1. John ǀ Cussen
0655457
0655457
Whiplash ǀ Rehabilitation ǀ Device
Research ǀ Report
2. M a y | 2010
Contents
Introduction ......................................................................................................... 2
Secondary ǀ research .......................................................................................... 3
Literary ǀ research ............................................................................................ 3
Patents ............................................................................................................ 4
Australian Patent .......................................................................................... 5
United States Patent .................................................................................... 6
Canadian Patent ........................................................................................... 8
Primary ǀ research ............................................................................................... 9
Focus ǀ groups ................................................................................................. 9
Observations ................................................................................................. 10
Behaviour ǀ mapping ...................................................................................... 11
Interviews ǀ questionnaires ............................................................................ 12
User trials ǀ Product–in-use ........................................................................... 15
Market ǀ analysis ............................................................................................ 17
Personality ǀ profiling ..................................................................................... 18
Style ǀ analysis ............................................................................................... 19
Appendices ....................................................................................................... 20
Interview with Professor Michele Sterling ...................................................... 21
Pictures.......................................................................................................... 23
Neck-brace experiment questions: ................................................................ 25
References........................................................................................................ 26
Journals ......................................................................................................... 28
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3. M a y | 2010
Introduction
The author has chosen physiotherapy as his field of study. The aim is to create
a device for rehabilitation at home for patients suffering from whiplash.
Whiplash is an injury caused by or related to a sudden distortion of the neck.
The injury is commonly associated with motor vehicle accidents, usually when
the vehicle has been hit from the rear. The injury can relate from aches and
pains in the neck to serious back problems. Symptoms include:
Neck pain
Headache
Shoulder pain
Low back pain
Difficulty swallowing
Blurred vision
Ringing in the ears
Nausea
Fatigue or weakness
Irritability
Dizziness
Vertigo
A 2004 survey by Daniel G. Baldyga showed that almost 10% of all whiplash
victims became totally disabled for long periods after the initial injury. This
survey also found that 60% of whiplash victims needed long-term treatment for
recurrence of the injury. The survey also suggested that almost a quarter of
whiplash patients feel the effects of the injury for up to 6 months after the initial
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injury. Whiplash patients are usually scheduled for a single session of
physiotherapy each week. During this session the ‘Stabilizer Bio-Feedback’ is
used as treatment.
Once this session ends there is an array of exercises that the patient is given to
do at home. However if not done properly these exercises can cause as much
as they can help. It is for this reason that the authors believes a device needs to
be created that instils confidence in both physio and patient that the
rehabilitation can be correctly continued outside of the designated physio
sessions.
Secondary ǀ research
Literary ǀ research
Literary research has mostly consisted of books and publications regarding
neck stress and whiplash. The author acquired a booklist containing over 75
books with information on the above from a physiotherapist specialising on
neuro and physio treatment. One of the stand out books was ‘Whiplash
Headache and Neck Pain’ by Gwen Jull. The book deals with the initial
evaluation and diagnosis of the injury and the different ways in which the injury
should be dealt with, how much rest to get, exercises to do etc. Using Jull as a
reference the author looked into different publications specialising in whiplash
related injuries. The journal of Rehabilitation Medicine, 2005 included two very
interesting publications, ‘Do dorsal head contact forces have the potential to
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5. M a y | 2010
identify impairments during graded crainiocervical flexor muscle contractions’
and ’Smooth pursuit neck torsion test in whiplash associated orders –
relationship to self reports of neck pain and disability, dizziness and anxiety’.
Another important specialist the author found helpful was Professor Michele
Sterling PhD MPhty Bphty from the University of Queensland, Australia. She
was involved in the both ‘Do dorsal head contact forces have the potential to
identify impairments during graded crainiocervical flexor muscle contractions’
and ’Smooth pursuit neck torsion test in whiplash associated orders –
relationship to self reports of neck pain and disability, dizziness and anxiety’.
One of her own publications ‘Whiplash (grade II) and cervical radiculopathy
share a similar sensory presentation: an investigation using quantitative sensory
testing’ featured in Clinical Journal of Pain, offered an insight into the effects of
a whiplash injury on the different systems in the body, most notably the nervous
system. Having read her publications and researched her patents the author
subsequently contacted Professor Sterling and she was more than happy to
answer the questions posed to her, answers from which were very helpful.
Patents
The author has also carried out patent searches related to the area of research;
the following are patents from Australia and the USA for similar Bio-Feedback
products.
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6. M a y | 2010
Australian Patent
no. 657277
1
Application details
Australian application no.: 85932/91 Patent application Type: standard Serial
no.: 657277 Application status: SEALED Paid to date: 18-10-2009 First
IPC mark: A61 5/22 (2006.01) Currently under opposition: No
proceeding type(s)
Invention title: Exercise monitoring device
Inventor(s): Jull, Gwendolen Anne; Richardson, Carolyn Anne
Agent name: Fisher & Kelly Address for legal service: 349 Coronation Drive
Milton QLD 4064 Filing date: 1991-10-18 Australian OPI date: 1993-
02-25 OPI published in journal Effective date of
patent: 1991-10-18 Expiry date: 2011-10-18
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7. M a y | 2010
United States Patent
no. 5338276
2
Application Details:
Application number: 783299
Filing date: October 1991
Summary of The Invention
The invention provides in one aspect an exercise monitoring device including a
pressure pad, an air pump, feedback means and an air line associated with the
pressure pad, air pump and feedback means to permit inflation of the pressure
pad for monitoring purposes.
The pressure pad may be of any suitable form and thus comprise a flexible
bladder or bag preferably formed of non-resilient or non-stretchable material
inclusive of plastics material such as vinyl, leather or fabrics like cotton or wool.
Although the pressure pad may comprise a single air chamber it is preferred
that there are provided a plurality of air chambers separated by boundaries only
permitting restricted air access between adjacent air chambers. It is preferred to
utilise a plurality of air chambers having restricted air access between the
chambers as this allows appropriate monitoring of variable changes (eg
rotation) of the patient's body position unlike a single air chamber.
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In another embodiment, the pressure pad may be formed of a plurality of
completely separate air chambers whereby each chamber has its own air line to
provide a plurality of air lines all communicating with a common manifold.
In a preferred embodiment therefore the pressure pad may comprise an air bag
which is suitably plate like in shape having a pair of opposed walls wherein
adjacent parts of each wall may be fused or welded together so as to form the
abovementioned boundaries with openings or air passages between each
boundary to provide access of air between adjacent air chambers.
The air pump may be of any suitable kind and suitably comprises an air bulb or
pressure bulb which may be actuated or pressurised manually. However this
does not preclude the use of other air pumps such as piston pumps or
diaphragm pumps for example.
The feedback means may be of any suitable type that permits monitoring or
metering of the pressure biofeedback which is transmitted by the pressure pad.
This may include an analogue meter for example such as an aneroid dial or
electronic or electrically operated meter such as a digital read out or a suitably
visual display unit or VDU.
In one form the feedback means may also include a pressure transducer such
as a strain gauge or pressure transducer based on a piezo electric effect or
variable resistance effect. In the latter arrangement this may operate with one
side or face of a membrane incorporating a circuit having the variable
resistance being subject to the pressure change which will result in a change in
the electrical resistance of the circuit which is related to or proportional to the
change.
The pressure transducer may be connected to the pressure pad in any suitable
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fashion such as by an air hose. The pressure transducer in turn may then be
connected to a digital read out or analogue meter or interfaced with a computer
which incorporates the VDU which if desired may be coupled to a printer. The
computer may use appropriate software so as to provide a thorough analysis of
the output of a patient undergoing an exercise routine which may be contained
in a suitable print out from the printer.
Preferably for ease and convenience the air bulb is directly coupled to an
aneroid dial so that the result on the aneroid dial may be read by the patient
undergoing the exercise so as to provide a form of self assessment.
There also may be provided valve means so as to adjust the pressure in the
pressure pad if required. In one form this may comprise a screw actuated valve
associated with an air passage between the aneroid dial and the air bulb. When
the valve is in an open position air may not reach the pressure pad but is
pumped directly to atmosphere. When the valve is closed or partially closed air
may be pumped to the pressure pad so as to inflate the pressure pad. Further
opening of the valve may decrease the pressure in the pressure pad as
recorded on the aneroid dial when required.
Canadian Patent
no. 2058233-2
3
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10. M a y | 2010
In the patents there is no mention of the products being designed for home use.
Only the hand pump device is mentioned as a form of pressure gauge, this is an
aspect of the product I hope to develop as the current method can be
unreliable.
Primary ǀ research
Focus ǀ groups
Since the beginning of the project in September 2009 the author has been to
the West Limerick Neuro and Physio Rehabilitation Clinic in Newcastle West,
co. Limerick. On two of these occasions the author has met with two of the
physio’s for focus groups where ideas were put on the table, pro’s and con’s
discussed and decisions made. Along with the focus group aspect of the
meetings the physio’s involved the author in demonstrations of the different
exercises and routines the patient is put through during the session, in
preparation for continuation of the exercise at home. Seeing the preparation
that goes into selecting the exercises for the patient to be doing at home was a
very important aspect of these meetings. All that was given to the patient was a
set of exercises based around what was done during the session on the
‘Stabilizer Bio-Feedback’ device. The Bio-Feedback device is the only
recognised piece of equipment currently available for the treatment of whiplash.
Both physios and patients of whiplash expressed mixed emotions when it came
to the Bio-Feedback device. The patient confessed to a lack of motivation when
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trying to recite exercises learned during physio sessions. The physio was
concerned in relation to mis-use of the exercise instructions given which may
lead to further aggravation of the injury.
4 Stabilizer Bio Feedback
Observations
The observations carried out by the author have been to do with two different
forms of whiplash treatment the first was the use of lasers on pre-designed
charts. This method is used when there is an imbalance or a misalignment of
the cranium. The activity involves the attaching of a laser to the patients head
with the use of an elastic band and a hair band. Both parties found this
particularly difficult as the physio had to securely attach the laser pen to the hair
band with the elastic band, this was awkward and time consuming. The
patient’s issues were to do with the insecurity of the bond between the pen and
the hair, making it difficult to carry out the appropriate exercises.
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5 Laser pen used for correcting cranium alignment 6 Charts also used in treatment
The second observation made by the author was the use of the bio-feedback
device. This method involved the patient lying on his/her back with the blue
piece of the apparatus behind their head. They then have to hold the pressure
gauge aloft in order to read the pressure as they completed the exercise. The
exercise involved retracting the chin towards the neck, against the pressure
built up in the blue apparatus. This device appeared both problematic and
awkward for physiotherapist and patient. The patient described it as
‘uncomfortable’ and ‘difficult to figure out’. The physio described it as ‘awkward’
and ‘more time consuming than necessary’. This view was due to the fact the
physio had to stay with the patient for most of the exercise, to ensure it was
being done properly but also because the patients arm was becoming fatigued
as result of holding the pressure gauge aloft.
Behaviour ǀ mapping
The patient can have many different characteristics so it is hard to map
behaviour. Whiplash is mostly suffered by those involved in car accidents but
can also be as result of a fall on a hard surface, a sports injury or just
aggravation of muscles with a sharp movement of the neck. On the other side of
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the treatment is the physiotherapist. He/she would generally work a regular
office day, often dealing with whiplash patients for one hour blocks at a time.
The use of the product is often determined by the seriousness of the injury
sustained, or the stage of the recovery the patient is at.
Interviews ǀ questionnaires
At the beginning of research, once the decision had been made to focus on the
neck, a questionnaire/social experiment was carried out with a neck brace. The
questionnaire involved candidates wearing the brace for a certain frame of time,
before rating the product on different qualities.
The aim of the experiment was to evaluate the effectiveness of the most basic
neck support products. The questionnaire had four questions, each answer was
to be given as a rating from 1 – 5 with 1 being weakest and 5 being strongest.
There were 12 candidates, 8 male, 4 female, 7 candidates fell in the 17-29 age
bracket, 1 in the 30-44, 3 in the 45-59 and 1 in the 60+.
For the age group 17-29 the average responses were Q1 moderate-okay, Q2
uncomfortable-noticeable, Q3 couldn’t move-restricted, Q4 supported-sufficient
support.
For the age group 30-44 Q1 okay, Q2 easy, Q3 slight movement, Q4 sturdy
support.
For the age group 45-59 Q1 okay, Q2 noticeable, Q3 no difference, Q4
supported-sufficient support. For the age group 60+Q1 difficult, Q2
uncomfortable, Q3 restricted, Q4 limited support.
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The social side of the experiment was carried out by the author and involved
him wearing a neck brace, while undertaking different activities during the
course of a regular day. These activities included reading a book, using a
laptop, eating a meal and watching TV. After approximately 5 minutes of
wearing the brace it because extremely uncomfortable and come the end of the
experiment found his neck muscles to be increasingly strained.
During the process of research and information gathering many different
therapists were interviewed by the author. The interviews were carried out at
different stages of the research; these offered both great insights into the range
of rehabilitation equipment already on the market and ideas as to what direction
that could be taken to improve this market range. The first official was in the
sports arena in UL, he agreed that there was little in the way of equipment for
those rehabilitating muscles other than thera-bands, which are prone to misuse.
The aspect of the idea that most appealed to him was the thought of a product
that would have the ability to be used for both sports injuries and general
physiotherapy. He recommended a meeting with more specialised
physiotherapists to get a more focused opinion on physical therapy.
Next to be interviewed were two physiotherapists based in Newcastle West, co.
Limerick. This was at a stage when the project was making a move towards
focusing on the neck. They have their own clinic, West Limerick Physiotherapy
& Neuro Rehabilitation Clinic in Newcastle West and were able to offer several
areas in the physiotherapy where products needed development. Products that
ranged from roller tubes for back pain to treatment tables.
The biggest problem they stated was cost, there was equipment out there but
because of increasing costs smaller practices like theirs were unable to afford
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them. On the second visit to the West Limerick Physiotherapy & Neuro
Rehabilitation Clinic the author was given demonstrations for several products
and could immediately see the areas either where new products or
improvements were needed. They gave a full list of books and publications to
read up on, and in particular mentioned Professor Michelle Sterling, an author
of several publications who is based in Queensland, Australia.
At this point the author successfully contacted Professor Sterling and she has
agreed to a Skype interview when she is free, but in the meantime offered to
answer any immediate questions.
The next interview carried out by the author was with a chartered
physiotherapist based in Castletroy, Limerick who has masters in sports
physiotherapy, he practices in the United Physiotherapy Clinic at Whitehorns,
Castletroy. The author asked him, what he felt were the major flaws in whiplash
treatment. He replied ‘after a trauma muscles become sensitised and the pain
felt by the affected neck muscles can spread through the nervous system,
making it difficult to treat, also with whiplash injuries, an x-ray of a perfectly
healthy neck and an x-ray of a neck post whiplash will look the exact same so it
can be hard to differentiate between tissue and muscle damage’. ‘Loads on
damaged muscles can leave them fatigued, hampering treatment and during
certain treatments the front neck muscles (deep neck flexors) become inhibited’.
The author then asked him his opinion on his own thoughts that home treatment
can be harmful as much as helpful! He agreed, stating that ‘there is a big
problem with home exercises as there is no guarantee the exercises are being
done properly and the exercises are being done at all’. He suggested maybe
some form of a video diary or clicker to indicate number of replications done. He
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also talked about Ultrasound treatment, this form of treatment allows the
physiotherapist to view the muscles contracting.
The author also contacted and visited physiotherapists in St. Camillus,
Shelbourne road, Limerick. The physio echoed a lot of the points of view
already gathered by the author, but was unable to offer more as they did not
deal with whiplash first hand in the clinic.
On the visit to St. Camillus the author was referred to their specialist physio
clinic, located within a kilometre of the main clinic. The author was familiar with
this clinic as he had completed rehabilitation there previously. The physio met
there was very helpful and offered her opinions on several of the devices
currently in use for whiplash rehabilitation. She felt the laser head-band/chart
idea was effective but could be made more user-friendly. She did not have any
major trouble with the bio-feedback either but again felt it could be more user-
friendly. She did confess though that her patients had more negative feelings
towards the bio-feedback than her.
User trials ǀ Product–in-use
Testing carried out by the author has included trials on different neck braces
and on the ‘Stabilizer Bio-Feedback’. This testing helped distinguish the exact
issues and flaws with the different treatment devices used for whiplash.
Problems with neck braces included height around the neck that caused
discomfort, other than this flaw the issues were to do with comfort and
restriction of movement; these however were unavoidable with compromising
the purpose of the brace.
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7 neck-brace front
8 neck-brace back
9 neck-brace side
Problems with the ‘Stabilizer Bio-Feedback’ were numerous. There were
complaints about the position it had to be used in, the struggle to get the exact
required pressure, having to keep the pressure gauge aloft for the duration of
the exercise and also the fact the patient couldn’t take the device home to
continue recovery.
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Videos involving these user trials for both the neck brace and the bio-feedback
device are available for viewing on www.johncussen.vox.com
Market ǀ analysis
At the moment Stabilizer are the only manufacturers of the bio feedback device.
As there are no other manufacturers, there are no other variations of the
product, meaning the current flaws remain constant. These flaws include a lack
of clarity over how exactly to use the product. The pressure is hard to correctly
gauge as there is constantly air moving between the tube connecting the
pressure pump and gauge to the head rest. The current version also requires
two people in order to use the device correctly for the duration of the exercise.
The rest which sits under the neck offers no support for the head, which leads
to doubt about how to position the device correctly this can also cause further
muscle issues. These flaws are mainly due to the fact the device was originally
invented for use by patients with back issues.
The author feels the following features need to be introduced to the device to
aid the physio and the patient.
Ability to use the device anytime, anywhere and in any position.
Easier to use.
Better neck support.
Incorporation of some sort of motivational device.
More cost effective.
Currently, there are no other variations of this device on the market, or plans to
introduce a new variation into the market. This gives the author reassurance
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that there is a hole in the market that can be filled with a well designed and
manufactured product that already has a concrete target market.
Personality ǀ profiling
The primary user will be the patient, with the secondary being the
physiotherapist.
Mike, 23, is a young male who is currently doing his masters degree in Biology,
in University of Limerick. He is an independent individual who lives away from
home and pays his own way in life by virtue of his part-time job. Mike is an
active member of his local GAA club and enjoys kick-a-bouts with his friends
during free evenings. He also has an active social life.
One evening driving home from work Mike is rear ended by another vehicle but
doesn’t suffer immediate health issues. A few weeks later however he
complains of muscle pains, is referred to a physiotherapist, Linda, and is
diagnosed with whiplash. With restricted movement and having to attend
physiotherapy sessions once a week, Mike’s life is completely disrupted. He is
unable to attend college, work or play any sports. He feels his treatment could
be progressing faster, especially if he could continue his rehabilitation after
physio sessions at home...
Linda, 52, has been working as a physiotherapist for almost 30 years. She owns
her own clinic and is used to dealing with whiplash victims, none more so than
patients involved in road accidents. She has recently had to let a
physiotherapist go because of spiralling expenses so as a result has a heavier
workload. As her clinic is based in the city centre she has many whiplash
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patients but little time to fit them all in for minimum one session a week. She
finds recovery times slow as well and wishes there was only some way she
could monitor her patients progress outside of sessions...
Style ǀ analysis
The styles a device for a neck muscle rehabilitation device would have to follow
the typical medical device features. These include the device being a clean soft
colour, having little or no ‘fancy tech add-ons’ and being designed to meet all
medical requirements especially the strict guidelines of what is and isn’t classed
as medical waste.
The device should also look comfortable and to wear. The patient will be
wearing the device for no longer than 10-15 minutes at any one time but it is still
important for the device to carry an appealing aesthetic.
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Appendices
The following is a list of individuals who have been interviewed, offered advice
or contributed to the project during research in any way.
Claire Noonan, Physiotherapist, West Limerick Physiotherapy and Neuro
Rehabilitation Clinic, Newcastle West
Fiona Taylor, Physiotherapist West Limerick Physiotherapy and Neuro
Rehabilitation Clinic, Newcastle West
Dr Johnson McEvoy, United Physiotherapy Clinic at Whitehorns, Castletroy
Dr Cian O’Neill, Course Director, health fitness, University of Limerick
Assoc Prof Michele Sterling, Associate Professor, University of Queensland,
Australia
Niall Deloughry, Lecturer, M&OE Department, UL
Dermot McInerney, Lecturer, M&OE Department, UL
Muireann McMahon, Lecturer, M&OE Department, UL
Sara Cox, Lecturer, M&OE Department, UL
Marion McCarthy, Physiotherapist, St.Camillus, Shelbourne Road
Sarah Breen, Post-graduate student, Department of physical education and
sport sciences, UL
Joseph Costello, Post-graduate student, Department of physical education and
sport sciences, UL
Dr Christy Gillick, Lecturer, M&OE department, UL
Dr Colin Fitzpatrick, Lecturer, Electronic Engineering, UL
Dr Pepijn Van de Ven, Lecturer, Electronic Engineering, UL
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Interview with Professor Michele Sterling
Q. The general time frame for recovery from a whiplash injury is said to be 8 to
12 weeks, is this true or a myth depending mostly on the seriousness of the
injury sustained?
A. This is a myth. Most data now indicates that around 50% will
still have symptoms at 12 months (see paper from Bone and Joint
Decade)
Q.Is there an age group of common whiplash sufferers?
A. Not really. Age is sometimes a predictor of outcome and
sometimes not.
Q. What are the muscles most affected during whiplash?
A. Evidence for direct muscle injury/damage is inconclusive (see
Siegmund paper). However there are certainly changes in muscle
morphology and recruitment patterns that occur in response to
either the injury or pain - it’s not clear which, (see Elliott and
sterling papers).
Q. Is there a minimum force that needs to be applied for a person to suffer neck
muscle damage, or does this depends on the physical condition of the person
involved?
A. A minimum force for injury has never been demonstrated as far
as I'm aware. People can be injured in low force/impact collisions.
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Q. I myself suffered a form of whiplash as result of a fall playing sport. How
common is a sports related whiplash injury?
A. Probably fairly common, but not much research done on this.
Probably because whiplash from car crashes costs a lot due to
compensation etc.
Q. I’ve recently used the bio-feedback rehabilitation device, and found it to be
unreliable and sometimes inaccurate, what is your opinion of it?
A. Reliability and accuracy improves with improved skills of the
tester. The PBU is a clinical tool only - i.e. feedback for the phsyio
and the patient. It is not really designed to be a diagnostic tool.
Q. Are there any other devices like the bio-feedback for whiplash treatment
currently available on the market?
A. Not that I'm aware of.
Q. Do you know of any devices for home treatment of whiplash injuries?
A. Not sure what you mean here? Do you mean exercise devices?
If so then no, not that I’m aware of.
Q. When doing physio for rehabilitation of my left hand, I was given exercises
to do outside of session time at home but found them to be doing as much harm
as they were help, do you think this is one of the main reasons injuries are
prolonged?
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A. In the case of whiplash, a group of patients demonstrate
widespread sensory hypersensitivity and cold allodynia that reflect
central nervous system hyperexcitability. If any form of exercise
aggravates these people's pain, then this will potentially further
wind up the CNS and yes do more harm than good. If the
exercises a pain free then things should be OK
Pictures
10
11
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12
13 14
15 16
17 18
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19
Neck-brace experiment questions:
Q. Is the product easy to get on?
Q. Is the product comfortable to wear?
Q. Is your movement restricted?
Q. Does it offer adequate support?
Each answer was to be given as a rating from 1 – 5 with 1 being weakest and 5
being strongest.
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References
1. http://pericles.ipaustralia.gov.au/ols/auspat/quickSearch.do?queryString=
657277&resultsPerPage=http://patft.uspto.gov/netacgi/nph-
Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=/netahtml/PTO/s
rchnum.htm&r=1&f=G&l=50&s1=5338276.PN.&OS=PN/5338276&RS=P
N/5338276
2. http://patft.uspto.gov/netacgi/nph-
Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=/netahtml/PTO/s
rchnum.htm&r=1&f=G&l=50&s1=5338276.PN.&OS=PN/5338276&RS=P
N/5338276
3. http://brevets-patents.ic.gc.ca/opic-
cipo/cpd/eng/patent/2058233/financial_transactions.html?type=number_
search
4. http://healthinfousa.com/chattanooga/biofeedback.jpg
5. Photos – John Cussen
6. Photos – John Cussen
7. Photos – John Cussen
8. Photos – John Cussen
9. Photos – John Cussen
10. Photos – John Cussen
11. Photos – John Cussen
12. Photos – John Cussen
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13. http://g-ecx.images-
amazon.com/images/G/01/books/promos/Muscles_Lateral_lg.jpg1
14. http://g-ecx.images-
amazon.com/images/G/01/books/promos/Muscles_Lateral_lg.jpg2
15. http://g-ecx.images-
amazon.com/images/G/01/books/promos/Muscles_Lateral_lg.jpg3
16. http://g-ecx.images-
amazon.com/images/G/01/books/promos/Muscles_Lateral_lg.jpg4
17. http://www.a3bs.com/imagelibrary/VR1132_L/anatomical-charts-poster-
size/VR1132_L_head-and-neck-chart.jpg1
18. http://www.a3bs.com/imagelibrary/VR1132_L/anatomical-charts-poster-
size/VR1132_L_head-and-neck-chart.jpg2
19. http://www.physiostuff.com/repository/product/15/img_9781587793752.jp
g
20. http://www.truckinfo.net/trucking/newwhiplashinformation.htm
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Journals
Whiplash Headache and Neck Pain, Jull, G.
The journal of Rehabilitation Medicine, 2005
Do dorsal head contact forces have the potential to identify impairments during
graded crainiocervical flexor muscle contractions, Jull, G. Sterling, M
Smooth pursuit neck torsion test in whiplash associated orders - relationship to
self reports of neck pain & disability, dizziness & anxiety, Jull, G. Sterling, M
Publications
Whiplash (grade II) and cervical radiculopathy share a similar sensory
presentation: an investigation using quantitative sensory testing’ Sterling, M
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