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Self-reported Dysphagia and Pharyngeal Volume Following Whiplash Injury

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Abstract

Difficulty swallowing has been reported following whiplash injury; however, the reasons remain poorly understood. A possible factor may be the observed changes in pharyngeal volume. The current exploratory study was designed to examine the prevalence of self-reported dysphagia after whiplash and the relationship with recovery status and change in pharyngeal volume. Data were available from a longitudinal study of adults with whiplash. Data included magnetic resonance imaging (MRI) of the cervical spine, the Dysphagia Handicap Index (DHI), and Neck Disability Index (NDI) collected over four timepoints (< 1 week, 2 weeks, 3 months, and 12 months post-injury). Initial cross-sectional analysis examined 60 patients with DHI data from at least one timepoint. A second, longitudinal analysis was conducted on 31 participants with MRI, NDI, and DHI data at both early (< 1–2 weeks) and late (3–12 months) timepoints. The pharynx was contoured on axial T2-weighted MRI slices using OsiriX image processing software and pharyngeal volume (mm3) was quantified. In the 60-patient cohort, prevalence of self-reported dysphagia (DHI ≥ 3) was observed in 50% of participants at least once in 12 months (M = 4.9, SD 8.16, range 0–40). In the longitudinal cohort (n = 31), mean total DHI significantly (p = 0.006) increased between early and late stages. There was no relationship (p = 1.0) between dysphagia and recovery status, per the NDI% score. Pharyngeal volume remained stable and there was no relationship between dysphagia and pharyngeal volume change (p = 1.0). This exploratory study supports the need for further work to understand the nature of dysphagia, extent of functional compromise, and the underlying pathophysiology post-whiplash.

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Data Availability

Data were taken at the Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

References

  1. Carroll LJ, Ferrari R, Cassidy JD. Reduced or painful jaw movement after collision-related injuries—a population-based study. J Am Dent Assoc. 2007;138(1):86–93. https://doi.org/10.14219/jada.archive.2007.0026.

    Article  PubMed  Google Scholar 

  2. Gronqvist J, Haggman-Henrikson B, Eriksson PO. Impaired jaw function and eating difficulties in whiplash-associated disorders. Swed Dent J. 2008;32(4):171–7.

    PubMed  Google Scholar 

  3. Häggman-Henrikson B, Österlund C, Eriksson P, Häggman-Henrikson B, Osterlund C, Eriksson PO. Endurance during chewing in whiplash-associated disorders and TMD. J Dent Res. 2004;83(12):946–50.

    Article  Google Scholar 

  4. Ferrari R, Russell AS, Carroll LJ, Cassidy JD. A re-examination of the whiplash associated disorders (WAD) as a systemic illness. Ann Rheum Dis. 2005;64(9):1337–42.

    Article  CAS  Google Scholar 

  5. Bordoni B, Marelli F, Morabito B. The tongue after whiplash: case report and osteopathic treatment. Int Med Case Rep J. 2016;9:179–82. https://doi.org/10.2147/IMCRJ.S111147.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sturzenegger M, Radanov BP, Di Stefano G. The effect of accident mechanisms and initial findings on the long-term course of whiplash injury. J Neurol. 1995;242(7):443–9.

    Article  CAS  Google Scholar 

  7. Hildingsson C, Hietala SO, Toolanen G. Scintigraphic findings in acute whiplash injury of the cervical spine. Injury. 1989;20(5):265–6. https://doi.org/10.1016/0020-1383(89)90164-2.

    Article  CAS  PubMed  Google Scholar 

  8. Gargan MF, Bannister GC. The rate of recovery following whiplash injury. Eur Spine J. 1994;3(3):162–4.

    Article  CAS  Google Scholar 

  9. Pennie B, Agambar L. Patterns of injury and recovery in whiplash. Injury. 1991;22(1):57–9.

    Article  CAS  Google Scholar 

  10. Kalezic N, Noborisaka Y, Nakata M, Crenshaw AG, Karlsson S, Lyskov E, Eriksson PO. Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD). Arch Oral Biol. 2010;55(6):447–53. https://doi.org/10.1016/j.archoralbio.2010.03.015.

    Article  PubMed  Google Scholar 

  11. Severinsson Y, Bunketorp O, Wenneberg B. Jaw symptoms and signs and the connection to cranial cervical symptoms and post-traumatic stress during the first year after a whiplash trauma. Disabil Rehabil. 2010;32(24):1987–98. https://doi.org/10.3109/09638281003797323.

    Article  PubMed  Google Scholar 

  12. Lampa E, Wanman A, Nordh E, Haggman-Henrikson B. Effects on jaw function shortly after whiplash trauma. J Oral Rehabil. 2017;44(12):941–7. https://doi.org/10.1111/joor.12571.

    Article  CAS  PubMed  Google Scholar 

  13. Anagnostara A, Athanassopoulou A, Kailidou E, Markatos A, Eystathidis A, Papageorgiou S. Traumatic retropharyngeal hematoma and prevertebral edema induced by whiplash injury. Emerg Radiol. 2005;11(3):145–9.

    Article  Google Scholar 

  14. Elliott J, Cannata E, Christensen E, Demaris J, Kummrow J, Manning E, Nielsen E, Romero T, Barnes C, Jull G. MRI analysis of the size and shape of the oropharynx in chronic whiplash. Otolaryngol—Head Neck Surg. 2008;138(6):747–51. https://doi.org/10.1016/j.otohns.2008.02.015.

    Article  PubMed  Google Scholar 

  15. Elliott JM, Pedler AR, Theodoros D, Jull GA. Magnetic resonance imaging changes in the size and shape of the oropharynx following acute whiplash injury. J Orthop Sports Phys Ther. 2012;42(11):912–8. https://doi.org/10.2519/jospt.2012.4280.

    Article  PubMed  Google Scholar 

  16. Molfenter SM, Amin MR, Branski RC, Brumm JD, Hagiwara M, Roof SA, Lazarus CL. Age-related changes in pharyngeal lumen size: a retrospective MRI analysis. Dysphagia. 2015;30(3):321–7. https://doi.org/10.1007/s00455-015-9602-9.

    Article  PubMed  Google Scholar 

  17. Iida T, Kagaya H, Inamoto Y, Shibata S, Saitoh E, Kanamori D, Hashimoto S, Katada K, Tohara H, Ueda K. Measurement of pharyngo-laryngeal volume during swallowing using 320-row area detector computed tomography. Dysphagia. 2017;32(6):749–58. https://doi.org/10.1007/s00455-017-9818-y.

    Article  PubMed  Google Scholar 

  18. Molfenter SM, Lenell C, Lazarus CL. Volumetric changes to the pharynx in healthy aging: consequence for pharyngeal swallow mechanics and function. Dysphagia. 2019;34(1):129–37. https://doi.org/10.1007/s00455-018-9924-5.

    Article  PubMed  Google Scholar 

  19. Molfenter SM, Brates D, Herzberg E, Noorani M, Lazarus C. The swallowing profile of healthy aging adults: comparing noninvasive swallow tests to videofluoroscopic measures of safety and efficiency. J Speech Lang Hear Res. 2018;61(7):1603–12. https://doi.org/10.1044/2018_JSLHR-S-17-0471.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Leonard R, Kendall KA, McKenzie S. Structural displacements affecting pharyngeal constriction in nondysphagic elderly and nonelderly adults. Dysphagia. 2004;19(2):133–41. https://doi.org/10.1007/s00455-003-0508-6.

    Article  PubMed  Google Scholar 

  21. Elliott J, Jull G, Noteboom JT, Galloway G. MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders (WAD). Man Ther. 2008;13(3):258–65. https://doi.org/10.1016/j.math.2007.01.012.

    Article  PubMed  Google Scholar 

  22. Kang CH, Hentz JG, Lott DG. Muscle tension dysphagia: symptomology and theoretical framework. Otolaryngol-Head Neck Surg. 2016;155(5):837–42.

    Article  Google Scholar 

  23. Kang CH, Zhang N, Lott DG. Muscle tension dysphagia: contributing factors and treatment efficacy. Ann Otol Rhinol Laryngol. 2020. https://doi.org/10.1177/0003489420966339.

    Article  PubMed  Google Scholar 

  24. Vernon H. The Neck Disability Index: state-of-the-art, 1991–2008. J Manip Physiol Ther. 2008;31(7):491–502. https://doi.org/10.1016/j.jmpt.2008.08.006.

    Article  Google Scholar 

  25. Crombez G, Vlaeyen JWS, Heuts PHTG, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1):329–39. https://doi.org/10.1016/S0304-3959(98)00229-2.

    Article  CAS  PubMed  Google Scholar 

  26. Walton D, Elliott JM. A higher-order analysis supports use of the 11-item version of the tampa scale for kinesiophobia in people with neck pain. Phys Ther. 2013;93(1):60–8. https://doi.org/10.2522/ptj.20120255.

    Article  PubMed  Google Scholar 

  27. Smith CA, Wallston KA, Dwyer KA. On babies and bathwater: disease impact and negative affectivity in the self-reports of persons with rheumatoid arthritis. Health Psychol. 1995;14(1):64. https://doi.org/10.1037/0278-6133.14.1.64.

    Article  CAS  PubMed  Google Scholar 

  28. Brown GK, Nicassio PM. Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. Pain. 1987;31(1):53.

    Article  Google Scholar 

  29. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med. 1994;10(2):77–84. https://doi.org/10.1016/S0749-3797(18)30622-6.

    Article  CAS  PubMed  Google Scholar 

  30. Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41(3):209–18. https://doi.org/10.1097/00006842-197905000-00004.

    Article  CAS  PubMed  Google Scholar 

  31. Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The dysphagia handicap index: development and validation. Dysphagia. 2012;27(1):46–52. https://doi.org/10.1007/s00455-011-9336-2.

    Article  PubMed  Google Scholar 

  32. Abbott R, Peolsson A, West J, Elliott JM, Aslund U, Karlsson A, Leinhard OD. The qualitative grading of muscle fat infiltration in whiplash using fat and water magnetic resonance imaging. Spine J. 2018;18(5):717–25. https://doi.org/10.1016/j.spinee.2017.08.233.

    Article  PubMed  Google Scholar 

  33. Karlsson A, Leinhard OD, Aslund U, West J, Romu T, Smedby O, Zsigmond P, Peolsson A. An investigation of fat infiltration of the multifidus muscle in patients with severe neck symptoms associated with chronic whiplash-associated disorder. J Orthop Sports Phys Ther. 2016;46(10):886–93. https://doi.org/10.2519/jospt.2016.6553.

    Article  PubMed  Google Scholar 

  34. Elliott JM, Courtney DM, Rademaker A, Pinto D, Sterling MM, Parrish TB. The rapid and progressive degeneration of the cervical multifidus in whiplash: a MRI study of fatty infiltration. Spine. 2015;40(12):E694–700. https://doi.org/10.1097/BRS.0000000000000891.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pink J, Petrou S, Williamson E, Williams M, Lamb SE. Economic and health-related quality of life outcomes of whiplash associated disorders. Spine. 2016;41(17):1378–86. https://doi.org/10.1097/brs.0000000000001512.

    Article  PubMed  Google Scholar 

  36. Brauer S. Acute whiplash: guidelines for the management of acute whiplash-associated disorders. Aust J Physiother. 2008;54(2):147.

    Google Scholar 

  37. Rosset A, Spadola L, Ratib O. OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging. 2004;17(3):205–16. https://doi.org/10.1007/s10278-004-1014-6.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Haggman-Henrikson B, Zafar H, Eriksson PO. Disturbed jaw behavior in whiplash-associated disorders during rhythmic jaw movements. J Dent Res. 2002;81(11):747–51.

    Article  CAS  Google Scholar 

  39. Papageorgiou AC, Silman AJ, Macfarlane GJ. Chronic widespread pain in the population: a seven year follow up study. Ann Rheum Dis. 2002;61(12):1071. https://doi.org/10.1136/ard.61.12.1071.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Campbell L, Smith A, McGregor L, Sterling M. Psychological factors and the development of chronic whiplash-associated disorder(s): a systematic review. Clin J Pain. 2018;34(8):755.

    Article  Google Scholar 

  41. Berecki-Gisolf J, Hassani-Mahmooei B, Collie A, McClure R. Prescription opioid and benzodiazepine use after road traffic injury. Pain Med. 2016;17(2):304–13. https://doi.org/10.1111/pme.12890.

    Article  PubMed  Google Scholar 

  42. Walton DM, Elliott JM. An integrated model of chronic whiplash-associated disorder. J Orthop Sports Phys Ther. 2017;47(7):462–71. https://doi.org/10.2519/jospt.2017.7455.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Walton DM, Pretty J, MacDermid JC, Teasel RW. Risk factors for persistent problems following whiplash injury: results of a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2009;39(5):334–50. https://doi.org/10.2519/jospt.2009.2765.

    Article  PubMed  Google Scholar 

  44. Côté P, Cassidy JD, Carroll L, Frank JW, Bombardier C. A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature. Spine. 2001;26(19):E445–58.

    Article  Google Scholar 

  45. Borsbo B, Peolsson M, Gerdle B. Catastrophizing, depression, and pain: correlation with and influence on quality of life and health—a study of chronic whiplash-associated disorders. J Rehabil Med. 2008;40(7):562–9. https://doi.org/10.2340/16501977-0207.

    Article  PubMed  Google Scholar 

  46. Buitenhuis J, de Jong PJ, Jaspers JP, Groothoff JW. Relationship between posttraumatic stress disorder symptoms and the course of whiplash complaints. J Psychosom Res. 2006;61(5):681–9. https://doi.org/10.1016/j.jpsychores.2006.07.008.

    Article  PubMed  Google Scholar 

  47. Coppieters I, Ickmans K, Cagnie B, Nijs J, De Pauw R, Noten S, Meeus M. Cognitive performance is related to central sensitization and health-related quality of life in patients with chronic whiplash-associated disorders and fibromyalgia. Pain Physician. 2015;18(3):E389–401.

    PubMed  Google Scholar 

  48. Daenen L, Nijs J, Roussel N, Wouters K, Van Loo M, Cras P. Dysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study. Clin Rheumatol. 2013;32(1):23–31.

    Article  Google Scholar 

  49. Davis CG. Mechanisms of chronic pain from whiplash injury. J Forensic Leg Med. 2013;20(2):74–85. https://doi.org/10.1016/j.jflm.2012.05.004.

    Article  PubMed  Google Scholar 

  50. Elliott JM, Noteboom JT, Flynn TW, Sterling M. Characterization of acute and chronic whiplash-associated disorders. J Orthop Sports Phys Ther. 2009;39(5):312–23. https://doi.org/10.2519/jospt.2009.2826.

    Article  PubMed  Google Scholar 

  51. Carroll LJ, Holm LW, Hogg-Johnson S, Côtè P, Cassidy JD, Haldeman S, Nordin M, Hurwitz EL, Carragee EJ, van der Velde G, Peloso PM, Guzman J. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manip Physiol Ther. 2009;32(2):S97–107. https://doi.org/10.1016/j.jmpt.2008.11.014.

    Article  Google Scholar 

  52. Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 2008;138(3):617–29. https://doi.org/10.1016/j.pain.2008.02.019.

    Article  PubMed  Google Scholar 

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Funding

The project described was supported by the National Institutes of Health (NIH) through Grant Number R01HD079076: Eunice Kennedy Shriver National Institute of Child Health & Human Development; National Center for Medical Rehabilitation Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia

    D. Stone, H. Bogaardt, R. Heard & J. M. Elliott

  2. Speech Pathology Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia

    D. Stone

  3. Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia

    D. Stone & J. M. Elliott

  4. School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR) Metro South Hospital and Health Services, Brisbane, QLD, Australia

    E. C. Ward

  5. Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    B. Martin-Harris

  6. Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA

    A. C. Smith

  7. Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    J. M. Elliott

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  1. D. Stone
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Stone, D., Ward, E.C., Bogaardt, H. et al. Self-reported Dysphagia and Pharyngeal Volume Following Whiplash Injury. Dysphagia 36, 1019–1030 (2021). https://doi.org/10.1007/s00455-020-10233-9

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