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Dysphagia. 2019 Aug 3. doi: 10.1007/s00455-019-10039-4. [Epub ahead of print]

Whiplash-Associated Dysphagia: Considerations of Potential Incidence and Mechanisms.

Author information

1
Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia. danielle.stone@health.nsw.gov.au.
2
Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia. danielle.stone@health.nsw.gov.au.
3
Neuromuscular Imaging Research Laboratory, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia. danielle.stone@health.nsw.gov.au.
4
Speech Pathology Department, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. danielle.stone@health.nsw.gov.au.
5
Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
6
Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
7
Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
8
Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
9
School of Physical Therapy, Regis University, Denver, CO, USA.
10
School of Physical Therapy, Western University, London, ON, Canada.
11
School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Services, Brisbane, QLD, Australia.
12
Neuromuscular Imaging Research Laboratory, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.
13
Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Abstract

Non-specific self-reports of dysphagia have been described in people with whiplash-associated disorders (WAD) following motor vehicle collision (MVC); however, incidence and mechanistic drivers remain poorly understood. Alterations in oropharyngeal dimensions on magnetic resonance imaging (MRI), along with heightened levels of stress, pain, and changes in stress-dependent microRNA expression (e.g., miR-320a) have been also associated with WAD, suggesting multi-factorial issues may underpin any potential swallowing changes. In this exploratory paper, we examine key biopsychosocial parameters in three patients with persistent WAD reporting swallowing change and three nominating full recovery after whiplash with no reported swallowing change. Parameters included (1) oropharyngeal volume with 3D MRI, (2) peritraumatic miR-320a expression, and (3) psychological distress. These factors were explored to highlight the complexity of patient presentation and propose future considerations in relation to a potential deglutition disorder following WAD. The three participants reporting changes in swallowing all had smaller oropharyngeal volumes at < 1 week and at 3 months post injury and lower levels of peritraumatic miR-320a. At 3 months post MVC, oropharyngeal volumes between groups indicated a large effect size (Hedge's g = 0.96). Higher levels of distress were reported at both time points for those with persistent symptomatology, including self-reported dysphagia, however, this was not featured in those nominating recovery. This paper considers current evidence for dysphagia as a potentially under-recognized feature of WAD and highlights the need for future, larger-scaled, multidimensional investigation into the incidence and mechanisms of whiplash-associated dysphagia.

KEYWORDS:

Deglutition; Deglutition disorders; Dysphagia; Muscle tension dysphagia; Whiplash; Whiplash-associated disorder

PMID:
31377863
DOI:
10.1007/s00455-019-10039-4

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