Self-reported dysphagia and pharyngeal volume following whiplash injury

Ms Danielle Stone1,2,3, Professor Liz Ward4,5, Dr Hans Bogaardt1,3, Dr Robert Heard1, Professor Bonnie Martin-Harris6, Dr Andrew Smith7, Professor Jim Elliott1,3,8

1Speech Pathology Department, Royal North Shore Hospital, St Leonards, Australia, 2Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 3Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, St Leonards, Australia, 4School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane, Australia, 5Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Services, Brisbane, Australia, 6Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Feinberg School of Medicine, Northwestern University, Chicago, USA, 7Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, School of Medicine, Denver, USA, 8Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA

Aim: To investigate i) prevalence of self-reported swallowing problems after whiplash, ii) temporal change over 12-months and iii) whether worsening dysphagia is associated with a) poor recovery and/or b) reduction in pharyngeal volume.

Design: Secondary analysis of a longitudinal cohort study

Method: 60 participants with acute whiplash were recruited from an emergency department. All completed the Dysphagia Handicap Index (DHI) and Neck Disability Index (NDI) and underwent magnetic resonance imaging (MRI) of the cervical spine at < 1- and 2 weeks, 3- and 12-months. Timepoints were allocated as early (< 1- and 2 weeks) or late (3- and 12 months). Recovery was determined by NDI score. An established DHI cut-off of >3 characterized dysphagia. Pharyngeal volume was quantified by manually contouring axial T2 weighted MRI slices using OsiriX image processing software. Thirty-one of the 60 participants had data at early and late timepoints for longitudinal analysis.

Results: Prevalence of self-reported dysphagia (DHI≥3) was observed in 50% of n=60 participants at least once in 12-months (M=4.9, SD: 8.16, range 0-40). In the longitudinal cohort (n=31), mean total DHI increased (p=0.006) between early and late stages. There was no relationship between dysphagia and recovery (p=1.0). Pharyngeal volume was stable with no relationship to dysphagia (p=1.0).

Conclusion: Self-reported dysphagia was common after whiplash and worsened overtime, however, did not align with changes in pharyngeal volume or recovery, suggesting other mechanisms at play.


Danielle Stone is a Clinical Specialist Speech Pathologist at Royal North Shore Hospital, Sydney, with 18 years clinical experience working in tertiary settings across Sydney and Canada. Danielle is in her second year of PhD studies investigating dysphagia and dysphonia in non-traumatic cervical spine injury and chronic pain. Danielle was awarded a 3 1/2 year full-time scholarship to complete her studies and since commencing, has been awarded a range of prizes for research presentations. Over the past 10 years Danielle has regularly lectured at The University of Sydney and Macquarie University.

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