Trunk sway in patients with and without, mild traumatic brain injury after whiplash injury O. Findling a,b , C. Schuster a , J. Sellner c , T. Ettlin a , J.H.J. Allum d, * a Reha Rheinfelden, Rheinfelden, Switzerland b Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland c Department of Neurology, Klinikum rechts der Isar, Technische Universita ¨t Mu ¨nchen, 81675 Mu ¨nchen, Germany d Department of Otorhinolaryngology, Basel University Hospital, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland 1. Introduction Dizziness is common in patients suffering from whiplash injury [1]. These patients are frequently affected by a mild traumatic brain injury (MTBI) due to unrestrained head movements occurring at the time of the accident [2]. However, there is a lack of data comparing the balance problems of those with whiplash injuries alone and those with additional MTBI. The term ‘‘whiplash’’ refers to an acceleration–deceleration transfer of energy to the neck, mostly caused by a rear-end motor vehicle collision. However it can also occur during other accidents [3]. Whiplash injury normally refers to trauma causing cervical musculoligamental sprain or strain of the neck without bone injuries to the cervical spine, head injuries or loss of consciousness. Exceptionally bone injuries are present. A system for classification of whiplash injuries was proposed by the Quebec Task Force (QTF) in 1995 [3]. Grade 1 is specified by pain, stiffness, or tenderness of the neck without other physical signs. Decreased range of motion and localised tenderness including neck and musculoskeletal complaints are typical for grade 2. Grade 3 is characterized by neck problems of grade 2 and neurological signs (decreased or absent tendon reflexes, sensory deficits, and muscle weakness), and grade 4 includes fracture or dislocation of the spine. The late or chronic whiplash associated disorder (WAD) was defined by the QTF as symptoms of whiplash persisting more than 6 months after the triggering event [3]. Reporting the frequency of acute whiplash injury is complicat- ed by the lack of standardised reporting systems in different countries leading to different rates of occurrence of neck pain, headache or both [4–6]. Thus, the reported prevalence of chronic WAD is different between countries. In Sweden 43% of car crash victims reported relevant discomfort after an average follow-up of two years [7], in Great Britain 22%, and in Switzerland 18% [8,9]. Symptoms of WAD include neck pain, headache, dizziness and/ or unsteadiness, brachialgia, and cognitive and psychological symptoms [1]. Due to these sequelae, the return to normal leisure and working activities is often complicated and leads to a high financial burden on public health care systems [10]. The reason for the persistence of WAD complaints remains unclear. During a whiplash injury, damage to different structures, including muscles, Gait & Posture 34 (2011) 473–478 A R T I C L E I N F O Article history: Received 2 February 2011 Received in revised form 22 June 2011 Accepted 25 June 2011 Keywords: Balance Posture Whiplash Mild traumatic brain injury A B S T R A C T Objective: This study assessed the addition effect of mild traumatic brain injury (MTBI) on the balance control of patients who simultaneously suffered a whiplash associated disorder (WAD). Background: Dizziness is common in patients suffering from whiplash injury with or without a MTBI, but data is lacking about the additional balance problems and dizziness caused by MTBI. Methods: 44 patients with WAD and MTBI and 36 WAD patients without MTBI participated in the study. A dizziness handicap index (DHI) was used to quantify self-perceived handicap. Balance control was assessed using measures of trunk sway for a battery of stance and gait tests. Results: Patients with WAD and MTBI perceived significantly higher dizziness and unsteadiness (higher score in DHI Emotional category) and had greater trunk sway than WAD patients without MTBI for stance tasks and complex gait tasks (e.g. walking up and down stairs). Both groups had greater sway than controls for these tasks. Both groups of patients showed equal reductions in trunk sway with respect to controls for simple gait tasks (e.g. walking while rotating the head). Conclusions: A similar pattern of balance impairment was present in patients with whiplash injury with and without MTBI. However, the impairment was greater for stance and complex gait tasks in WAD patients with MTBI. ß 2011 Elsevier B.V. All rights reserved. * Corresponding author. Tel.: +41 61 265 2040, fax: +41 61 265 2750. E-mail address: jallum@uhbs.ch (J.H.J. Allum). Contents lists available at ScienceDirect Gait & Posture jo u rn al h om ep age: ww w.els evier.c o m/lo c ate/g aitp os t 0966-6362/$ – see front matter ß 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.gaitpost.2011.06.021