Clinical Case Scenario #1
Treatment plan following acceleration deceleration injury
Twenty-eight year old Maria B. is involved in a rear-end collision while driving at a speed < 20 mph. The next day she experiences pain and stiffness in her neck and shoulders. Following radiologic and physical exam, the chiropractor diagnoses her condition as an acceleration/deceleration injury (whiplash). As there are no signs of neurologic involvement, referral to a neurologist is deemed unnecessary.
The chiropractor uses Rehabilitation Reference Center (RRC) to review the latest evidence based information about treatment modalities that will alleviate Maria’s symptoms and promote return to her prior level of functioning.
Searching in RRC
From the Home Page, the Physical Therapist searches Acceleration Deceleration Injury and from the Clinical Reviews, chooses Cervical Muscle Strain/Sprain.
Reading the Clinical Review, she checks completeness of her exam based on the current best available evidence, for example causes, pathogenesis, and risk factors; overall contraindications/precautions; and medical, social and occupational history.
Clicking on Assessment/Plan of Care, the Physical Therapist reviews the Treatment Summary and learns that the results of a randomized controlled trial of whiplash-related injuries by Rosenfeld et al strongly support early mobilization (starting at 96 hours versus 14 days post-MVA) and active intervention for reduction of neck pain and days of sick leave taken over 3 years.
The Physical Therapist works with Maria to formulate a customized plan which includes manual traction, cervical immobilization and NSAIDS, followed by a combination of stretching and range of motion exercises.
The Physical Therapist returns to the Results List in Rehabilitation Reference Center and chooses the Patient Education tab to print a handout on Whiplash after educating Maria in the nature of the injury and its usual course of treatment.
After returning to the home screen, she chooses the Exercise Images tab and under the Main Category tab, she scrolls down to Orthopedic. From there she chooses Cervical Spine, where she’ll select Flexibility (Neck Stretch) and Range of Motion (AROM-Active Range of Motion): Neck Flexion and Neck Extension exercises. These images are printed, and following rest and intermittent immobilization, Maria will use these customized exercises based on her tolerance and functional improvement goals.
Desired Outcomes / Outcome Measures will include re-evaluation of cervical range of motion, strength, pain level, and Maria’s return to prior level of functioning.
The Physical Therapist adds the collection of evidence-based papers to a designated Cervical Injuries Folder in RRC.
See how to browse Exercise Images below:
Click the Exercise Images tab:
Continue to select subcategories.
Main Categories > Orthopedic > Cervical Spine.
Main Categories > Orthopedic > Cervical Spine > Flexibility.
Click the image thumbnail to view the Exercise Image.
The Image is displayed and can be printed, emailed, or saved.