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DOI: 10.1055/s-0032-1314427
Okulomotorisches Training bei Whiplash-Associated Disorders[ * ]
FallstudieOculomotor Exercise in Whiplash-Associated DisordersCase StudyPublication History
Publication Date:
23 May 2012 (online)
Zusammenfassung
In der Physiotherapie stellen Patienten mit Nackenbeschwerden die zweitgrößte Behandlungsgruppe dar. Ein Großteil der Beschwerden ist durch Verletzungen nach einem Verkehrsunfall verursacht und präsentiert sich mit einem Distorsionstraumata der HWS (Whiplash-associated disorders, WAD). In ca. 20 % der Fälle entwickelt sich ein chronischer Zustand mit komplexen Störungen und Einschränkungen bei Aktivitäten sowie reduzierter Lebensqualität.
Das prospektive Fallbeispiel (Pre-post Design) untersucht die Effektivität und den Einfluss eines speziellen okulomotorischen Trainingsprogramms bei einer WAD-Patientin. Außerdem werden die Kontextfaktoren sowie mögliche Beschwerdeursachen beleuchtet.
Es fanden sich signifikante Verbesserungen der Schmerzintensität (–50 %), des Neck Disability Index und des Joint position error . Die Berg-Balance-Skala und der Cover-Test zeigten keine signifikanten Veränderungen.
Okulomotorisches Training hatte eine positive Auswirkung auf das subjektive und objektive Beschwerdebild bei einer Patientin mit chronischen WAD. Das Ergebnis ist zwar nicht auf alle WADPatienten übertragbar, weist aber Kliniker und Forscher darauf hin, wie sich okulomotorisches Training in die Therapie und zukünftige Forschungsprojekte integrieren lässt.
Abstract
Patients with neck pain are considered to be the second largest treatment group in physiotherapy. A large number of complaints are caused by road traffic accident injuries and presents with distorsion trauma of the cervical spine (whiplash-associated disorder, WAD). In 20 % of the cases a chronic condition with complex activity disorders and limitations as well as reduced quality of life develop.
This prospective case study (pre-post design) investigates effectiveness and influence of a specific oculomotor exercise programme in a female WAD patient. In addition, the contextual factors and possible causes of the disorders are illustrated.
Significant improvement of pain intensity (–50 per cent), in the neck disability index and in joint position error were found. The Berg Balance Scale and cover test revealed no significant changes.
In a female chronic WAD patient oculomotor exercise had positive effects on subjective and objective clinical presentation. Although this result cannot be transferred to all WAD patients, it points out to both clinicians and researchers how oculomotor exercise can be integrated into therapy and future research.
Anmerkungen
eingereicht: 30.8.2011 | akzeptiert: 20.10.2011
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Literatur
- 1 Bärtschi E. Propriozeption der HWS: Ist ein koordinatives Training bei Nackenbeschwerden sinnvoll?. manuelletherapie 2009; 13: 14-22
- 2 Berg K, Wood-Dauphinée S, Williams JI et al. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada 1989; 41: 304-311
- 3 Bijur PE, Silver W, Gallagher EJ. Reliability of the Visual Analog Scale for Measurement of Acute Pain. Academic Emergency Medicine 2001; 8: 1153-1157
- 4 Brown S. Effect of whiplash injury on accommodation. Clinical Experimental Ophthalmology 2003; 31: 424-429
- 5 Burke JP, Orton HP, West J et al. Whiplash and its effect on the visual system. Graefe’s Archive for Clinical Experimental Ophthalmology 1992; 230: 335-339
- 6 Cronbach JL, Gleser GC, Nanda H et al. The dependability of behavioral measurements: theory of generalisability for scores and profiles. New York: Wiley; 1972
- 7 Heikkila H, Heikkila E, Eisemann M. Predictive factors for the outcome of a multidisciplinary pain rehabilitation programme on sick-leave and life satisfaction in patients with whiplash trauma and other myofascial pain: A follow-up study. Clinical Rehabilitation 1998; 12: 487-496
- 8 Hildingsson C, Toolanen G. Outcome after soft-tissue injury of the cervical spine: A prospective study of 93 car-accident victims. Acta Orthopaedica Scandinavica 1990; 61: 357-359
- 9 Hoving JL, O’Leary EF, Niere KR et al. Validity of the neck disability index, Northwick Park pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders. Pain 2003; 102: 273-281
- 10 Jull G, Sterling M, Falla D et al. Whiplash, headache and neck pain. Research-based directions for physical therapy. Edinburgh: Churchill Livingstone; 2008
- 11 Kristjansson E, Treleaven J. Sensomotor Function and Dizziness in Neck Pain: Implications for assessment and Management. Journal of Orthopaedic and Sports Physical Therapy 2009; 39: 364-365
- 12 McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med 1988; 18: 1007-1019
- 13 Montfoort I, Kelders WPA, van der Geest JN et al. Interaction between ocular stabilization reflexes in patients with whiplash injury. Investigative Ophthalmology & Visual Science 2006; 47: 2881-2884
- 14 Obermann M, Riegel A, Thiemann D et al. Prospektion und Prädiktion von chronischen Kopfschmerzen nach Halswirbelsäulenbeschleunigungsverletzung. Aktuelle Neurologie 2007; 34: 508-515
- 15 Von Piekartz HJM (Hrsg). Kiefer, Gesichts- und Zervikalregion. Neuromuskuloskeletale Untersuchung, Therapie und Management. Stuttgart: Thieme; 2005
- 16 Von Piekartz D, Von Piekartz H, Hengeveld E. Okuläre Dysfunktionen bei WAD: Behandlungsmöglichkeiten und Effekte von neuromuskuloskeletaler Therapie – Systematischer Review. manuelletherapie 2012; 16: 42-51
- 17 Pool JJ, Ostelo RW, Hoving JL et al. Minimal clinically important change of the Neck Disability Index and the Numerical Rating Scale for patients with neck pain. Spine 2007; 32: 3047-3051
- 18 Radanov BP, Stefano GD, Augustiny KF. Systematic approach to posttraumatic headache and its possible implications for treatment. European Spine Journal 2001; 10: 403-407
- 19 Revel M, Andre-Deshays C, Minquett M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Archives of Physical Medicine and Rehabilitation 1991; 72: 288-291
- 20 Schomacher J. Gütekriterien der visuellen Analogskala zur Schmerzbewertung. physioscience 2008; 4: 125-133
- 21 Spitzer WO, Skovron ML, Salmi LR et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash“ and its management. Spine 1995; 20: 1S-73S
- 22 Sturzenegger M. Headache and neck pain: the warning symptoms of vertebral artery dissection. Headache: The Journal of Head and Face Pain 1994; 34: 187-193
- 23 Swait G, Rushton AB, Miall C et al. Evaluation of Cervical Proprioceptive Function. Spine 2007; 32: E692-E701
- 24 Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Journal of Rehabilitation Medicine 2003; 35: 36-43
- 25 Treleaven J, Jull G, Grip H. Head eye co-ordination and gaze stability in subjects with persistent whiplash-associated disorders. Manual Therapy 2011; 16: 252-257
- 26 Vernon H, Mior S. The neck disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapy 1991; 14: 409-415
- 27 Versteegen GJ, van Es FD, Kingma J et al. Applying the Quebec Task Force criteria as a frame of reference for studies of whiplash injuries. Injury 2001; 32: 185-193
- 28 Wenngren B, Petersson K, Lowenhielm G et al. Eye motility and auditory brainstem response dysfunction after whiplash injury. Acta Otolaryngol 2002; 122: 276-283
- 29 World Medical Association (WMA). Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. www.wma.net