Neck Solutions

Postural sway and cervical vertigo after whiplash injury

July 18, 2008 on 9:08 am | In Neck Pain, Whiplash, Posture |

Consciously postural sway and cervical vertigo after whiplash injury

From: Spine. 2008 Jul 15;33(16):E539-42.

Cross-sectional study of whiplash injury patients with vertigo and healthy volunteers consciously pretending to have postural sway as in malingering. The aim of this study was to evaluate the postural sway in malingerers by posturography. Malingering is not a problem in the majority of cases with whiplash injury and diagnosis should be made carefully. However, some patients with whiplash injury might exaggerate their symptoms or be malingerers because of the potential gain associated with insurance claims. We designed a diagnostic study to screen putative malingerers.

Subjects were 20 healthy volunteers who were tested under standing condition (normal group), consciously swaying the body under standing condition like malingerers (pseudomalingering group) and 32 patients who complained of neck pain with vertigo or dizziness after whiplash injury with whiplash associated disorders grade I and II . The movement of the center of pressure (COP) was measured using a force platform to quantify postural sway. Static posturography was performed under open and closed eyes. We analyzed (1) total envelop area per unit of time, (2) shifting length per second, (3) sway pattern, and (4) Romberg rate representing total shifting length under eyes-closed/eyes-open.

In open eyes condition, the values of envelop area and length per second were significant higher under pseudomalingering than both of the control and whiplash associated disorders groups. The Romberg rate was 1.30 +/- 0.17, 1.13 +/- 0.19, and 1.83 +/- 0.94 in control, pseudomalingering, and whiplash associated disorders group, respectively, and was less than 1.0 in 45% of pseudomalingering. There were significant differences in the envelop area, length per second, and Romberg rate between pseudomalingering and the other 2 groups.

Results suggest that compared with normal subjects and whiplash associated disorder patients, malingerers are more likely to exhibit a wide envelop area, a long sway length per second, and a low Romberg rate. Malingering must be diagnosed carefully and posturography could be a helpful supplementary tool for differentiating whiplash associated vertigo from malingering.