Comparison of child and ATD belt fit and posture on belt-positioning boosters during self-selected, holding device, and nominal conditions.

OBJECTIVE: Pediatric anthropomorphic test devices (ATDs) are important tools for the assessment of child occupant protection and should represent realistic child belt fit and posture on belt-positioning boosters. Previous comparisons have been made to children in either self-selected or nominal postural conditions. This study compares belt fit and postural measurements between pediatric ATDs and a single cohort of children assuming different postures on boosters: self-selected, holding a portable electronic device, and nominal. METHODS: A cohort of children (n = 25) were evaluated in a stationary vehicle on five boosters and in three postural conditions: nominal, self-selected, and a representative holding electronic device position. The Hybrid III 6- and 10-year-old and Q-Series 6- and 10-year-old ATDs were evaluated in the same five boosters and in two postural conditions: nominal and a representative holding electronic device position. A 3D coordinate measurement device was used to quantify belt fit (shoulder belt score, lap belt score, maximum gap size, and gap length) and anatomic landmark positions (head, suprasternale, ASIS, and patella). Landmark positions and belt fit were compared between ATDs and children for each booster and postural condition, and Pearson correlations (r) were assessed across boosters. RESULTS: ATDs generally represented Nominal child postures across boosters. In the Device condition, ATDs were seldom able to be positioned to represent both the torso and head position of children, due to limited ATD spinal flexibility. When the torso position was matched, the ATD head was more rear by 63 mm. Correlations between Nominal child and ATD belt fit and belt gap metrics were generally weak and not significant, with the exception of lap belt score (all ATDs p < 0.07, r = 0.8549-0.9857). DISCUSSION: ATDs were generally able to represent realistic child postures and lap belt fit in Nominal and short duration Self-selected postures in a laboratory setting. However, these results display the potential difficulty of utilizing ATDs to represent more naturalistic child postures, especially the more forward head positions and flexed spinal posture associated with utilizing a portable electronic device.

Biofidelity assessment of the GHBMC M50-O in a rear-facing seat configuration during high-speed frontal impact.

The objective of this study was to assess the biofidelity of the Global Human Body Models Consortium (GHBMC) 50th male (M50-O) v6.0 seated in an upright (25-degree recline) all-belts-to-seat (ABTS) in a 56 km/h rear-facing frontal impact. The experimental boundary conditions from the post-mortem human subjects (PMHS) tests were replicated in the computational finite element (FE) environment. The performance of the rigidized FE ABTS model obtained from the original equipment manufacturer was validated via simulations using a Hybrid III FE model and comparison with experiments. Biofidelity of the GHBMC M50-O was evaluated using the most updated NHTSA Biofidelity Ranking System (BRS) method, where a biofidelity score under 2 indicates that the GHBMC response varies from the mean PMHS response by less than two standard deviations, suggesting good biofidelity. The GHBMC M50-O received an occupant response score and a seat loading score of 1.71 and 1.44, respectively. Head (BRS = 0.93) and pelvis (BRS = 1.29) resultant accelerations, and T-spine (avg. BRS = 1.55) and pelvis (BRS = 1.66) y-angular velocities were similar to the PMHS. The T-spine resultant accelerations (avg. BRS = 1.93) and head (BRS = 2.82), T1 (BRS = 2.10) and pelvis (BRS = 2.10) Z-displacements were underestimated in the GHBMC. Peak chest deflection in the anterior-posterior deflection in the GHBMC matched with the PMHS mean, however, the relative upward motion of abdominal contents and subsequent chest expansion were not observed in the GHBMC. Updates to the GHBMC M50-O towards improved thorax kinematics and mobility of abdominal organs should be considered to replicate PMHS characteristics more closely.

Comparison of small female PMHS thoracic responses to scaled response corridors in a frontal hub impact.

OBJECTIVE: The purpose of this study was to generate biomechanical response corridors of the small female thorax during a frontal hub impact and evaluate scaled corridors that have been used to assess biofidelity of small female anthropomorphic test devices (ATDs) and human body models (HBMs). METHODS: Three small female postmortem human subjects (PMHS) were tested under identical conditions, in which the thorax was impacted using a 14.0 kg pneumatic impactor at an impact velocity of 4.3 m/s. Impact forces to PMHS thoraces were measured using a load cell installed behind a circular impactor face with a 15.2 cm diameter. Thoracic deflections were quantified using a chestband positioned at mid-sternum. Strain gages installed on the ribs and sternum identified fracture timing. Biomechanical response corridors (force-deflection) were generated and compared to scaled small female thoracic corridors using a traditional scaling method (TSM) and rib response-based scaling method (RRSM). A BioRank System Score (BRSS) was used to quantify differences between the small female PMHS data and both scaled corridors. RESULTS: Coefficients of variation from the three small female PMHS responses were less than 2% for peak force and 7% for peak deflection. Overall, the scaled corridor means determined from the TSM and RRSM were less than two standard deviations away from the mean small female PMHS corridors (BRSS < 2.0). The RRSM resulted in smaller deviation (BRSS = 1.1) from the PMHS corridors than the TSM (BRSS = 1.7), suggesting the RRSM is an appropriate scaling method. CONCLUSIONS: New small female PMHS force-deflection data are provided in this study. Scaled corridors from the TSM, which have been used to optimize current safety tools, were comparable to the small female PMHS corridors. The RRSM, which has the great benefit of using rib structural properties instead of requiring whole PMHS data, resulted in better agreement with the small female PMHS data than the TSM and deserves further investigation to identify scaling factors for other population demographics.

Biomechanical effects of a halo orthotic on a pediatric anthropomorphic test device in a simulated frontal motor vehicle collision.

Objective: Cervical spine injuries in children under 10 frequently involve the craniocervical junction. In patients too small for conventional spinal instrumentation, treatment may involve placement of a halo orthotic, and these patients will frequently be discharged home in a halo orthotic. To date, little research has been done on the biomechanics of motor vehicle collisions involving young children in halo orthotics. To better understand possible safety concerns, we applied a halo orthotic to an appropriately sized anthropomorphic test device (ATD, or crash test dummy) on an acceleration sled to simulate a frontal motor vehicle collision.Methods: For the tests, a Hybrid III 3-year-old ATD was instrumented with head and chest accelerometers, head angular rate sensors, a six-axis upper neck load cell, and a chest linear potentiometer. Four tests were conducted on an acceleration sled, and kinematics were recorded with high speed video. Testing variables included 1) with or without a halo orthotic and 2) with a standard booster seat or a commercially available harness vest.Results: The halo orthotic reduced flexion and extension but was associated with increased rotation, especially in the condition of a halo orthotic with a standard booster seat. Increased cervical distraction was noted with the halo orthotic, and this was especially increased in the condition of a halo orthotic with the harness vest.Conclusions: The biomechanics of a child involved in a motor vehicular collision may be dramatically altered with a halo orthotic, as modeled by an acceleration sled test. While cervical spine flexion and extension are reduced with the halo orthotic, rotation appears to increase. Immobilization from a halo orthotic also appears to increase cervical distraction, especially when used in conjunction with a harness vest. Further testing is needed to determine the safest restraints for this small, but at-risk, population.

Development of a Strain-Based Model to Predict Eviscerated Thoracic Response From Dynamic Individual Rib Tests.

The objective of this study was to develop an analytical model using strain-force relationships from individual rib and eviscerated thorax impacts to predict bony thoracic response. Experimental eviscerated thorax forces were assumed to have two distinct responses: an initial inertial response and subsequently, the main response. A second-order mass-spring-damper model was used to characterize the initial inertial response of eviscerated thorax force using impactor kinematics. For the main response, equivalent strains in rib levels 4-7 were mapped at each time point and a strain-based summed force model was constructed using individual rib tests and the same ribs in the eviscerated thorax test. A piecewise approach was developed to join the two components of the curve and solve for mass, damping, stiffness parameters in the initial response, transition point, and scale factor of the strain-based summed force model. The final piecewise model was compared to the overall experimental eviscerated thorax forces for each postmortem human subjects (PMHS) (n = 5) and resulted in R2 values of 0.87-0.96. A bootstrapping approach was utilized to validate the model. Final model predictions for the validation subjects were compared with the corridors constructed for the eviscerated thorax tests. Biofidelity ranking system score (BRSS) values were approximately 0.71 indicating that this approach can predict eviscerated responses within one standard deviation from the mean response. This model can be expanded to other tissue states by quantifying soft tissue and visceral contributions, therefore successfully establishing a link between individual rib tests and whole thoracic response.

Evaluation of static belt fit and belt torso contact for children on belt-positioning booster seats.

Objective: Previous studies have indicated that gap between the seatbelt and torso (reduced belt torso contact) for children on belt-positioning booster seats (BPBs) may lead to less torso engagement and increased likelihood of shoulder belt slip-off during evasive vehicle maneuvers, potentially increasing injury risk during crashes. However, current BPB belt fit measures do not quantify belt gap and may not be able to fully discriminate between designs which provide good vs. poor dynamic outcomes. The goal of this study was to evaluate both novel (belt gap characteristics) and conventional measures of seatbelt fit for BPB-seated children.Methods: Ten BPBs and three seatbelt anchor locations were investigated. Fifty volunteers (4-14 years) were recruited and each evaluated on six unique combinations of BPB and seatbelt anchor location on a vehicle rear seat in a laboratory setting. A 3 D coordinate measurement system quantified positions of anatomic, seatbelt, BPB, and vehicle reference points. Novel belt gap (gap size, length, location, and percent torso contact) and conventional belt fit (position of belt on shoulder and pelvis) metrics were calculated using anatomic and seatbelt landmarks. Variation in belt fit and belt gap outcomes due to BPB, seatbelt anchor location, and anthropometry were investigated.Results: BPBs produced significantly different outcomes, while seatbelt anchor location did not. BPBs with features that directly routed the lower portion of the shoulder belt more forward on the buckle side produced the largest (29.3 ± 12.6 mm) and longest (106.9 ± 68.2 mm) belt gap on average, while BPBs that pulled the belt less forward or did not directly route the belt produced the smallest (13.9 ± 6.7 mm) and shortest (16.9 ± 33.9 mm) gap on average. Belt gap outcomes were not strongly correlated with conventional belt fit metrics, indicating that evaluation of belt gap may provide additional insight when attempting to discriminate between BPBs which provide good vs. poor seatbelt engagement during vehicle maneuvers and crashes.Conclusions: This is the first study to evaluate belt gap characteristics for BPB-seated children. Results suggest that belt fit and belt gap are influenced by BPB design, particularly lower shoulder belt routings, and may have implications for belt engagement during dynamic events.

Evaluation of LATCH vs. non-LATCH installations for boosters in frontal impacts.

OBJECTIVES: The objective was to understand how the use or nonuse of the Lower Anchors and Tethers for Children (LATCH) system affects the performance of booster seats during frontal impacts. METHODS: Sixteen frontal impact sled tests were conducted at 24.8 ± 0.3 g and 50.1 ± 0.2 kph. A production vehicle seat buck was attached to the sled. Four high-back boosters or combination seats in high-back booster mode and two backless booster models were tested. Each booster model was installed two different ways: using the LATCH system ("LATCH" installation) and without using the LATCH system ("non-LATCH" installation). All installations used a 3-point seat belt with retractor in emergency locking mode (ELR) to restrain a Hybrid III 6-year-old anthropomorphic test device (ATD). The retractor, belt webbing, buckle, vehicle seat cushion, and booster were replaced after each test. Some conditions were tested twice to establish repeatability. ATD and booster responses were compared between LATCH and non-LATCH tests. RESULTS: Using LATCH reduced the forward movement of the booster itself by 32.3% to 71.5% compared to non-LATCH installations. Differences in most other metrics were small and often within the range of normal test-to-test variation. Forward movements of the ATD head and heel were similar between LATCH and non-LATCH tests (typically less than 10% difference). HIC36 values trended slightly higher for LATCH installations compared to non-LATCH installations (0.8% to 17.2%). Chest resultant accelerations were typically 7.3% to 21.2% higher for LATCH installations, except for one booster for which it was lower with LATCH. Chest deflections trended higher for LATCH installations compared to non-LATCH installations for the backless boosters (6.9% to 14.1%). For high-back boosters, chest deflection was similar between installation conditions (less than 5% difference). Shoulder belt loads showed the greatest reductions when LATCH installations included a top tether (12.9% to 20.8%). Instances of the ATD submarining under the lap belt were not observed in these tests. CONCLUSIONS: Overall, the differences in kinematics and injury metrics were small between boosters installed using LATCH vs. non-LATCH.

System providing automated feedback improves task learning outcomes during child restraint system (CRS) installations.

OBJECTIVES: The objective was to build and test an automated, interactive educational system to teach adults how to install a child restraint system (CRS) into a vehicle seat. METHODS: The automated feedback system (AFS) consisted of a mockup vehicle fixture, convertible CRS, and doll. Sensors were implemented into the equipment so that forward-facing (FF) CRS installation errors could be detected. An interactive display monitor guided users through the CRS installation process and alerted them when steps were done incorrectly. Sixty adult volunteers were recruited and randomized into either the treatment group or the control group. The treatment group used the AFS to guide them through a practice installation. The control group also completed a practice installation using the same equipment fixture without the feedback feature turned on; they only had standard printed instruction manuals to guide their tasks. Then, participants from both groups completed a second CRS installation in a real vehicle with standard instruction manuals only. The frequencies and types of errors in all the installations were evaluated by a Child Passenger Safety Technician (CPST). Error rates were compared between the treatment and control groups using lower-tailed t-tests and Pearson's chi-square tests. Error rates were evaluated considering minor and serious errors together and also considering serious errors alone. RESULTS: Compared to the control group, participants who trained with the AFS exhibited fewer overall errors (minor and serious) in their fixture installations (p < 0.0001) as well as their follow-up vehicle installations (p < 0.0001). Specifically, participants in the treatment group had fewer errors in choosing an installation method, locking the seat belt (SB), tightening the SB or lower anchors (LA), and tightening the harness (p = 0.0002, p = 0.0003, p = 0.0084, and p = 0.0098, respectively, compared to control group during follow-up vehicle installations). The treatment group also performed significantly better than the control group when only serious errors were considered. CONCLUSIONS: An automated feedback system is an effective way to teach basic CRS installation skills to users.

Efficacy of dance-based paradigms, wearable sensors, and auditory feedback for gait retraining in children: A feasibility study.

BACKGROUND: Different feedback modes such as auditory, visual and haptic have been used in the past for gait retraining or learning movement patterns. The primary goal of this study was to investigate whether real time auditory feedback would be effective in children learning novel, dance-based movement patterns. For this purpose, a prototype wearable sensor was developed to provide auditory feedback whenever a child touches their heel to the ground. METHODS: To test the effectiveness of the auditory feedback in learning new patterns, typically developing children were taught simple Indian dance protocols consisting of four counts of foot-work which involved alternating heel-toe movements. The effect of wearing the sensor was assessed by the maximum vertical force with which the subjects struck their foot on the plate. RESULTS: Auditory feedback reduced the learning time and increased the number of correct movement patterns for trial duration of 2 min. The prototype device did not alter the maximum force with which the subject placed the foot on the ground. CONCLUSIONS: Real time auditory feedback can be reliably used to learn novel movement patterns.

Biomechanical Responses and Injury Assessment of Post Mortem Human Subjects in Various Rear-facing Seating Configurations.

The objective of this study was to generate biomechanical corridors from post-mortem human subjects (PMHS) in two different seatback recline angles in 56 km/h sled tests simulating a rear-facing occupant during a frontal vehicle impact. PMHS were placed in a production seat which included an integrated seat belt. To achieve a repeatable configuration, the seat was rigidized in the rearward direction using a reinforcing frame that allowed for adjustability in both seatback recline angle and head restraint position. The frame contained instrumentation to measure occupant loads applied to the head restraint and seatback. To measure PMHS kinematics, the head, spine, pelvis, and lower extremities were instrumented with accelerometers and angular rate sensors. Strain gages were attached to anterior and posterior aspects of the ribs, as well as the mid-shaft of the femora and tibiae, to determine fracture timing. A chestband was installed at the mid sternum to quantify chest deformation. Biomechanical corridors for each body and seat location were generated for each recline angle to provide data for quantitatively evaluating the biofidelity of ATDs and HBMs. Injuries included upper extremity injuries, rib fractures, pelvis fractures, and lower extremity injuries. More injuries were documented in the 45-degree recline case than in the 25-degree recline case. These injuries are likely due to the excessive ramping up and corresponding kinematics of the PMHS. Biomechanical corridors and injury information presented in this study could guide the design of HBMs and ATDs in rigid, reclined, rear-facing seating configurations during a high-speed frontal impact.

Evaluation of interventions to make top tether hardware more visible during child restraint system (CRS) installations.

Objectives: The objective of the study is to determine whether specific child restraint system (CRS) or vehicle conditions improve top tether attachment rates during volunteer installations. Methods: A factorial randomized controlled trial was designed to evaluate 4 different experimental categories: (1) Color of tether adjuster casing (black or red), (2) labeling on tether adjuster casing (labeled with "Tether: Use for forward-facing" or unlabeled), (3) storage location of tether (bundled in a rubber band on the back of CRS or Velcroed over the forward-facing belt path), and (4) labeling in vehicle (labeled under head restraint and below anchor or unlabeled). Ninety-six volunteers were randomly assigned to one combination of conditions. One installation per volunteer was completed. The primary outcome measure was acceptable attachment of the top tether to the tether anchor. The secondary outcome measure was overall secureness of the installation. Pearson's chi-square tests were used to identify significant predictors of acceptable outcomes and logistic regression was used to investigate interaction effects. Results: A total of 66/96 subjects (68.8%) attached the top tether in an acceptable manner, with either zero errors (n = 50) or minor errors (n = 16). A total of 30/96 subjects (31.2%) had unacceptable tether outcomes, with either major errors (n = 10) or nonuse the tether at all (n = 20). None of the 4 experimental categories significantly affected tether outcomes. Subjects who opted to install the CRS with the lower anchors (LAs) had higher rates of acceptable tether attachment compared to subjects who installed using the seat belt or those who used both LA and seat belt together (χ2 = 6.792, P = .034). Tether outcomes were not correlated with previous CRS experience, use of instruction manual(s), age, or sex. Only 15.6% of subjects produced overall correct and tight installations. Of those who used the seat belt in some manner, 70.2% neglected to switch the retractor into locking mode. Conclusions: Conditions in this study including tether color, tether labeling, storage location, and vehicle labeling did not significantly affect tether attachment rates. High rates of tether misuse and nonuse warrant further exploration to find effective solutions to this usability problem.

A Military Case Review Method to Determine and Record the Mechanism of Injury (BioTab) from In-Theater Attacks.

A recent study of all mounted vehicle underbody blast attacks found that 21% of Abbreviated Injury Scale Severity 2+ injuries in the Joint Trauma Analysis and Prevention of Injury in Combat network were injuries to the leg and ankle. To develop effective countermeasure systems for these attacks, the epidemiology and mechanisms of injury from this loading environment need to be quantified. The goal of this study was to develop a military correlate of an existing civilian case review framework, the Crash Injury Research and Engineering Network (CIREN), to consider the differences in military event types and the amount of available vehicle/attack information. Additional data fields were added to the CIREN process to cover military-specific data and "certainty" definitions in the proposed injury hypothesis were modified. To date, six group reviews have been conducted analyzing 253 injuries to the foot/ankle, tibia, femur, pelvis, and lumbar spine from 52 occupants. The familiar format and unclassified nature of the presentations allowed for the involvement of biomechanics experts from multiple disciplines.

Human Response and Injury Resulting from Head Impacts with Unmanned Aircraft Systems.

Unmanned aircraft systems (UAS), commonly known as drones, are part of a new and budding industry in the United States. Economic and public benefits associated with UAS use across multiple commercial sectors are driving new regulations which alter the stringent laws currently restricting UAS flights over people. As new regulations are enacted and more UAS populate the national airspace, there is a need to both understand and quantify the risk associated with UAS impacts with the uninvolved public. The purpose of this study was to investigate the biomechanical response and injury outcomes of Post Mortem Human Surrogates (PMHS) subjected to UAS head impacts. For this work, PMHS were tested with differing UAS vehicles at multiple impact angles, locations and speeds. Using a custom designed launching device, UAS vehicles were accelerated into the frontal, parietal, or vertex portions of subjects' craniums at speeds up to 22 m/s. Of the 35 UAS impacts carried out, one AIS 2+ injury was observed: a 13 cm linear skull fracture resulting from a Phantom 3 impact. Additionally, injury risk curves used in automotive testing were found to over predict the risk of injury in UAS impact scenarios. Finally, localized skull deformation was observed during severe impacts; the effect that this deformation had on measured kinematics should be further evaluated. Overall, the study found that AIS 2+ head injuries may occur as a result of UAS impacts and that automotive injury metrics may not be able to accurately predict head injury risk in UAS impact scenarios.

A Novel Approach to Scaling Age-, Sex-, and Body Size-Dependent Thoracic Responses using Structural Properties of Human Ribs.

Thoracic injuries are frequently observed in motor vehicle crashes, and rib fractures are the most common of those injuries. Thoracic response targets have previously been developed from data obtained from post-mortem human subject (PMHS) tests in frontal loading conditions, most commonly of mid-size males. Traditional scaling methods are employed to identify differences in thoracic response for various demographic groups, but it is often unknown if these applications are appropriate, especially considering the limited number of tested PMHS from which those scaling factors originate. Therefore, the objective of this study was to establish a new scaling approach for generating age-, sex-, and body size- dependent thoracic responses utilizing structural properties of human ribs from direct testing of various demographics. One-hundred forty-seven human ribs (140 adult; 7 pediatric) from 132 individuals (76 male; 52 female; 4 pediatric) ranging in age from 6 to 99 years were included in this study. Ribs were tested at 2 m/s to failure in a frontal impact scenario. Force and displacement for individual ribs were used to develop new scaling factors, with a traditional mid-size biomechanical target as a baseline response. This novel use of a large, varied dataset of dynamic whole rib responses offers vast possibilities to utilize existing biomechanical data in creative ways to reduce thoracic injuries in diverse vehicle occupants.

Usability of non-standard lower anchor configurations for child restraint system (CRS) installation.

OBJECTIVES: The objective of this study was to determine whether the amount of tension required for proper child restraint system (CRS) installation varies with lower anchor spacing and to determine whether nonexperts can produce adequate tension on wider-than-standard lower anchor configurations. METHODS: CRSs were installed by certified child passenger safety technicians (CPSTs; n = 6 subjects, n = 72 installations) and nonexperts (n = 30 subjects, n = 120 installations) on a mock-up vehicle seat fixture with lower anchors set at 11 (standard), 15, 19, and 23 in. apart from one another. Each CPST installed a rear-facing (RF) infant base, RF convertible, and forward-facing (FF) convertible into each of the 4 spacing configurations in random order. The CPSTs were instructed to tighten the lower connector strap until the tension was exactly at the threshold between passing and failing the 1-in. test. Each nonexpert installed one CRS model into all 4 spacing conditions in random order. Nonexperts were instructed to install the CRS to the best of their ability. The tension produced on the lower connector strap was recorded via load cell in the lower anchor assembly of the vehicle seat. Resultant tension magnitudes were compared across spacing conditions using matched pair t-tests. The CPSTs' mean 1-in. test threshold values were compared to tensions produced by nonexperts. Installations were visually evaluated for errors and qualitative usability feedback was collected via survey. RESULTS: CPSTs installed the infant base with higher tensions in the 15-, 19-, and 23-in. configurations compared to the standard 11-in. configuration (P = .034, .032, and .003, respectively). The nonexperts installed the infant base with higher tension in the 15- and 23-in. configurations compared to the 11-in. configuration (P = .004 and .026, respectively). The RF convertible and FF convertible installations showed no significant differences in tension among any of the spacing configurations for either group. Only 19% of the nonexperts' installations were tight enough to pass CPST thresholds, and the pass rate did not vary with respect to lower anchor spacing. In feedback surveys, the nonexpert group did not show a consistent preference for either standard or wider-than-standard lower anchor configurations. CONCLUSIONS: The amount of tension required to pass the 1-in. rule did not vary with lower anchor spacing configurations for the RF and FF convertible CRS, but the infant base required more tension in wider anchor configurations. Nonexperts tended to produce less than ideal tension in all configurations, although their tension magnitudes increased for the infant base in wider configurations.

A heel-strike real-time auditory feedback device to promote motor learning in children who have cerebral palsy: a pilot study to test device accuracy and feasibility to use a music and dance-based learning paradigm.

BACKGROUND: Cerebral palsy (CP) is a developmental disorder of movement and posture that occurs due to damage to the developing nervous system. As part of therapy, wearable sensors that trigger interactive feedback may provide multi-sensory guidance and motivation. A prototype of a heel-strike real-time feedback system has been developed which records the number of heel strikes during gait and indicates successful heel contact through real-time auditory feedback. The first aim of this feasibility study was to test the prototype accuracy.Since the end user for this device is a child, the device should be esthetically appealing and sufficiently motivating for children to perform repetitive challenging therapeutic movements. The second aim of this study was to collect feedback from the subjects with regard to the device usability and understand if the bell sound used as feedback used was motivating enough for children to continue using the prototype. This would help us in developing the next generation of the device. METHODS: The prototype was tested with typically developing children and children who have CP. The accuracy in detecting heel strikes was calculated. As part of the study, the subjects were also asked questions to test the device compliance and acceptability of the musical beats with the pediatric population. RESULTS: The device accuracy in identifying heel strikes is 97.44% (95% CI 96.31, 98.88%). The subjects did not show any hesitation to put on the device and the sound feedback motivated them to move. Based on this pilot study, a minimum age limit of 5 years is appropriate and the intervention study should be conducted for no more than 30 min per week. CONCLUSIONS: The pilot study showed that a main study can be conducted to test auditory feedback as an intervention to promote motor learning in children who have cerebral palsy. No adverse event or safety issues were reported in the feasibility study.

Sources of Variability in Structural Bending Response of Pediatric and Adult Human Ribs in Dynamic Frontal Impacts.

Despite safety advances, thoracic injuries in motor vehicle crashes remain a significant source of morbidity and mortality, and rib fractures are the most prevalent of thoracic injuries. The objective of this study was to explore sources of variation in rib structural properties in order to identify sources of differential risk of rib fracture between vehicle occupants. A hierarchical model was employed to quantify the effects of demographic differences and rib geometry on structural properties including stiffness, force, displacement, and energy at failure and yield. Three-hundred forty-seven mid-level ribs from 182 individual anatomical donors were dynamically (~2 m/s) tested to failure in a simplified bending scenario mimicking a frontal thoracic impact. Individuals ranged in age from 4 - 108 years (mean 53 ± 23 years) and included 59 females and 123 males of diverse body sizes. Age, sex, body size, aBMD, whole rib geometry and cross-sectional geometry were explored as predictors of rib structural properties. Measures of cross-sectional rib size (Tt.Ar), bone quantity (Ct.Ar), and bone distribution (Z) generally explained more variation than any other predictors, and were further improved when normalized by rib length (e.g., robustness and WBSI). Cortical thickness (Ct.Th) was not found to be a useful predictor. Rib level predictors performed better than individual level predictors. These findings moderately explain differential risk for rib fracture and with additional exploration of the rib's role in thoracic response, may be able contribute to ATD and HBM development and alterations in addition to improvements to thoracic injury criteria and scaling methods.

Quantification of Skeletal and Soft Tissue Contributions to Thoracic Response in a Dynamic Frontal Loading Scenario.

Thoracic injuries continue to be a major health concern in motor vehicle crashes. Previous thoracic research has focused on 50th percentile males and utilized scaling techniques to apply results to different demographics. Individual rib testing offers the advantage of capturing demographic differences; however, understanding of rib properties in the context of the intact thorax is lacking. Therefore, the objective of this study was to obtain the data necessary to develop a transfer function between individual rib and thoracic response. A series of non-injurious frontal impacts were conducted on six PMHS, creating a loading environment commensurate to previously published individual rib testing. Each PMHS was tested in four tissue states: intact, intact with upper limbs removed, denuded, and eviscerated. Following eviscerated thoracic testing, eight individual mid-level ribs from each PMHS were removed and loaded to failure. A simplified model in which ribs of each thorax are treated as parallel springs was utilized to evaluate the ability of individual rib response data to predict each subject's eviscerated thoracic response. On average across subjects, denuded thoraces retained 89% and eviscerated thoraces retained 46% of intact force. Similarly, denuded thoraces retained 70% and eviscerated thoraces retained 30% of intact stiffness. The rib model did not adequately predict eviscerated thoracic response but provided a better understanding of the influence of connective tissue on a rib's behavior with-in the thorax. Results of this study could be used in conjunction with the database of individual rib test results to improve thoracic response targets and help assess biofidelity of current anthropomorphic test devices.

Compatibility of booster seats and vehicles in the U.S. market.

OBJECTIVE: The objective of this study was to analyze booster and rear vehicle seat dimensions to identify the most frequent compatibility problems. METHODS: Measurements were collected from 40 high-back and backless boosters and 95 left rear and center rear row seating positions in 50 modern vehicles. Dimensions were compared for 3,800 booster/vehicle seat combinations. For validation and estimation of tolerance and correction factors, 72 booster installations were physically completed and compared with measurement-based compatibility predictions. Dimensions were also compared to the International Organization for Standardization (ISO) volumetric envelopes of forward-facing child restraints and boosters. RESULTS: Seat belt buckles in outboard positions accommodated the width of boosters better than center positions (success rates of 85.4 and 34.7%, respectively). Adequate head restraint clearance occurred in 71.9 to 77.2% of combinations, depending on the booster's head support setting. Booster recline angles aligned properly with vehicle seat cushion angles in 71.5% of combinations. In cases of poor angle alignment, booster angles were more obtuse than the vehicle seat angles 97.7% of the time. Head restraint interference exacerbated angle alignment issues. Data indicate success rates above 90% for boosters being fully supported by the length of the seat cushion and for adequate height clearance with the vehicle roofline. Comparison to ISO envelopes indicates that most boosters on the U.S. market are taller and angled more obtusely than ISO target envelopes. CONCLUSIONS: This study quantifies some of the common interferences between boosters and vehicles that may complicate booster usage. Data are useful for design and to prioritize specific problem areas.

COMPARISON OF A HEAD MOUNTED IMPACT MEASUREMENT DEVICE TO THE HYBRID III ANTHROPOMORPHIC TESTING DEVICE IN A CONTROLLED LABORATORY SETTING.

BACKGROUND: Reports estimate that 1.6 to 3.8 million cases of concussion occur in sports and recreation each year in the United States. Despite continued efforts to reduce the occurrence of concussion, the rate of diagnosis continues to increase. The mechanisms of concussion are thought to involve linear and rotational head accelerations and velocities. One method of quantifying the kinematics experienced during sport participation is to place measurement devices into the athlete's helmet or directly on the athlete's head. PURPOSE: The purpose of this research to determine the accuracy of a head mounted device for measuring the head accelerations experienced by the wearer. This will be accomplished by identifying the error in Peak Linear Acceleration (PLA), Peak Rotational Acceleration (PRA) and Peak Rotational Velocity (PRV) of the device. STUDY DESIGN: Laboratory study. METHODS: A helmeted Hybrid III 50th percentile male headform was impacted via a pneumatic ram from the front, side, rear, front oblique and rear oblique at speeds from 1.5 to 5 m/s. The X2 Biosystems xPatch® (Seattle, WA) sensor was placed on the headform's right side at the approximate location of the mastoid process. Measures of PLA, PRA, PRV from the xPatch ® and Hybrid III were analyzed for Root Mean Square Error (RMSE), and Absolute and Relative Error (AE, RE). RESULT: Seventy-six impacts were analyzed. All measures of correlation, fixed through the origin, were found to be strong: PLA R2=0.967 p<0.01, PRA R2=0.933 p<0.01, PRV R2=0.999 p<0.00. PLA RMSE was 34%, RE 31.0%±14.0, and AE 31.1%±13.7. PRA RMSE was 23.4%, RE -6.7 ± 22.4 and AE 18.9%±13.8. PRV RMSE was 2.2%, RE 0.1 ± 2.2, and AE 1.8 ± 1.3. CONCLUSION: Without including corrections for effect of skin artifact, the xPatch® produces measurements highly correlated with the gold standard yet above the average error of testing devices in both PLA and PRA, but a low error in PRV. PLA measures from the xPatch® system demonstrated a high level of correlation with the PLA data from the Hybrid III mounted data collection system. LEVEL OF EVIDENCE: 3.