Three-dimensional head kinematics and cervical range of motion in the diagnosis of patients with neck trauma.

OBJECTIVE

To create a statistical model using three-dimensional (3D) head kinematics and range of motion (ROM) to distinguish between people with whiplash syndrome and asymptomatic controls.

STUDY DESIGN

Cross-sectional study to estimate validity of diagnostic measures.

METHODS

Fifty-one asymptomatic controls (most of whom were women), 18-35 yr old and 30 matched whiplash trauma patients seeking care from suburban outpatient clinics were sought. 3D kinematic parameters of head motion were obtained during tracking tasks (e.g., flexion, extension, etc.) and cervical ROM was measured via a head mounted inclinometer. Their level of pain and disability was assessed via a self-administered neck disability index questionnaire and visual analog pain scale (VAS).

RESULTS

A scoring system of biomechanical abnormalities derived from the vertical piercing point, its second derivative and symmetry during oblique tasks. The scores ranged from a minimum of 0 to a maximum of 3. A cutoff of > or = 0.5 correctly identified the greatest number of subjects and minimized false positives (sensitivity 77%, specificity 82%, likelihood ratio 4.5). ROM performed similarly well at a cutoff of 1 SD below the normative mean (sensitivity 77%, specificity 84%, likelihood ratio 3.9).

CONCLUSIONS

There is potential for biomechanical analysis to objectively detect abnormalities. The statistical model yielded moderate to high sensitivity and specificity using 3D helical-axis parameters of the head and standard ROM. The model development will continue via this process in future studies. These data could be a first step toward the creation of useful, noninvasive protocols for the diagnosis and management of soft tissue trauma of the neck.