Neuropsychological, emotional, personality and pain profiles in litigating whiplash patients, preliminary evidence for differentiation into subgroups based on presence and level of cervical injury

by Dicks, Lorraine M.

Neuropsychological. affective. personality, and physical consequences of postconcussion syndrome following an indirect blow to the head sustained through rapid acceleration/decelerationforces causing hyperextensionhyperflexion(whiplash) injury were investigated. A mild traumatic brain injury cornparison group (MTBI) was used. Al1 but one patient was involved in litigation at the time of their assessment. Whiplash patients were divided into three groups based on presence and level of cervical injury. Patients with upper cervical spine injw were classified as the cervicoencephalic syndrome group (CES); lower cervical spine injury. the lower cervical spine syndrome (LCSS) group; and patients without stnicmral damage. the 'no objective evidence of pathology' (NOEP) group. The study sought to substantiate this differential diagnosis. Whiplash patients experienced fewer and less severe cognitive compromise than MTBI patients. In general. they were not memory impaired as was the MTBI poup. The higher the level of neck injury. the greater the propensity for impaired attentional functions and speed of information processing. This may be attributable to proxirnity of brainstem structures. Resuits provide preliminary support for the differentiation of whiplash patients into separate groups based on presence and level of cervical injury as proposed by Radanov et al. (1 992). The NOEP group performed better overall than any of the other groups on attentional measures and speed of information processing. This supports the belief that their injuries are less severe. . . 11 A predictabie pattern emerged whereby as perceived pain intensi~ and interference due to physical discomfort increased. ability to control pain and activity levels decreased. and patients were more susceptible to depression. This pattern ursmost apparent in the CES group and tended in the same direction in the NOEP group. In contrast. as perceived control of pain and activity levels increased. pain intensity and interference decreased, with less susceptibility to depression. This was most obvious in the head injured group and tended in the same direction in the LCSS group. Cognitive deficits following whiplash and MTBI were independent of levels of pain and coping responses to physical discomfort; emotional disturbance: and personality traits. That these patterns were not predictive of neuropsychological profiles suggests that they are based on different etiological origins.