Eye movements in patients with Whiplash Associated Disorders: a systematic review

textabstractBackground: Many people with Whiplash Associated Disorders (WAD) report problems with vision, some of which may be due to impaired eye movements. Better understanding of such impaired eye movements could improve diagnostics and treatment strategies. This systematic review surveys the current evidence on changes in eye movements of patients with WAD and explains how the oculomotor system is tested. Methods: Nine electronic data bases were searched for relevant articles from inception until September 2015. All studies which investigated eye movements in patients with WAD and included a healthy control group were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the Methodology Checklists provided by the Scottish Intercollegiate Guidelines Network. Results: Fourteen studies out of 833 unique hits were included. Ten studies reported impaired eye movements in patients with WAD and in four studies no differences compared to healthy controls were found. Different methods of eye movement examination were used in the ten studies: in five studies, the smooth pursuit neck torsion test was positive, in two more the velocity and stability of head movements during eye-coordination tasks were decreased, and in another three studies the cervico-ocular reflex was elevated. Conclusions: Overall the reviewed studies show deficits in eye movement in patients with WAD, but studies and results are varied. When comparing the results of the 14 relevant publications, one should realise that there are significant differences in test set-up and patient population. In the majority of studies patients show altered compensatory eye movements and smooth pursuit movements which may impair the coordination of head and eyes

Eye movements in patients with Whiplash Associated Disorders: A systematic review

Background: Many people with Whiplash Associated Disorders (WAD) report problems with vision, some of which may be due to impaired eye movements. Better understanding of such impaired eye movements could improve diagnostics and treatment strategies. This systematic review surveys the current evidence on changes in eye movements of patients with WAD and explains how the oculomotor system is tested. Methods: Nine electronic data bases were searched for relevant articles from inception until September 2015. All studies which investigated eye movements in patients with WAD and included a healthy control group were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the Methodology Checklists provided by the Scottish Intercollegiate Guidelines Network. Results: Fourteen studies out of 833 unique hits were included. Ten studies reported impaired eye movements in patients with WAD and in four studies no differences compared to healthy controls were found. Different methods of eye movement examination were used in the ten studies: in five studies, the smooth pursuit neck torsion test was positive, in two more the velocity and stability of head movements during eye-coordination tasks were decreased, and in another three studies the cervico-ocular reflex was elevated. Conclusions: Overall the reviewed studies show deficits in eye movement in patients with WAD, but studies and results are varied. When comparing the results of the 14 relevant publications, one should realise that there are significant differences in test set-up and patient population. In the majority of studies patients show altered compensatory eye movements and smooth pursuit movements which may impair the coordination of head and eyes

The influence of cervical movement on eye stabilization reflexes

To investigate the influence of the amount of cervical movement on the cervico-ocular reflex (COR) and vestibulo-ocular reflex (VOR) in healthy individuals. Eye stabilization reflexes, especially the COR, are changed in neck pain patients. In healthy humans, the strength of the VOR and the COR are inversely related. In a cross-over trial the amplitude of the COR and VOR (measured with a rotational chair with eye tracking device) and the active cervical range of motion (CROM) was measured in 20 healthy participants (mean age 24.7). The parameters were tested before and after two different interventions (hyperkinesia: 20 min of extensive active neck movement; and hypokinesia: 60 min of wearing a stiff neck collar). In an additional replication experiment th

Sensorimotor disturbances in people with non-specific neck pain

This thesis aimed to describe the interactions between head and eye movement systems in people with neck pain. The first paper (_chapter 2_) of this thesis was a systematic review in which we described joint position sense error (JPSE) in people with neck pain. In general, it can be concluded that people with neck pain show a larger cervical JPSE error when it is measured over at least six trials. There was no difference between onset, pain intensity, or duration regarding the joint position sense error. The paper concerning the cervico-ocular reflex (COR) in people with non-specific neck pain (_chapter 3_) showed an altered gain of the COR in non-specific neck pain in comparison to people without neck pain. The VOR did not differ between these two groups. The COR differed on a group level, and there was no correlation between cervical range of motion, pain intensity, dizziness, and the gain of the COR. This was the first study describing the COR in a study population of people with non-specific neck pain, which is by far the majority of people with neck pain. _Chapter 4_ was a letter to the editor on ‘the cervico-ocular reflex is increased in people with non-specific neck pain.’ In _chapter 5_ we described the relationship between the COR and the JPSE. Here we presented a correlation between the COR and the JPSE in a vertical plane. As both tests receive information from the cervical spine, this was expected. What was less expected was the result that there was no correlation between the COR and the JPSE in the horizontal because the COR was measured in a horizontal plane and not in a vertical plane. The fact that the JPSE is a representation of different aspects of sensorimotor function can explain this finding. In _chapters 6 and 7_, we described the effect of static neck torsion and target predictability on smooth pursuit eye movements and saccadic eye movements in people without neck pain and people with neck pain. The Smooth Pursuit Neck Torsion test is used as a clinical measure for oculomotor disorders in people with neck pain. However, it is doubtful that the SPNT merely tests the influence of cervical proprioception on smo

Analgesic effects of manual therapy in patients with musculoskeletal pain : a systematic review

BACKGROUND: Current evidence shows that manual therapy elicits analgesic effect in different populations (healthy, pain inflicted and patients with musculoskeletal pain) when carried out at the spinal column, although the clinical significance of these effects remains unclear. Also the analgesic effects of manual therapy on peripheral joints have not been systematically reviewed. METHODS: A systematic review was carried out following the PRISMA-guidelines. Manual therapy was defined as any manual induced articular motion with the aim of inducing analgesic effects. Outcome measure was pain threshold. RESULTS: A total of 13 randomized trials were included in the review. In 10 studies a significant effect was found. Pressure pain thresholds increased following spinal or peripheral manual techniques. In three studies both a local and widespread analgesic effect was found. No significant effect was found on thermal pain threshold. DISCUSSION: Moderate evidence indicated that manual therapy increased local pressure pain thresholds in musculoskeletal pain, immediately following the intervention. No consistent result was found on remote pressure pain threshold. No significant changes occured on thermal pain threshold values. The clinical relevance of these effects remains contradictory and therefore unclear