Stabilometry and balance training for functional recovery and rehabilitation of a patient with a whiplash associated disorder
By definition, Whiplash is a bony or soft tissue injury, resulting from rear-end or side impact, predominantly in motor vehicle accidents, consequence of “an acceleration-deceleration mechanism of energy transfer to the neck”. The incidence of Whiplash associated disorders (WAD) increase during last years. Sometimes, clinical practice reveals rare signs, symptoms or complications of this clinical pattern. We present a female patient of 25 years, transferred t our PRM Department one week after traffic accident, with persistent clinical manifestations, including excessive pain and stiffness in the neck region and muscles around it; headache, arm tingling; balance and gait instability; attention, concentration and memory troubles; reactive depression and anxiety. During clinical exam (at the admission) we diagnosed: vertebral and cervico-brachial radicular syndromes, balance and gait instability, positive Romberg. Spine X-Ray demonstrates osteochondrosis and spondylosis, static disturbances with reduction of the physiological cervical lordosis. Magnetic Resonance Imagery (MRI) of the cervical spine revealed multi-level discal herniation (predominantly C5-6 and C6-7). During Computerized Stabilometry, we observed altered center-of-Pressure (COP) trajectories and COP-oscillations with open and closed eyes. We applied a complex rehabilitation, including paravertebral infiltrations, preformed physical modalities (TENS and Magnetic field), individualized physiotherapeutic and occupational therapeutic programme, balance and gait training, patient education. We noticed significant efficacy of the rehabilitation: improvement of the range of motion of the cervical spine, pain relief, balance and gait stabilization, amelioration of autonomy in activities of daily life. Our opinion is, that every patient after traffic accident needs consultation with a medical doctor – specialist in Neurology and in Physical and rehabilitation medicine. We consider that early rehabilitation must be considered in cases with whiplash-associated disorder. We emphasize on the impact of stabilometry for objective evaluation of the equilibrium disturbances. Some recommendations for the rehabilitation complex are formulated.