Health Capacity Graduate Project in Community Rehabilitation and Disability Studies
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Whiplash is a common injury that occurs to the neck after a sudden acceleration and deceleration of force. The most common cause of whiplash injuries are Motor Vehicle Accidents (MVAs), in which one car (the struck vehicle) is hit from behind by another vehicle. A whiplash injury involves the hyperextension of the lower cervical vertebrae (bones in the neck) while the upper cervical vertebrae are in a hyper flexed position. See below:
Click to enlarge
The term “whiplash” was first used in 1928 and came from the term “railway spine” which was used to describe a similar injury that happened to people that were involved in train accidents. Over one third of collisions are rear-ending (Del Palomar, 2008) of that third 40% of the victims suffer whiplash. Research has shown that whiplash can occur at almost any speed (Crouch et al, 2006). This means, you can still get whiplash at slower speeds. It should be noted that a whiplash injury is not always caused by MVAs. It can also occur from sports and other high impact activities.
The following video will provide an illustration of what your body experiences from the impact of a collision
http://www.youtube.com/watch?v=6CFJgsG5SO0
There are two terms that are used to describe Whiplash:
1. Whiplash Injury – refers to the damage to the bones, muscles and ligaments in the neck
2. Whiplash Associated Disorders – refers to more of the severe and chronic disorders. Although variable and difficult to predict, and a source of debate in the medical community, Whiplash Associated Disorder (WAD) is one of the most common diagnosis following a motor vehicle accident (Suissa, 2003; Kwan and Friel, 2003). WAD includes heaviness or tingling in the arms, dizziness, ringing in the ears, vision changes, fatigue, poor concentration or memory and difficulty sleeping.
How do the muscles become injured in whiplash injuries?
Muscles and ligaments surround and support the spinal column in your neck. All of these structures have nerve supplies, and therefore, injury to any one can cause pain. During a MVA whiplash injury the anterior neck muscles (the muscles on the front of your neck) which are responsible for assisting you to keep your head in a normal upright position are stretched out in a manner that stretches them beyond their normal range of motion.
What are the main muscles that are injured in whiplash injuries?
Large muscle groups can become injured as a result of a whiplash injury. The posterior neck muscles (the ones that run from the top of your shoulders to the top of your neck) are most affected and are referred to as the trapezius muscles, levator scapulae and the cervical spinal erectors.
To get more information on the Trapezius muscle click on the link below (hint – click on the blue words to see how the muscle moves in the body):
http://www.getbodysmart.com/ap/muscularsystem/shouldermuscles/posteriormuscles/trapezius/tutorial.html
To get more information on the Levator Scapulae muscle click on the link below (hint – click on the blue words to see how the muscle moves in the body):
http://www.getbodysmart.com/ap/muscularsystem/shouldermuscles/posteriormuscles/levatorscapulae/tutorial.html
Quick Tip If you ice your neck for up to 15 minutes, 2 to 3 times per day using a bag of frozen vegetables, you can improve your overall discomfort and improve healing. Ice decreases the inflammation in the muscles. The inflammation that occurs 1 – 3 days post-accident can create additional problems beyond the original injury that occured as a result of the car accident. Therefore, it is important to ice your injury following an MVA.
Diagnosis
Whiplash is diagnosed first by your Doctor. You will need to describe the accident and what happened to your body during the crash. You should also tell your Doctor about any pain you are experiencing. Whiplash pain is not as prevalent during the first few hours after the accident. It tends to become worse 2 to 3 days after the accident. This is also when the muscles start to feel really stiff and it will likely hurt to shrug your shoulders and turn your head. The pain tends to be achy without movement and then becomes sharper when you start to use your shoulder muscles.
Grades of Injury
You may be diagnosed with one of four grades of WAD injury. If you suffer from:
Grade 0: no neck pain or soreness and do not show any physical signs
Grade I: neck pain and soreness but show no physical signs. Your doctor may not recommend any medication; as well, he/she will recommend that you continue doing your daily activities, including work
Grade II: Neck pain. As well, you have difficulty moving your neck. In this case, your doctor may prescribe pain medication, a short period (usually a few days) of rest and if you are working, a temporary modification of your work site would also be recommended.
Grade III: neck pain; do not feel any tendon reflexes, weakness of the muscle and numbness. If after 6 to 12 weeks following your initial diagnosis, you continue to experience the above symptoms; your doctor may refer you to a specialist for further evaluation.
Grade IV: dislocation or injury to your spinal cord
For further information on Whiplash, refer to the following website:
http://74.125.95.132/search?q=cache:ys1ZnPkhL3oJ:www.bourassarehab.com/editor/assets/media%2520folder/Whiplash%2520Associated%2520Disorders.ppt+different+grades+of+whiplash+associated+disorder&cd=3&hl=en&ct=clnk&gl=ca
Questions and Symptoms to list for your Medical Visits
The following provides you with examples of things you should think about and write down before your appointment with your doctor
1. What Happened? To determine the cause and area of injury.
2. How fast was the car going before the crash?
3. When did the accident occur? Has the pain improved or worsened since the accident?
4. Did you crash into another car that was moving in the opposite direction coming towards you or was it an object (like a pole) that was stationary?
5. Have you had headaches since the accident? 50-80% of patients with whiplash also have headaches.
6. Describe where the pain is on your body and describe how the pain feels. If you would like to see how you could diagram where your pain is in your body, click on link – PAIN DIAGRAM
7. Did you have any neck pain before the accident? To determine whether or not the accident you were involved in was caused by a pre-existing neck condition (can also be known as subarachnoid hemorrhage).
8. Describe any changes in how the pain feels since the accident. For example, does the pain feel different when you get up in the morning? Describe how the pain changes throughout the day. To get some help on how to track your pain, click on link PAIN TRACKER
9. Do you find it difficult to concentrate since the accident? This can be a symptom of whiplash.
10. Is your hearing o.k.? Deafness and tinnitus (ringing in the ears) can occur from whiplash.
11. Describe any activities you are having trouble doing. To understand how to record your activities, click on the link ACTIVITY TRACKER
Questions that you can ask your doctor
1. I was OK when I got out of the car, but now my neck is completely stiff; did I break it?
2. My neck hurts. Will I make it worse by moving it?
3. Should I wear a soft collar?
4. Should I use a cervical pillow?
5. Would it help the pain if I saw a chiropractor?
6. Shall I use icepacks or a heat lamp for my neck pain?
7. When can I drive again?
8. When can I return to work?
9. When should I schedule a re-evaluation?
Medical Tests
Your doctor may ask you to undergo some tests to rule out severe injuries to the neck. Some of the tests you may complete include:
Cervical spine (Neck) X-rays are initiated when
-you experience neck pain at rest
-the cervical vertebrae are sore when your physician touches it
-you have difficulties moving the cervical spine
-you feel tired and have little energy
Flexion extension views (bending your neck forward and back) (normally requested by specialist): these are useful for excluding ligamentous injury in
patients who have significant signs and symptoms but no evidence of injury on standard 3-view X-rays
Magnetic resonance imaging (MRI) scan (normally requested by specialist): this is completed to view soft-tissue injuries and injuries to the spinal cord.
For more information about MRI visit http://www.radiologyinfo.org/en/info.cfm?pg=bodymr
CT scan and myelography (normally requested by specialist): these imaging tests are indicated if MRI is not available.
For more information about myelography visit http://www.radiologyinfo.org/en/info.cfm?pg=myelography
Pain Medication
As noted above, depending on the grade of injury, your doctor may prescribe pain medication, anti-inflammatory drugs, muscle relaxants, a cervical collar and/or anti-depressants. Other treatments that your doctor may recommend are range of motion exercises, physical therapy, cervical traction, and heat application to relieve muscle tension.
For related publications and information visit this website http://www.ninds.nih.gov/disorders/whiplash/whiplash.htm
When you visit your treating rehabilitation professional, prior to starting your treatment, you should find out what costs are associated with the therapy. For instance, you can ask the rehabilitation professional for a fee schedule, which outlines additional fees and methods of invoicing. Also, find out what the company’s cancellation policy is and if there are any associated fees.
Before agreeing to participate in the therapy, find out how many people will be involved in providing the therapy, and if all the individuals involved have their professional designation.
In addition, ask your therapist how you can obtain copies of your health records if you need them. There may be consent forms that you need to complete in order to obtain your records. Find out how long it takes for you to receive your records.
Physiotherapy and Chiropractor
As your first step after experiencing an MVA you may feel comfortable going to your family physician. However, there are also options to go directly to a physical therapist or chiropractor (or both in some instances). If you already have a physical therapist or chiropractor that you are familiar with, you can use the same Questions and Symptoms list (above) for the first assessment as well. You don’t always need to attend your doctor’s office first. If you do decide to go directly to a Chiropractor or Physical Therapist as your first step after you have been in a car accident, you should call first and ask if their office has a different process for intake just to be sure.
Research has shown that when physical therapy and chiropractic treatments are compared for back related injuries there is little difference in the overall outcomes (Hurwitz, et al., 2002; Cherkin, et al., 1998; Hsieh, et al., 2002). Deciding on which treatment is better for you depends on your preferences. Understanding more about the differences between Chiropractic Treatment and Physical Therapy is important to make an informed decision.
Physical Therapy
Physical therapy focuses on the muscles and bones as they act together and create movement of your body. There are several different specialties within Physical Therapy. Physical therapists that specialize in whiplash injuries and whiplash associated disorders are called orthopedic physical therapists.
The First Assessment
Physical therapists will start their assessments with taking a history of how the injury happened, your health history and your activity level both prior to the injury and after the injury occurred. Then, they will ask you to take off any heavy sweaters and will most likely want to see your shoulders directly. It is best to wear a light T-shirt (if you are female wear a sports bra under the t-shirt) for the assessment. The physiotherapist needs to see the shape of your muscles and how you are standing (for example, if you are favoring one shoulder over the other when you are standing up). They will also want to see if there is any swelling or bruising on your skin in order to make an accurate diagnosis. Experienced physiotherapists can move through an assessment fairly quickly, so don’t be nervous. If you are nervous, you can ask that a family member attend during the assessment. This may also be helpful if you are having trouble remembering things and you need extra help to make sure you understand what is going on during the assessment.
After the physical therapists ask you the initial questions and look at your posture, they will ask you to show how well you can move your arms, shoulder and neck on your own. They will be checking for range of motion and will ask you when you are feeling pain during the movement. Make sure you are telling them when you feel pain. They will also ask you if you can move further even if it is painful. Go ahead and try but don’t worry if you cannot move past the pain. This is not a pass or fail test and there are no right or wrong ways to answer the physical therapist’s questions. The questions give the physical therapist information on the severity and type of your whiplash injury.
Last, the physiotherapist will ask you to relax your muscles and will move your arms and neck for you. You will be standing for most of the tests but you may also be lying down on a rehabilitation bed for some of the tests as well.
After all of these tests are completed, the physical therapist will make a decision on a diagnosis and then will talk to you about their recommendations for a rehabilitation plan.
For more information on physical therapy and for lists of questions that a physical therapist will ask and questions that you can ask a physical therapist click on the following link: Physical Therapy Information
Chiropractor
Chiropractors specialize in manual therapy, especially spinal manipulation. Chiropractors are considered alternative medicine from the perspective of mainstream medicine (Kaptchuk & Eisenberg, 1998). However, chiropractic practice has been around for over a century. The basic premise of chiropractic diagnosis and treatment is that neurologic dysfunction is created by nerves that are being impinged. This impingement causes most of the disease and pain in the body and spinal manipulation (adjustment) removes the impingement and restores health and function (Meeker & Haldeman, 2002).
The First Assessment
Chiropractors will ask you to report the history of your injury and your complaints of pain. The list above (Questions and Symptoms list) is very useful for you to take to your first appointment with the chiropractor. You need to be sure to give them a full description of the car accident and your activities since the accident. It is also important to wear light clothing to the assessment although they do not always need to see your skin directly.
Chiropractors will use their expertise to diagnosis the site of injury through the history and their manipulation skills. They may also take X-rays to help them make a decision on diagnosing and treating injuries. You will most likely be lying on a rehabilitation bed during the assessment so that the Chiropractor can feel where your bones and joints are out of alignment. Your muscles will need to be as relaxed as possible to give the Chiropractor the best opportunity to assess your injury and come up with a diagnosis. If you are nervous about going, you can ask a family member to attend the initial assessment.
To get a better understanding of what Chiropractors can offer, click on the link below:
http://www.alternativesforhealing.com/chiropractors.htm
For more chiropractic treatment and for lists of questions that a chiropractor will ask and questions that you can ask click on the following link:
Chiropractor Information
Quick Tip for Families of People with Whiplash
If you are a family member who is supporting someone through the initial stages of injury, remember that until a person has a name for what is going on (diagnosis) and a plan for how to proceed (treatment plan) they are unsure of how to behave. The assessment tells a person what is injured and how severe. Typically, before a person really understands their whiplash, they will be very cautious because they may be afraid of making the injury worse.
Injury Healing Process
The severity of the spinal cord injury can be a predictor of the neurological deficit that you may have suffered.
Studies show that pain management when you have no neurological deficits is good.
If after 12 weeks, you continue to experience neck pain, numbness and weakness in the muscles, ask to see a specialist. If your physician does not feel that you need to see a specialist, you may want to get a second opinion to rule out any possibility of serious and/or permanent damage to the spinal cord. The timeline for recovery is related to the number of symptoms, such as dizziness, pain, deafness, and other unusual signs that you experience with respect to the muscles, bones, spinal cord or nerves (Suissa, Harder, and Veilleux, 2001).
For a guideline on how to manage whiplash associated disorder https://www.cebp.nl/media/m393.pdf. This guideline was developed by the Quebec Task Force following their research findings.
Additional Factors that can Effect the Rate of Healing from Whiplash
Post Traumatic Disorder (PTSD)
Post Traumatic Stress Disorder PTSD is responsible for ongoing whiplash pain symptoms -23% of motor vehicle victims develop PTSD.
Studies reveal that there are psychological issues that arise following an accident. Some reactions that people experience immediately following an accident are anxiety, anger, and shakiness. The pain perception associated with a MVA can cause irritability, psychological distress, fear, focus on pain, and insomnia, all of these symptoms can impact how well the healing process occurs (Buitenhuis, et al, 2006). PTSD may create long-lasting whiplash issues and sabotage the healing progress (Buitenhuis, et al, 2006).
Many people have recurring thoughts about the accident (Mayou and Bryant, 2002). Some other symptoms that people experience are reluctance to drive, feeling detached from friends and family, and irritability.
For more information on post-traumatic stress disorder visit this website
http://www.vac-acc.gc.ca/clients/sub.cfm?source=mhealth/ptsd_families
One of the differences that a person suffering from PTSD related to an MVA is the possible development of chronic pain condition. Click on this link to review a checklist of symptoms associated with PTSD. PTSD CHECKLIST. If you experience some of the symptoms outlined in the checklist, you should speak to your physician and receive the appropriate guidance.
Economic Status
The existence of whiplash and its extent in causing debilitating pain is still questioned within the medical field. Studies show that the individuals claiming to have whiplash are part of the lower socio-demographic population. Normally they tend to be: uneducated individuals with below average income pre-disposed to belonging in stressful single parent homes; manual workers or uneducated professionals with poorer opportunities for advancement in life; individuals with pre-existing or likely future depressive/psychological distressing tendencies.
Studies have shown that those in a high position of work (educated professionals); better adjusted physically and mentally sound individuals are less likely to fall into a ‘whiplash victim’ role seeking both financial compensation and maximizing the amount of time off work. Studies prove that those in educated, higher socio-demographic living situations close their insurance claims faster and return to work anywhere between 1 day to two weeks even if their injuries are more significantly painful/disabling whereas those less educated in lower socio-demographic living situations with medically minor conditions and yet claims of intense pain are less likely to report improvements in rehabilitation in fear of wounding the possibility for future or continued insurance compensation. They are also most likely to take anywhere from a few weeks to 6 months time off of work. Interestingly the population belonging in the lowest socio-demographics, typically in untrained manual labour who do not receive paid time off work rarely claim ‘whiplash’ post motor vehicle collisions.
All this evidence suggests ‘whiplash’ is grossly abused as a symptom following motor vehicle collisions for the profit of financial compensation and paid time off of work, more typically by those who struggle financially and who’s employment is of a less professional, and perhaps therefore rewarding, nature.
Age and Health
Older age and or prior health concerns at time of whiplash injury after a car accident has been shown to have a longer and more challenging recovery (Suissa, 2003; Hijioka et al, 2001). That being said, there is no reason to expect that the muscles cannot achieve recovery. Studies show that maintenance of physical and mental health supports an individual to bounce back faster after negative events occur. An active and healthy older adult will recover better than a younger adult who has been inactive and is in poor health. It is not only activity that is important to consider, your eating habits are also going to contribute to your ability to heal from whiplash injury. Click on the link for information on Canada’s Physical Activity Guide and Canada’s Food Guide. Keep active and eat well as an excellent strategy for healing and health.
http://www.phac-aspc.gc.ca/pau-uap/paguide/older/index.html
http://www.phac-aspc.gc.ca/pau-uap/paguide/index.html
http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
Ways to Encourage Healing
Early Identification -One sure way to speed your recovery from whiplash is through early identification. The earlier you are diagnosed and treated for whiplash, the faster you can return to you normal activities. Dufton et al (2006) stated early identification led to most successful reduction of whiplash. Those who did not receive early diagnosis and treatment were shown to have poor outcomes and longer healing times (Dufton et al, 2006).
Exercise – We have already pointed out how exercise can improve your healing process above. It is important to follow the instructions your doctor, physical therapist and/or chiropractor have given you in the treatment of your whiplash. Timelines for sprain/strain type healing can occur from one to two days for minor injuries to up to 6 months for more severe injuries. Your exercises will be important to keep up as this will promote circulation to the injured area and maintain and promote an increase in range of motion.
For a resource on healing times for whiplash associated disorder (WAD), click on the following link:
http://www.health-disciplines.ubc.ca/whiplash.bc/module1/mod1_3.html
Homeopathy - Homeopathic remedies can be attributed to a new revolution of ‘natural medicines’, ‘eating organic’, and ‘natural living’. Homeopathic remedies work with the bodies natural chemistry, healing injuries from the inside out without harming or negatively affecting other organs in the body. They are considered the perfect resolution of pain as they have been shown to gently work with the body, heading to its process of healing. Another form of homeopathy that has been widely used is acupuncture.
Acupuncture can be used to treat a wide array of symptoms associated with whiplash. Acupuncture uses small needles that are inserted into the skin (not like an actual needle that punctures the skin). These treatments have been shown to be effective at relieving the pain symptoms associated with whiplash. For more information on homeopathic treatments, click on the following links:
http://www.gotosee.co.uk/healtharticles/2008/11/natural-cures-for-whiplash/
http://ezinearticles.com/?Homeopathic-Cure-For-Chronic-Whiplash-and-Concussion-&id=1791245
http://www.thescientificworld.co.uk/TSW/toc/TSWJ_ArticleLanding.asp?ArticleId=1749
http://www.selfgrowth.com/articles/Homeopathic_Cure_For_Chronic_Whiplash.html
http://www.chronicwhiplash.com/
Positive Thinking and Relaxation Activities
Thinking positively about your situation can help speed up your recovery process. This can be difficult at times, especially when you are experiencing pain from whiplash injury. However, research suggests that individuals who were diagnosed with whiplash and had positive expectations for recovery had a better prognosis(Holm, 2007). Research has also shown that positive attitdues are important as they affect the way a person will respond to treatment, resulting in faster healing (Holm, 2007; Wicksell, 2008; Kwan and Friel, 2003). Wicksel et al (2008) stressed the importance of a behavioural medicine approach or cognitive therapy in treatment of on-going pain.
This approach focused on being positive and accepting of the injury (Buitenhuis, J et al, 2003; Dufton et al, 2006).
Using meditative imagery and relaxation techniques have been shown to provide excellent results for managing pain and improving recovery. Relaxation techniques reduce blood pressure, heart rate and muscle tension. Studies have demonstrated that by using relaxation techniques in the first two weeks after injury can reduce the symptoms of pain.
Check out the links for more information:
http://www.som.uq.edu.au/som_cms/whiplash/Treatment/TreatmentTable/tabid/143/Default.aspx
http://www.allaboutcounseling.com/relaxation_techniques.htm
Psychological Counseling
Depending on the grade of the whiplash associated disorder (WAD), an individual’s quality of life as well as their psychological functioning may be affected. Therefore, it may be beneficial to seek counselling to help adjust and move forward with the rehabilitation process.
Seat belts – Although some research has shown that there may be a link between seat belt use and whiplash injury (Suissa, 2003) there is still overwhelming evidence that indicates that wearing a seatbelt can save your life and reduce the overall severity of injuries associated with car accidents. Martin et al (2008) and Suissa et al (2003) show that wearing a seatbelt, driving a heavier car and being older than 65 years decreases the incidence of whiplash. In addition to wearing a seatbelt, car mass appeared to be related to the proportion of whiplash victims - the higher the mass the lower the incidence of whiplash (Martin et al, 2008).
The bottom line seems to be – wear your seat belt!
Head Restraints – There is plenty of research to support that having a head rest that is appropriately set to fit you reduces the severity of whiplash injury (Welcher and Szabo, 2001;Tencer et al, 2001; Viano, 2003; Linder et al , 2001; Farmer et al, 2003). There is also research that indicates specialized car seats are also highly effective in reducing and preventing whiplash injury.
For more detailed information, check out the links below:
http://www.which.co.uk/advice/dealers-safety-advice-on-test/whiplash-prevention/index.jsp
http://www.spineuniverse.com/article/whiplash-prevention-4190.html
Possible Resources for Funding the Treatment of Whiplash
There are different funding options that may be available to you based on your individual insurance policies. Depending on the province, you may be eligible for additional funding.
If you reside in Ontario, please visit http://www.fsco.gov.on.ca/english/insurance/auto/drs/default.asp#d for information regarding accident benefits.
For options when no accident benefit insurance exists visit
http://www.fsco.gov.on.ca/english/insurance/auto/mvacf/
A resource material that discusses the different options available in British Columbia is a book written by Jill Franklin. Auto Accident Survivor’s Guide for British Columbia: Navigating the medical-legal insurance system is a book about Jill’s experience following a motor vehicle accident and the options that were available to her. She outlines the different public and private resources available to people. To view the table of content of the book, visit
http://www.autoaccidentsurvivorsguide.com/Table_of_Contents.html
For information pertaining to accident benefits and eligibility for compensation in Alberta, please visit
http://www.justice.gov.ab.ca/mvac/Default.aspx?id=4655
New Brunswick – For information on sources of funding and other programs, visit
http://www.gnb.ca/0048/PCSDP/DirectoriesForPersons/DirectoryofRehabEquipmentFunding/tableofcontents-e.asp
We can all probably think of “comical” movies or sitcoms where an individual is rear ended in a car accident and the driver gets out of his car grabbing his neck, screaming “Whiplash!” Those who have suffered through it understand that it is not a humorous situation.
Hidden barriers to successful rehabilitation for people who experienced an MVA whiplash injury
Treatment Professionals - Whiplash is often overlooked by professionals because this type of injury does not involve the bones or organs, and therefore, it is often dismissed as minor and treated with pain killers. In situations where the treating Physician cannot locate the problem or cause of pain, MVA patients may feel that their pain is being disconfirmed. Physicians continue to focus on the biomedical model instead of psychological and social influences that are relevant to a patient’s distress and this is likely to negate rehabilitation success.
What this means for the MVA victim and family: Do your research. Learn about whiplash injury and investigate ways which may improve your recovery process. Don’t rely on professionals to help you fully recover; you also have to be an active participant beyond the rehabilitation/professional arena. Talk to others who have experienced similar injuries. Understand that professionals may not understand your unique situation and the extent of your pain, but often they are doing their best and what they have been trained to do.
How your healing progress is viewed- There is wide variability in the selection and application of outcome measures across clinical environments. Practitioners tend to rely on their clinical skills to determine a change in patients’ conditions or to detect the benefits of interventions. Health practitioners who greet their clients with questions such as “How are you today?” or “Has your pain improved?” is an informal attempt to track changes over the course of treatment and can lead to an insufficient measure of the patients’ progress. Difficulties arise because each individual’s situation is unique and there is no objective measure that can record how much pain the patient experiences. As a result, medical professionals who deal with MVA patients are faced with the problems of the patient responding unfavorably to interventions, coupled with further downward progression of the patients’ pain, disability and emotional and psychological well being.
What this means for the MVA victim and family: You must communicate frequently with medical staff. Keep a journal of your daily activities, challenges and degrees of pain. Remember to include the time of day, and reasons why you may not have engaged in a planned activity or stopped various activities. This information may lead you to appropriate rehabilitation interventions and provide medical staff with detailed information regarding your status.
Conflicting Perspectives – Many people are involved in a patient’s life when they experience an MVA, including third party payers and compensation insurers, who also fund treatment, rehabilitation professionals and pain programs. The person involved with the patient has the power to influence what constitutes success and make recommendations for further interventions. When patients do not participate in a rehabilitation plan, this may be understood as a failure to comply with rehabilitation. Consequently, it may be interpreted that the patient’s personality or disposition is preventing recovery which may result in the patient’s financial benefits being severed due to malingering issues. These beliefs have the potential to alienate patients who are undertaking litigation.
What this means for the MVA victim and family: You are often expected to participate in rehabilitation programs initiated by insurance companies to demonstrate that you are attempting to recover and return to employment. It is advisable to cooperate to ensure that you continue to receive your financial benefits. However, if it is a program which you do not feel comfortable participating in for various reasons, then do your homework and present an alternative option to the insurance company as they may be open to alternative therapies.
Proof of Disability– People who experience an MVA, often need to prove that they are injured as much as they claim, which encourages them to become pain focused and delay their recovery. This can guide insurance companies to be unsupportive of effective communication or treatment options and can lead to a relationship which lacks trust. In effect the patient experiences a loss of control and support, which creates a stigma and shame for those submitting claims.
What this means for the MVA victim and family: Delaying recovery and becoming pain focused because of the belief that you need to prove your disability, can lead to a decline in your recovery process. Further, this presents as a barrier for coping and accepting disability and being able to reconstruct/transform the self. It is your legal right to file a claim for whiplash injury. However, it is important to remember that the goal of the insurance company is for you to recover and return to your activities of daily living which includes earning an income. It is hoped that you share this goal and work to improve your functionality; otherwise this can lead to an untrusting relationship and create a stigma for others.
Social Control in Hospital Environment: Social control refers to any reaction by which a spectator communicates to the individual that his/her behavior or actions are not acceptable by the majority/society (Chaurand & Brauer, 2008). In review of research, trauma patients who experience injuries related to Motor Vehicle Accidents often describe the hospital environment as a business deal, a busy and strange place, and mechanical, aloof, insensitive and showing lack of interest with their progress (Tan, Lim & Chiu, 2008).
What Does This Mean? This research highlighted that psycho-social support is a significant requirement for MVA patients within hospitals because of the trend to control symptoms and follow structured guidelines.
Why Does This Social Control Occur? Perhaps a driving force is cost effectiveness and limited budgets. Short cuts enable professionals to form stereotypes which view all disabled individuals as a single entity with similar characteristics. This can perhaps save time and increase decision making. This way of operating has the potential for compromising rehabilitation effectiveness and service provision (Gething, 1992).
How Can We Overcome This Social Control? Engaging in healthy behavior change and acceptance can be influenced by positive social control agents, such as front line staff offering to engage in healthy behaviours with the patient, or by doing things that make it easier for the patient to change their health habits. MVA patients who experience negative social control (imposing guilt, meeting criteria on checklists) may ignore the social control agent and decrease their recovery because they have less of a desire to be rehabilitated. Negative social control strategies elicit negative affective responses and encourage maladaptive
behavior and may also undermine positive psychological states (Tucker, Orlando, Elliott & Klein, 2006).
The “Worthy Victim” Versus the “Non-Worthy Victim”- Society
Characterological judgments are made by society about people who are involved in MVAs. Research has shown that the driver’s moral worth (dependable and trustworthy versus not very dependable and a bit untrustworthy) has strong effects on how society judges the driver in terms of moral character, as well as likability (Feather & Deverson, 2000). Further, gender has been shown to affect judgments of moral character and the reported liking for the driver. For instance, Feather and Deverson (2000) found that the female driver was perceived to have higher moral character than the male driver. Studies have demonstrated that mitigating circumstances have strong effects on society’s reactions to a MVA, especially in regard to the degree of responsibility that they assigned to the driver (Feather & Deverson, 2000). Those who were in an accident as a result of mitigating factors (such as a slippery road) were deemed to be less responsible for the accident, and therefore, looked upon more fondly than those individuals who had no mitigating factors.
What Does This Mean? Society is responsible for causing the stigmatization among those involved in an MVA. We live in a society where specific types of people are generally devalued and disrespected (Loseke, 2008).
What Can We Do To Change This Stigmatization? For social change to occur, there needs to be a change in culture, or the way people think about those involved in MVAs. A change in society’s attitude, will ideally lead to a change in society’s behaviours. Social activists can help to change cultural evaluations of people involved in MVAs. As well, to gain support for those involved in MVAs, programs such as sensitivity training for front line staff may be more feasible, than to promote policies that restructure the process that MVA victims go through. Although there can be a social stigma attached to those involved in MVAs and the claims associated with this, most times it is the victim’s legal right to file a claim and this should not be overlooked.
The language we use to categorize people who are involved in an MVA (“MVA victim”) constructs collective identities of images of these people. Society constructs images of those involved in an MVA as socially devalued. Cultural transformation needs to occur by increasing the self esteem and worth accorded to these “types of people” (Loseke, 2008). Stewart and Lord (2002) proposed that the term Motor Vehicle Accident (MVA) should be replaced with the term Motor Vehicle Crash (MVC) because crash encompasses a wider range of potential causes for vehicular crashes than does the term accident. The authors argued that potential problems may emerge for victims struggling to deal with trauma or loss following a crash if the term “accident” is used. Further, they suggested that the term ‘crash’ can be more validating and meaningful than ‘accident’ for crash survivors or persons who have experienced a loss. Therefore, the language we use when communicating to a person involved in a traumatic situation may influence their coping abilities.
The widespread belief is that litigation and its settlement capacity plays a major role in the psychological symptoms and disability progress among MVA patients. The persistent view is that whiplash claims are frequently fraudulent (Empke, 2008). Literature consists of terms such as “accident neurosis”, “compensable neurosis” and “litigation neurosis” to describe the symptoms of a person involved in an MVA (Blanchard, Hickling, Taylor, Buckley, Loos, & Walsh, 1998). Society assumes that MVA patients will continue their symptomatic complaints until a settlement is reached in order to enhance their chances of collecting a more substantial settlement. An assumption that society holds is that once the suit is settled one can expect to see a dramatic improvement in the patient’s psychological symptoms and behaviours. Although the industry pays most whiplash claims without controversy, there is still a strong public stereotype of such persons (Empke, 2008).
Miller (1961) concluded in his study that the cause of “accident neurosis” is not a result of the physical injury but arises a) when the accident is due to someone else’s fault; and b) has occurred in circumstances where payment of financial compensation is potentially involved. Society stigmatizes those who experience MVAs in similar ways and assumes that people experience accident related symptoms not as a direct result of the accident but a concomitant of the compensation situation and of the hope of financial gain (as cited in Blanchard et al., 1998 p. 338).
As well, a common misconception about whiplash injury is that if the vehicle does not sustain damage in a low speed impact, then whiplash injury to the occupant does not occur. In reality, low impact collisions can produce correspondingly higher dynamic loading on the occupants because the lack of crushing metal to absorb the forces results in a greater force applied to items or occupants within the vehicle.
What Does This Mean for the MVA Victim and Family?
“Disempowered group”
People who experience pain from Whiplash injury are in a difficult situation because pain cannot be seen or proven to exist. Therefore, they are faced with the difficult decision as to whether to pursue financial gain through demonstrating increasing disability, or to improve their position and condition, at the risk of losing their legal entitlements.
Dealing with legal issues can have negative consequences for those experiencing whiplash injury from a MVA. People often become powerless, and at the mercy of the litigation system. Research suggests that being able to access social support and having support networks helps people involved in MVAs to escape from the litigation process and become empowered. This is critical for those individuals who intend to provide rehabilitation and help MVA patients overcome barriers to successful recovery. Unless adequate support systems and networks are provided, ongoing dependency on compensation systems are likely to continue.
As common as whiplash injuries are, there still seems to be a shame attached to making a whiplash claim. This should not be the case though, as there is a greater amount of vehicles on the road. If you are injured in an accident then you need to make a claim, irrespective of what the injuries are. Nothing would be said in light of receiving recompense for the loss of a limb, so why should people think that whiplash is moot? It is a person’s civil right to claim compensation for whiplash.
“Empowered group”
Research suggests that the people who are able to cope effectively after an injury are highly motivated to deal with the pain and complete tasks to the best of their ability despite their limitations. As well, those who are able to cope with their new lives appear able to find options and problem solve. Most professionals agreed that support is a key feature in successful rehabilitation. Some health care professionals indicated that failing to offer total support is a barrier to patient recovery. As well, failing to understand the individual motivations of each patient is a barrier. It is important for front line staff and families to understand how and what works for patients, when it works and how it is linked to self-esteem.
Final Thoughts
Recovering from MVAs is a complex and individual process. The people whom patients encounter during their recovery can impact their acceptance and coping from traumatic events. Family and friends can serve as a solid support network assisting in the patients’ recovery process. As well, guidance and support from front line staff such as nurses can assist patients with the challenges of self-transformation. The nurse-patient relationship is a critical factor for a successful recovery process. Education for front line staff should focus on personal communication behaviours and addressing patient sensitiveness to traumatic events.
In review of literature, visible disability is a cue which influences impressions that others form of a person. These impressions extend beyond the actual disability to include personality and social characteristics (Gething, 1992). This judgment has spread to include health professionals and raises concerns regarding quality of care.
Negative stereotypes about people with disabilities can become internalized. The usual implication is that a person with a disability is less capable because they deviate from the cultural norm. Evidence suggests that beliefs and attitudes of rehabilitation professionals are similar to the general population (Gething, 1992). Le Loach and Greer (1981) found that health professionals tended to underestimate the capabilities of people with disabilities and to misinterpret their behavior. These authors listed professional behaviours which imply low opinions of clients with disabilities and deprive them of their humanness: interpreting as abnormal behaviours as “normal” in nondisabled people, overemphasizing the effects of disability on adjustment, underestimating the potential of clients and treating them in terms of their disabilities rather than in terms of personal characteristics (as cited in Gething, 1992, p. 810).
Overall, it appears important for frontline staff to be aware of MVA patients’ vulnerability and to communicate openly in order to build a trusting relationship. Support from family and friends appear to be critical factors in assisting patients to move forward through the rehabilitation process. Front line staff can lead patients toward a purposeful life through construction of new values and self.
It is hoped that this information educates those involved in a MVA, front line staff and families about society’s way of controlling and stigmatizing those involved in MVAs. By becoming aware of the social problem of MVAs/physical disabilities we can help make a difference and begin to make changes.
The following website links provide information regarding steps to making claims.
http://www.articlesbase.com/wellness-articles/claiming-against-whiplash-injuries-4-essential-tips-544048.html
http://www.streetdirectory.com/travel_guide/94/auto_insurance/motor_vehicle_accident_insurance_claim_guide.html
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