though the patient reported no neck pain at rest, she endorsed persisting mildmoderate cervical hypertonicity with concomitant reduced cervical active range of motion. The variability between neutral and rotated cervical spine position is within normal testing variability
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
