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Prehospital Spinal Immobilization: Effect of Effort on Kinematics of Voluntary Head-neck Motion Assessed using Accelerometry

Published online by Cambridge University Press:  17 December 2015

Rob Pryce  and
Neil McDonald
Rob Pryce*
Affiliation:
Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada
Neil McDonald
Affiliation:
Winnipeg Fire and Paramedic Service, Winnipeg, Manitoba, Canada
*
Correspondence: Rob Pryce, PhD, CAT(C) Department of Kinesiology and Applied Health University of Winnipeg 515 Portage Avenue Winnipeg, Manitoba, Canada, R3B 2E9 E-mail: r.pryce@uwinnipeg.ca
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Abstract

Introduction

Standards for immobilizing potentially spine-injured patients in the prehospital environment are evolving. Current guidelines call for more research into treatment practices. Available research into spinal immobilization (SI) reveals a number of limitations.

Problem

There are currently few techniques for measuring head and neck motion that address identified limitations and can be adapted to clinically relevant scenarios. This study investigates one possible method.

Methods

Study participants were fitted with miniaturized accelerometers to record head motion. Participants were exposed to three levels of restraint: none, cervical-collar only, and full immobilization. In each condition, participants were instructed to move in single planes, with multiple iterations at each of four levels of effort. Participants were also instructed to move continuously in multiple planes, with iterations at each of three levels of simulated patient movement. Peak and average displacement and acceleration were calculated for each immobilization condition and level of effort. Comparisons were made with video-based measurement. Participant characteristics also were tracked.

Results

Acceleration and displacement of the head increased with effort and decreased with more restraint. In some conditions, participants generated measurable acceleration with minimal displacement. Continuous, multi-dimensional motions produced greater displacement and acceleration than single-plane motions under similar conditions.

Conclusion

Study results suggest a number of findings: acceleration complements displacement as a measure of motion in potentially spine-injured patients; participant effort has an effect on outcome measures; and continuous, multi-dimensional motion can produce results that differ from single-plane motions. Miniaturized accelerometers are a promising technology for future research to investigate these findings in realistic, clinically relevant scenarios.

PryceR, McDonaldN. Prehospital Spinal Immobilization: Effect of Effort on Kinematics of Voluntary Head-neck Motion Assessed using Accelerometry. Prehosp Disaster Med. 2016;31(1):36–42.

Keywords

accelerometercervical range of motionEmergency Medical Servicesimmobilizationspinal injuries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 1 , February 2016 , pp. 36 - 42
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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References

1. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors. 8th ed. Chicago, Illinois USA: American College of Surgeons; 2008.Google Scholar
2. McSwain, N, Salomone, J, Pons, P. PHTLS: Prehospital Trauma Life Support. 7th ed. St Louis, Missouri USA: Mosby JEMS; 2011.Google Scholar
3. National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. EMS spinal precautions and the use of the long backboard. Preshop Emerg Care. 2013;17(3):392-393.Google Scholar
4. White, IV CC, Domeier, RM, Millin, MG; Standards and Clinical Practice Committee, National Association of EMS Physicians. EMS spinal precautions and the use of the long backboard -resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. Preshop Emerg Care. 2014;18(2):306-314.CrossRefGoogle Scholar
5. Connor, D, Greaves, I, Porter, K, Bloch, M; consensus group, Faculty of Pre-Hospital Care. Pre-hospital spinal immobilization: an initial consensus statement. Emerg Med J. 2013;30(12):1067-1069.Google Scholar
6. Moss, R, Porter, K, Greaves, I. Minimal patient handling: a faculty of prehospital care consensus statement. Emerg Med J. 2013;30(12):1065-1066.Google Scholar
7. Alson, R, Copeland, D. Long backboard use for spinal motion restriction of the trauma patient. https://www.itrauma.org/wp-content/uploads/2014/05/SMR-Resource-Document-FINAL.pdf. Updated 2014. Accessed September 4, 2014.Google Scholar
8. Morrissey, JF, Kusel, ER, Sporer, KA. Spinal motion restriction: an educational and implementation program to redefine prehospital spinal assessment and care. Prehosp Emerg Care. 2014;18(3):429-432.Google Scholar
9. American College of Emergency Physicians, Board of Directors. EMS management of patients with potential spine injury. http://www.acep.org/Physician-Resources/Policies/Policy-Statements/EMS-Management-of-Patients-with-Potential-Spinal-Injury/. Updated 2015. Accessed April 14, 2015.Google Scholar
10. Voss, S, Page, M, Benger, J. Methods for evaluating cervical range of motion in trauma settings. Scand J Trauma Resusc Emerg Med. 2012;20:50-7241-20-50.Google Scholar
11. Ivancic, PC. Do cervical collars and cervicothoracic orthoses effectively stabilize the injured cervical spine? A biomechanical investigation. Spine (Phila Pa 1976). 2013;38(13):E767-E774.CrossRefGoogle ScholarPubMed
12. Manix, T. The tying game. How effective are body-to-board strapping techniques? J Emerg Med Serv JEMS. 1995;20(6):44-50.Google ScholarPubMed
13. Sarig-Bahat, H, Weiss, PL, Laufer, Y. Cervical motion assessment using virtual reality. Spine (Phila Pa 1976). 2009;34(10):1018-1024.Google Scholar
14. Dixon, M, O’Halloran, J, Cummins, NM. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof of concept study. Emerg Med J. 2014;31(9):745-749.CrossRefGoogle ScholarPubMed
15. Engsberg, JR, Standeven, JW, Shurtleff, TL, Eggars, JL, Shafer, JS, Naunheim, RS. Cervical spine motion during extrication. J Emerg Med. 2013;44(1):122-127.CrossRefGoogle ScholarPubMed
16. Shafer, JS, Naunheim, RS. Cervical spine motion during extrication: a pilot study. West J Emerg Med. 2009;10(2):74-78.Google Scholar
17. Decoster, LC, Burns, MF, Swartz, EE, et al. Maintaining neutral sagittal cervical alignment after football helmet removal during emergency spine injury management. Spine (Phila Pa 1976). 2012;37(8):654-659.CrossRefGoogle ScholarPubMed
18. Treme, G, Diduch, DR, Hart, J, Romness, MJ, Kwon, MS, Hart, JM. Cervical spine alignment in the youth football athlete: recommendations for emergency transportation. Am J Sports Med. 2008;36(8):1582-1586.Google Scholar
19. Perry, SD, McLellan, B, McIlroy, WE, Maki, BE, Schwartz, M, Fernie, GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phila Pa 1976). 1999;24(17):1839-1844.CrossRefGoogle ScholarPubMed
20. Boissy, P, Shrier, I, Briere, S, et al. Effectiveness of cervical spine stabilization techniques. Clin J Sport Med. 2011;21(2):80-88.Google Scholar
21. Hauswald, M. A re-conceptualization of acute spinal care. Emerg Med J. 2013;30(9):720-723.Google Scholar
22. Tao, W, Liu, T, Zheng, R, Feng, H. Gait analysis using wearable sensors. Sensors (Basel). 2012;12(2):2255-2283.Google Scholar
23. Troiano, RP, Berrigan, D, Dodd, KW, Masse, LC, Tilert, T, McDowell, M. Physical activity in the united states measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181-188.Google Scholar
24. Gottlieb, GL, Corcos, DM, Agarwal, GC. Organizing principles for single-joint movements. I. a speed-insensitive strategy. J Neurophysiol. 1989;62(2):342-357.Google Scholar
25. Rowson, S, Duma, SM. Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration. Ann Biomed Eng. 2013;41(5):873-882.Google Scholar
26. Wilcox, BJ, Beckwith, JG, Greenwald, RM, et al. Head impact exposure in male and female collegiate ice hockey players. J Biomech. 2014;47(1):109-114.Google Scholar
27. Webber, SC, Kriellaars, DJ. The effect of stabilization instruction on lumbar acceleration. Clin Biomech (Bristol, Avon). 2004;19(8):777-783.Google Scholar
28. Bell, KM, Frazier, EC, Shively, CM, et al. Assessing range of motion to evaluate the adverse effects of ill-fitting cervical orthoses. Spine J. 2009;9(3):225-231.Google Scholar
29. Chi, CH, Wu, FG, Tsai, SH, Wang, CH, Stern, SA. Effect of hair and clothing on neck immobilization using a cervical collar. Am J Emerg Med. 2005;23(3):386-390.Google Scholar
30. Holla, M. Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med J. 2012;29(2):104-107.CrossRefGoogle ScholarPubMed
31. Sandler, AJ, Dvorak, J, Humke, T, Grob, D, Daniels, W. The effectiveness of various cervical orthoses. An in vivo comparison of the mechanical stability provided by several widely used models. Spine (Phila Pa 1976). 1996;21(14):1624-1629.Google Scholar
32. Shrier, I, Boissy, P, Briere, S, et al. Can a rescuer or simulated patient accurately assess motion during cervical spine stabilization practice sessions? J Athl Train. 2012;47(1):42-51.Google Scholar
33. Lebel, K, Boissy, P, Hamel, M, Duval, C. Inertial measures of motion for clinical biomechanics: comparative assessment of accuracy under controlled conditions - effect of velocity. PLoS One. 2013;8(11):e79945.Google Scholar
34. Shrier, I, Boissy, P, Lebel, K, et al. Cervical spine motion during transfer and stabilization techniques. Prehosp Emerg Care. 2015;19(1):116-125.Google Scholar