Whiplash-associated Disorders Research Articles

Effectiveness of interventions for middle-aged and ageing population with neck pain: a systematic review and network meta-analysis protocol

IntroductionNeck pain (NP) is a common musculoskeletal complaint and is increasing in prevalence. Current clinical practice guidelines and systematic reviews recommended conservative, pharmacological and invasive interventions for individuals with NP....

Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury: study protocol for a randomized controlled study using a hybrid 2 design

BackgroundPersistent pain and disability in whiplash-associated disorders (WAD) grades II and III are common. In two randomized controlled trials (RCTs) of neck-specific exercises (NSE), we have seen promising results in chronic WAD, with a sustained clinically important reduction in pain and disability. NSE can also be delivered through internet support (NSEIT) and a few visits to a physiotherapist, saving time and cost for both patients and providers. NSE have been shown to have positive effects in other neck pain disorders and we will evaluate the diffusion of the exercises to other patients. The aims of the proposed study are to evaluate an implementation strategy for NSEIT and NSE in primary health care and to evaluate the effectiveness of NSEIT and NSE in clinical practice.MethodsThe proposed study is a prospective cluster-randomized mixed-design study with hybrid 2 trial design. Reg. physiotherapists working in twenty physiotherapy clinics will be included. The primary implementation outcome is proportion of patients with neck pain receiving neck-specific exercise. Secondary outcomes are; physiotherapists attitudes to implementation of evidence-based practice, their self-efficacy and confidence in performing NSEIT/NSE, number of patients visits, and use of additional or other exercises or treatment. To further evaluate the implementation strategy, two qualitative studies will be performed with a sample of the physiotherapists. The primary outcome in the patient effectiveness evaluation is self-reported neck disability according to the Neck Disability Index (NDI). Secondary outcomes are pain intensity in the neck, arm, and head; dizziness; work- and health-related issues; and patient’s improvement or deterioration over time. All measurements will be conducted at baseline and at 3 and 12 months. Physiotherapists´ self-efficacy and confidence in diagnosing and treating patients with neck pain will also be evaluated directly after their instruction in NSEIT/NSE.DiscussionThis trial will evaluate the implementation strategy in terms of adoption of and adherence to NSEIT and NSE in clinical primary health care, and measure diffusion of the method to other patients. In parallel, the effectiveness of the method will be evaluated. The results may guide physiotherapists and health care providers to sustainable and effective implementation of effective exercise programs.Trial registrationThe randomized trial is registered on ClinicalTrials.gov, NCT05198258, initial release date January 20, 2022.

Sex-related differences in sternocleidomastoid muscle morphology in healthy young adults: A cross-sectional magnetic resonance imaging measurement study

BackgroundChanges in sternocleidomastoid (SCM) muscle cross-sectional area (CSA) and volume may contribute to neck-related concussion symptoms and whiplash-associated disorders. Magnetic resonance imaging (MRI) data on healthy SCM morphology can provide information that may lead to targeted treatment protocols. ObjectivesTo examine sex-related differences in MRI-based SCM CSA, SCM volume and neck area in healthy young adults, to analyze associations between measurements and participant variables and to assess inter-rater reliability for measurement quantification. DesignCross-sectional study. Methods13 males and 14 females underwent MRI scans. Slices obtained from C3–C7 were analyzed by three raters. SCM CSA at C4, total SCM volume from C3–C7 and neck area at C4 were quantified. Measurements were calculated as absolute and normalized values by body mass. Multivariable regression was used to analyze associations between normalized measurement values and participant variables. Inter-rater reliability was determined using intraclass correlation coefficients (ICC). ResultsFemales had significantly lower normalized overall average SCM CSA (mean difference 1.3 mm2/kg (95% CI 0.4–2.2, p = 0.006) and total SCM volume (mean difference 140.8 mm3/kg (95% CI 66.1–215.5, p < 0.001) than males. Regression models indicated female sex was associated with lower normalized overall average SCM CSA (p = 0.004) and total SCM volume (p < 0.001). Inter-rater reliability was excellent for SCM CSA (ICC3,3 = 0.909), SCM volume (ICC3,3 = 0.910) and neck area (ICC3,3 = 0.995). ConclusionsThese results enhance our understanding of sex-related differences in SCM morphology and will inform future research and clinical practice related to cervical muscle injury.

Associations Between Resting Heart Rate, Resting Blood Pressure, Psychological Variables and Pain Processing in Chronic Whiplash-Associated Disorder: A Cross-Sectional Study.

Autonomic nervous system dysfunction has been implicated in chronic whiplash-associated disorder (WAD). However, the relationship between autonomic variables (e.g., resting heart rate and blood pressure) and clinical factors in chronic WAD is not well understood. This study sought to examine the associations between resting heart rate, resting blood pressure, pain processing and psychological variables in chronic WAD and in pain-free controls. Secondary analysis of a cross-sectional study. University clinical research laboratory. Thirty-six people with chronic WAD Grade II (mean [SD] age 40.1 [14.6] years, 28 females) and 25 pain-free controls (35.6 [13.0] years, 17 females). Participants had resting heart rate, systolic and diastolic blood pressure measured. Pain processing measures comprised: (i) pain pressure threshold at the cervical spine, hand and leg, (ii) temporal summation at the cervical spine and hand, and (iii) conditioned pain modulation. Psychological outcomes included measures of kinesiophobia, pain catastrophizing and post-traumatic stress symptoms. Correlations between autonomic variables, pain processing and psychological variables were determined (P &lt; .05, 5% FDR). No significant correlations between autonomic and pain processing variables, or autonomic and psychological variables were found in the chronic WAD group. In the control group, diastolic blood pressure was positively correlated with cervical spine pressure pain threshold (r = 0.53, P = .007). An association between blood pressure and pain sensitivity was observed in the control group but not the chronic WAD group. Such an association appears to be disrupted in chronic WAD, which may infer involvement of autonomic pathways in the pathophysiology of this condition.

Do expectations of recovery improve risk assessment for people with whiplash-associated disorders? Secondary analysis of a prospective cohort study

BackgroundWhipPredict, which includes prognostic factors of pain-related disability, age and hyperarousal symptoms, was developed and validated for prediction of outcome in people with whiplash associated disorders (WAD). Patient expectations of recovery was not an included factor, though is known to mediate outcomes. The aim of this study was to determine whether the addition of expectations of recovery could improve the accuracy of WhipPredict.MethodsTwo hundred twenty-eight participants with acute WAD completed questionnaires (WhipPredict and expectations of recovery) at baseline. Health outcomes (neck disability index (NDI) and Global Perceived Recovery (GPR)) were assessed at 6- and 12-months post injury. Cut-off points for expectations of recovery predictive of both full recovery (NDI ≤10 % , GPR ≥ 4) and poor outcome (NDI ≥30 % , GPR ≤ − 3) were determined, and multivariate logistic regression analyses were used to compare models with and without this variable.ResultsExpectations of recovery improved or maintained the accuracy of predictions of poor outcome (6-months: sensitivity 78 to 83%, specificity maintained at 79.5%; 12-months: sensitivity maintained at 80%, specificity 69 to 73%). The sensitivity of predictions of full recovery improved (6-months: 68 to 76%; 12-months: 57 to 81%), though specificity did not change appreciably at 6 months (80 to 81%) and declined at 12 (83 to 76%). ROC curves indicated a larger and more consistent improvement in model performance when expectations of recovery were added to the pathway predictive of full recovery.ConclusionsThe addition of expectations of recovery may improve the accuracy of WhipPredict, though further validation is required.

Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes

ObjectiveTo explore the safety and feasibility of a single autologous injection of platelet-rich plasma (PRP) in cervical facet joints of people with chronic WAD and facet-mediated pain, and explore the association between pain relief reported with diagnostic medial branch blocks (MBBs) and 3-months post-PRP. DesignA prospective case series of people with chronic whiplash-associated disorders and cervical facet joint mediated pain in a community setting. InterventionsA single autologous PRP injection was provided to cervical facet joints under ultrasound and fluoroscopic guidance. MeasuresAdverse events were recorded one-week, and measures of pain (numerical pain rating scale - NPRS) and disability (Neck Disability Index - NDI) were collected prior to and 3-months following cervical facet joint PRP. People not reached for follow-up were considered failures for worst-case analysis. The correlation between percentage response to diagnostic cervical medial branch blocks (MBBs) and percentage pain relief reported at 3-months was also investigated. ResultsForty-four people (82% female; mean age (SD): 45.2 (10.8) years) underwent cervical facet joint PRP. There was a significant improvement in pain and disability following PRP. Seventy percent of people exceeded MCID for pain. For NDI scores, 80% of people exceeded MCID. Forty-one percent of people reported greater than 50% relief of pain 3-months post-cervical facet joint PRP.There was no significant correlation between percentage relief of pain with cervical MBBs and percentage relief of pain 3-months post-PRP (r ​= ​0.06, p ​= ​0.73).There were no adverse events reported. ConclusionIn people with chronic WAD and facet-mediated pain, preliminary data suggests that PRP is safe and it is feasible to move forwards with randomized studies to further investigate efficacy and effectiveness.

Ultrasound assessment of deep cervical extensors morphology and quality in populations with whiplash associated disorders: An intra- and inter-examiner reliability study

BackgroundUltrasound imaging (US) has shown to be a reliable and valid tool for assessing muscle morphology and quality. However, most studies have focused on asymptomatic populations. ObjectiveTo investigate intra- and inter-rater reliability estimates of muscle morphology and quality of cervical multifidus (CM) and short rotators (SR) in patients with whiplash associated disorders (WAD). DesignAn intra- and inter-examiner reliability study. MethodsUS images were acquired in a blinded fashion in 34 patients (35% males) by two experienced and two novice examiners. Cross-sectional area (CSA), perimeter, mean echo-intensity (EI) and the percentage of fatty infiltration were assessed twice, one-week apart, in a randomized order. Reliability estimates (i.e., intra-class correlation coefficients –ICC–, standard error of measurement -SEM-, minimal detectable change, mean of measurements, absolute and percent errors) were calculated. ResultsIntra-examiner reliability for experienced assessors ranged from good to excellent for CM and SR (ICC3,1 = 0.888–0.975 and 0.810–0.964 respectively) and from moderate-to-good for novices (ICC3,1 = 0.708–0.790 and 0.655–0.796 respectively). The agreement between the experienced examiners was moderate to good (ICC3,2 = 0.737–0.899 and 0.728–0.899 CM and SR respectively); between novice and experienced examiners was moderate to good (ICC3,2 = 0.617–0.873 and 0.657–0.766 CM and SR respectively); and between novice examiners was moderate-to-good for CM (ICC3,2 = 0.610–0.777) and moderate for SR (ICC3,2 = 0.600–0.730). ConclusionCM and SR intra-examiner reliability was good-to-excellent for novice and experienced examiners. However, inter-examiner reliability was clinically acceptable just for experienced examiners at the C4/C5 level in WAD populations.

Spinal Cerebrospinal Fluid Leak: Current Concepts and Management Policies

In this article we provide an update on the recent developments in understanding the diagnosis and treatment of spinal cerebrospinal fluid(CSF)leaks. Patients with spinal CSF leak show an increasingly broad spectrum of clinical presentations including intractable whiplash-associated disorder(WAD)and orthostatic dysregulation in childhood, in addition to classical spontaneous intracranial hypotension(SIH). A simple understanding of the condition defined by the presence of low CSF pressure is no longer sufficient or accurate. Fat-suppressed T2-weighted magnetic resonance images and continuous epidural fluid infusion as a diagnostic therapy ensure accurate diagnosis. Accurate localization of the leak followed by targeted epidural blood patch(EBP)significantly improves the outcome of patients with spinal CSF leak. In addition to the known sites of CSF leakage, a newly identified CSF leak site, at the craniovertebral junction dural entry point of the vertebral artery(VA), is described.

The Neck Disability Index Reflects Allodynia and Headache Disability but Not Cervical Musculoskeletal Dysfunction in Migraine.

ObjectiveThe Neck Disability Index (NDI) is a self-rated disability tool originally developed for whiplash-associated disorders and validated in cervical musculoskeletal conditions. It is now commonly used to assess neck disability in migraine, but it is unknown whether NDI scores relate to migraine and hypersensitivity, cervical musculoskeletal dysfunction, or both. This single-blinded observational study aimed to determine whether the presence of cervical musculoskeletal dysfunction, migraine features, and hypersensitivity predict NDI scores and whether alternate versions of the NDI (NDI-physical, NDI-8, NDI-5) relate more to cervical musculoskeletal dysfunction.MethodsMigraine and neck pain features, the Headache Impact Test (HIT-6), NDI, Allodynia Symptom Checklist (ASC12), and pressure pain thresholds were assessed in 104 participants with migraine and neck pain, 45 previously identified with cervical musculoskeletal dysfunction and 59 without. The NDI score was regressed on the presence or absence of cervical dysfunction, migraine features, HIT-6, total pressure pain threshold, and ASC12 while accounting for neck pain features. The presence of cervical dysfunction was regressed on the scores of NDI versions.ResultsThe ASC12 (standardized ß = 0.20) and HIT-6 (standardized ß = 0.18) were significantly predictive of total NDI score, as were neck pain intensity (standardized ß = 0.32) and frequency (standardized ß = 0.44). No scores from alternate NDI versions related to cervical dysfunction.ConclusionThe NDI score is a complex measure of neck disability influenced by migraine disability and hypersensitivity beyond the presence of cervical musculoskeletal dysfunction. This has implications for the clinical interpretation of NDI scores in patients with migraine.ImpactMany patients with migraine and neck pain report neck disability; therefore, it is important to understand if migraine impacts neck disability. The results of this study indicate that clinicians need to consider migraine-related disability and hypersensitivity when managing neck disability in this population.

Higher Neck Pain Intensity and the Presence of Psychosocial Factors Are More Likely When Headache is Present after a Whiplash Injury: A Case-Control Study.

Several factors such as neck pain intensity, disability, anxiety, depression, female sex, or a previous history of headache are associated with post-whiplash headache. However, the possible role of psychosocial factors contributing to the presence of headache or worsening of headache after a whiplash trauma remains unclear. To address this gap in knowledge, there is the need to assess psychosocial factors concerning headache shortly after a whiplash injury. To evaluate psychological features, pain and disability in people with acute whiplash associated disorders (WAD) and compare these features between those with and without headache. Case-control study. A secondary care traumatology center. Forty-seven people with acute WAD were recruited; 28 with headache, and 19 without. All participants completed self-reported questionnaires including Visual Analogue Scale (VAS) for neck pain intensity, the Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia-11 (TSK-11), and State-Trait Anxiety Inventory. Neck pain intensity (P < .001), neck disability (P < 0.001), pain catastrophizing (P < .001), kinesiophobia (P < .001), and anxiety state (P = .007) and trait (P = .05) were higher in those with headache when compared to those without. In addition, high levels of neck pain (P = .025), moderate levels of neck disability (P < .001), moderate levels of pain catastrophizing (P = .015), and moderate (P = .002) and severe (P = .016) levels of kinesiophobia were related to the presence of headache. The level of neck pain intensity and disability, kinesiophobia, catastrophizing, and anxiety were all greater in people with acute WAD who presented with a headache compared to those without headache.

Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders?

This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159–0.909) and 2-year (p = 0.029, 0.057–0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: −0.28–0.499) and 2 years (p = 0.401, −0.226–0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.

Cranio-Mandibular Disorders after Whiplash Injury: A Mono-Institutional Clinical Study on 31 Patients.

Background: Whiplash is a consequence of traumatic injuries, mostly related to road accidents, with variable clinical manifestations, also known as Whiplash Associated Disorders, such as neck, head and temporo-cranio-mandibular pain. Methods: The current study aims to evaluate the onset and evolution of temporomandibular joint pain in people with whiplash in a study group treated with the use of Zimmer Collars (adjustable rigid cervical collars for neck immobilization), as compared to a control group. This prospective study included 31 patients followed by the Dental Prosthesis Department of the University of Bari “Aldo Moro”: 20 patients with whiplash (age range: 20–39 years) treated with Zimmer collars and 11 patients with whiplash (age range: 20–33 years) who were not. Immediately after the whiplash occurred, a visual analogue scale (VAS) was used to describe the intensity of pain and to complete the chart of the European Academy of Craniomandibular Disorders. Five out of twenty patients, already treated with a Zimmer collar, wore an occlusal splint as well because of persistent pain reported at the 28-day and 60-day follow-up and were supported by pharmacological therapy with analgesics (paracetamol) and muscle relaxants (thiocolchicoside). Results: During the last follow-up (at six months), three out of five patients displayed a residual VAS score of 3, 4, and 5, respectively, while the remaining two displayed a VAS of 0. In the control group, four out of eleven patients needed to wear an occlusal splint but without muscle relaxants and analgesics pharmacological therapy; these four corresponded to the patients showing a residual painful symptomatology, with VAS reaching value of 2, and also were the oldest patients of the group. Data regarding VAS values and Zimmer collar use, both at the first visit and six months later, were statistically analyzed. Conclusion: Our prospective study highlights how whiplash-associated acute disorders are often self-limiting over a period of few months, thus reducing the possibility of symptom chronicity; the latter seems to be strictly related to lesion severity, pre-existence of a craniomandibular dysfunction and patient age, but appears to be independent from Zimmer collar use, as statistically confirmed.

From Where We've Come to Where We Need to Go: Physiotherapy Management of Chronic Whiplash-Associated Disorder.

From Where We've Come to Where We Need to Go: Physiotherapy Management of Chronic Whiplash-Associated Disorder.

Autologous Platelet Rich Plasma for the Treatment of Cervical Facet Joint Mediated Pain in Whiplash-Associated Disorders: A Case Series

Autologous Platelet Rich Plasma for the Treatment of Cervical Facet Joint Mediated Pain in Whiplash-Associated Disorders: A Case Series

A Scoping Review for Economic Evaluation of Korean Medicine for Whiplash Associated Disorders

Objectives This study is aimed to evaluate cost-effectiveness of treatment of Korean Medicine for whiplash associated disorders (WAD) and to suggest the direction of future research. Methods We searched papers in Pubmed database to use some keywords indicating whiplash injury syndrome, treatment of Korean Medicine and cost-effectiveness. After searching, appropriate papers were selected depending on the exclusion criteria. The selected papers were analyzed in the sections of author, publication year, intervention and control groups, outcome measurement, the list including in the cost, cost-effectiveness, cost-utility and study design. Results Four studies about effect of Korean medicine and 3 studies about economic evaluation were finally included. Acupuncture was effective for balance disorder and neck pain. Economic evaluation studies used analytical decision model or cost-consequence analysis. Cost-effectiveness analysis using visual analog scale and cost-utility analysis using quality adjusted life years were performed. Initiating timing of proper management affected the consequence of treatments. Direct and indirect medical costs including supportive devices, and non-medical costs such as litigation were considered. Conclusions We conclude that studies haven’t been conducted so far to evaluate the cost-effectiveness of Korean Medicine in whiplash injury syndrome. Thus, future studies are needed in this section.

Are Measures of Physical Function of the Neck Region Associated With Poor Prognosis Following a Whiplash Trauma?: A Systematic Review.

The objective of this study was to synthesize the current evidence regarding the predictive ability of measures of physical function (PF) of the neck region and perceived PF on prognosis following a whiplash injury. Electronic databases were searched by 2 independent reviewers up to July 2020, including MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science as well as gray literature. Eligible studies were selected by 2 reviewers who then extracted and assessed the quality of evidence. Observational cohort studies were included if they involved participants with acute whiplash-associated disorders (WAD), followed for at least 3 months postinjury, and included objective measures of neck PF or self-reported measures of PF as prognostic factors. Data could not be pooled and therefore were synthesized qualitatively. Fourteen studies (13 cohorts) were included in this review. Low to very low quality of evidence indicated that initial higher pain-related disability and higher WAD grade were associated with poor outcome, while there was inconclusive evidence that neck range of motion, joint position error, activity of the superficial neck muscles, muscle strength/endurance, and perceived functional capacity are not predictive of outcome. The predictive ability of more contemporary measures of neck PF such as the smoothness of neck movement, variability of neck motion, and coactivation of neck muscles have not been assessed. Although initial higher pain-related disability and higher WAD grade are associated with poor outcome, there is little evidence available investigating the role of neck PF on prognosis following a whiplash injury.

A Review of the Clinical Utility of Therapeutic Facet Joint Injections in Whiplash Associated Cervical Spinal Pain.

Background and Objective Whiplash neck injury was described by Crowe in 1928. Whiplash-associated disorder (WAD) is defined as a cervical spinal injury following an acceleration-deceleration mechanism. It is a constellation of symptoms due to psychological factors and neural adaptations, with significant social costs. Review Summary There are multiple classification systems for WAD in the literature. The Quebec Classification is most reported and is predictive of the likelihood of progression to chronicity. The facet joint has been identified as a pain generator in 50% of cases. We outline the likely anatomical cause of WAD and summarize the protocol of medial branch block injections for diagnostic and therapeutic purposes, as well as the indications for and published results of facet joint ablation in WAD. We also highlight the development of ultrasound as an alternative to computed tomography or fluoroscopy for injection guidance. Conclusions WAD is a complex condition associated with sensory disturbance, pain, motor chronic pain, and psychological distress. The literature supports a single diagnostic medial branch block followed by a therapeutic facet joint ablation for chronic pain. WAD should be managed in a multidisciplinary fashion, with an early involvement of psychological specialists when required.

Efficacy of acupuncture for whiplash injury: A protocol for systematic review and meta-analysis.

Background:Studies in both Eastern & Western countries such as the United States and Europe have evaluated the efficacy of acupuncture for whiplash injury or whiplash-associated disorder (WAD). However, no systematic reviews on the effectiveness of acupuncture on WAD have been conducted since 2014. Therefore, we are planning an updated systematic review of studies published since 2014 to overcome the limitations of existing evidence.Methods:Literature will be identified from searches of relevant databases, including international databases such as PubMed, Ovid-Medline, Embase, The Cochrane Library, and China National Knowledge Infrastructure and Korean databases such as Korea Med, Korean Studies Information Service System, Oriental Medicine Advanced Searching Integrated System, and National Digital Science Library. Only randomized controlled trials using acupuncture or electro-acupuncture for whiplash injury will be included. The primary outcomes will be the visual analog scale or numerical rating scale of the neck pain, while the secondary outcome is the range of motion of the neck. The risk of bias for individual papers will be assessed by two independent investigators using the Cochrane “Risk of Bias” assessment tool.Dissemination:We plan to report the results of the study in a peer-reviewed journal after completing the research. In addition, we expect this study to provide invaluable information to clinicians treating patients with WAD with acupuncture or electro-acupuncture.Trial registration number:PROSPERO 2021: CRD42021261595. Registered on 18 July 2021. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=261595

Are physical factors associated with poor prognosis following a whiplash trauma?: A systematic review

Purpose: The aim of this systematic review was to summarise and synthesis the current evidence regarding the predictive ability of physical factors in individuals with acute whiplash Associated Disorders (WAD) transitioning to chronic WAD.

Sleep architecture and the absence of trapezius muscle atonia in women with chronic whiplash-associated disorder: a pilot study.

Sleep disturbances frequently occur in people with whiplash-associated disorder (WAD) and have been evaluated using questionnaires or actigraphy. It is not clear whether sleep architecture, as assessed by polysomnography (PSG), is altered in individuals with WAD. Additionally, in people with WAD, muscle dysfunction is observed during tasks performed during wakefulness. Thus, this study aimed to analyze the sleep architecture of patients with chronic WAD as well as to evaluate trapezius muscle activity during sleep. Nine women with chronic WAD and nine healthy age-matched women participated in the study. Two PSG recordings were conducted for each participant. Surface electromyography signal samples of the right and left trapezius, and mentonian muscles were obtained from N2, N3, and REM sleep stages for analysis. Significant differences were found in the percentages of total sleep time in the N1 and N2 stages between the two groups. While the muscle tone of the three muscles analyzed decreased progressively across the sleep stages in the healthy group, in the chronic WAD group, this decrement was observed only in the mentonian muscle, and the trapezius muscle continued to exhibit the same muscle tone throughout the sleep stages without atonia during REM sleep. The absence of trapezius muscle atonia during REM sleep in the WAD patients may be related to dysfunction of the mechanisms that regulate motor activity.