Whiplash-associated dysphagia and dysphonia – a scoping review

Ms Danielle Stone1, Professor Liz Ward4,5, Ms Stefani Knijnik6, Dr Hans Bogaardt1,3, Professor Jim Elliott1,3,7

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, 6The Federal University of Health Sciences of Porto Alegre; The Pontifical Catholic University of Rio Grande do Sul, Partenon, Brazil, 7Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA

Aim: Investigate the incidence and nature of patient reported swallowing and voice deficits after whiplash.

Design: A scoping review was conducted across six databases, covering available sources from 1950 to March 2019.

Methods: A total of 18 studies were included for review. Study purpose, design, outcome measures, participant characteristics and outcomes reported were extracted. Level of evidence (LOE) was assessed by the American Speech-Language Language Association (ASHA)’s LOE system.

Results: All studies were exploratory, with 68% rated as poor (<3) on quality ratings. Nearly half (n=6) were single case reports. Only 3 investigated some type of swallow-related outcome specifically within the study aim/s. Incidence of swallow problems ranged from 2-29%, with unspecified complaints of “swallowing difficulty”, “dysphagia” and fatigue and pain whilst chewing reported. Neither swallowing biomechanics nor the underlying pathophysiology of complaints was investigated in any study. Four case studies presented post-whiplash voice complaints; 2 describing loss of pitch range. Others described hoarseness, loss of vocal control and weak phonation. Most studies only mentioned swallow- or voice- related deficits when reporting a wider set of post-injury symptomatology and 6 did not describe the outcome measure used.

Conclusion: The available literature is limited and of low quality, resulting in an unclear picture of the true incidence and underlying mechanisms of patient-reported swallow and voice deficits following whiplash.


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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