The Effect of MIPS, Headform Condition, and Impact Orientation on Headform Kinematics Across a Range of Impact Speeds During Oblique Bicycle Helmet Impacts.

Bicycle helmets are designed to attenuate both the linear and rotational response of the head during an oblique impact. Here we sought to quantify how the effectiveness of one popular rotation-attenuating system (MIPS) varied across 3 test headform conditions (bare, covered in stockings, and hair), 3 oblique impact orientations, and 4 impact speeds. We conducted 72 freefall drop tests of a single helmet model with and without MIPS onto a 45° angled anvil and measured the peak linear (PLA) and angular acceleration (PAA) and computed the angular velocity change (PAV) and brain injury criterion (BrIC). Across all headform conditions, MIPS reduced PAA and PAV by 38.2 and 33.2% respectively during X-axis rotation, 47.4 and 38.1% respectively during Y-axis rotation, and 22.9 and 20.5% during a combined ZY-axis rotation. Across all impact orientations, PAA was reduced by 39% and PAV by 32.4% with the bare headform while adding stockings reduced PAA and PAV by 41.6 and 36% respectively and the hair condition reduced PAA and PAV by 30.2 and 24.4% respectively. In addition, our data reveal the importance of using consistent headform conditions when evaluating the effect of helmet systems designed to attenuate head rotations during oblique impacts.

Density Variation in the Expanded Polystyrene Foam of Bicycle Helmets and Its Influence on Impact Performance.

Bicycle helmets attenuate head impacts using expanded polystyrene (EPS) foam liners. The EPS density plays a key role in determining the helmet and head response during an impact. Prior pilot work in our lab showed that EPS density varied by up to 18 kg/m3 within a single helmet, and thus the purpose of this study was to quantify the regional density variations within and between helmets and to establish how these variations influence helmet impact performance. We evaluated 10-12 samples of two traditional and two bicycle motocross (BMX) bicycle helmets with EPS liners. The bulk liner density and density of 16-19 cores extracted from specific locations on each sample were measured. Additional samples of two of these helmet models were then impacted at 3.0, 6.3, and 7.8 m/s to determine the relationship between local EPS density and helmet impact performance. We found that density varied significantly within each sample in all helmet models and also varied significantly between samples in three helmet models. The density variations were not symmetric across the midline in two of the four helmet models. The observed density variations influenced the helmets' impact performance. Our data suggest that variations in peak headform acceleration during impacts to the same location on different samples of the same helmet model can be partially explained by density differences between helmet samples. These density variations and resulting impact performance differences may play a role in a helmet's ability to mitigate head injury.

Impact Performance of Certified Bicycle Helmets Below, On and Above the Test Line.

Bicycle helmets are effective in reducing many head injuries, but their effectiveness could be improved if they provided protection over a larger range of impact locations. We sought to quantify the impact performance of 12 helmet models below, on and above the CPSC prescribed test line. All helmets were drop tested at an impact speed of 6.2 m/s. One helmet adequately attenuated impacts below the CPSC limit of 300 g for all impact locations tested below, on and above the test line. Five helmets met this limit for impacts on or above the test line as required in the CPSC standard, but failed to meet it below the test line (not required in the standard). The remaining six helmets failed to meet the criterion on and/or above the test line. Our findings indicate that consumers should not assume that all portions of a helmet provide adequate and equivalent protection. Our findings also suggest that the CPSC's current system of self-regulation and self-testing by manufacturers does not prevent substandard bicycle helmets from being sold. Public availability of manufacturers' impact test data, an independent testing panel, and/or a wider distribution of impact locations are needed to better protect bicyclists.

The effect of motorcycle helmet fit on estimating head impact kinematics from residual liner crush.

Proper helmet fit is important for optimizing head protection during an impact, yet many motorcyclists wear helmets that do not properly fit their heads. The goals of this study are i) to quantify how a mismatch in headform size and motorcycle helmet size affects headform peak acceleration and head injury criteria (HIC), and ii) to determine if peak acceleration, HIC, and impact speed can be estimated from the foam liner's maximum residual crush depth or residual crush volume. Shorty-style helmets (4 sizes of a single model) were tested on instrumented headforms (4 sizes) during linear impacts between 2.0 and 10.5m/s to the forehead region. Helmets were CT scanned to quantify residual crush depth and volume. Separate linear regression models were used to quantify how the response variables (peak acceleration (g), HIC, and impact speed (m/s)) were related to the predictor variables (maximum crush depth (mm), crush volume (cm3), and the difference in circumference between the helmet and headform (cm)). Overall, we found that increasingly oversized helmets reduced peak headform acceleration and HIC for a given impact speed for maximum residual crush depths less than 7.9mm and residual crush volume less than 40cm3. Below these levels of residual crush, we found that peak headform acceleration, HIC, and impact speed can be estimated from a helmet's residual crush. Above these crush thresholds, large variations in headform kinematics are present, possibly related to densification of the foam liner during the impact.

Age Does Not Affect the Material Properties of Expanded Polystyrene Liners in Field-Used Bicycle Helmets.

Bicycle helmet foam liners absorb energy during impacts. Our goal was to determine if the impact attenuation properties of expanded polystyrene (EPS) foam used in bicycle helmets change with age. Foam cores were extracted from 63 used and unused bicycle helmets from ten different models spanning an age range of 2-20 yrs. All cores were impact tested at a bulk strain rate of 195 s(-1). Six dependent variables were determined from the stress-strain curve derived from each impact (yield strain, yield stress, elastic modulus, plateau slope, energy at 65% compression, and stress at 65% compression), and a general linear model was used to assess the effect of age on each dependent variable with density as a covariate. Age did not affect any of the dependent variables; however, greater foam density, which varied from 58 to 100 kg/m(3), generated significant increases in all of the dependent variables except for yield strain. Higher density foam cores also exhibited lower strains at which densification began to occur, tended to stay within the plateau region of the stress-strain curve, and were not compressed as much compared with the lower density cores. Based on these data, the impact attenuation properties of EPS foam in field-used bicycle helmets do not degrade with the age.

Laboratory Validation of Two Wearable Sensor Systems for Measuring Head Impact Severity in Football Players.

Wearable sensors can measure head impact frequency and magnitude in football players. Our goal was to quantify the impact detection rate and validity of the direction and peak kinematics of two wearable sensors: a helmet system (HITS) and a mouthguard system (X2). Using a linear impactor, modified Hybrid-III headform and one helmet model, we conducted 16 impacts for each system at 12 helmet sites and 5 speeds (3.6-11.2 m/s) (N = 896 tests). Peak linear and angular accelerations (PLA, PAA), head injury criteria (HIC) and impact directions from each device were compared to reference sensors in the headform. Both sensors detected ~96% of impacts. Median angular errors for impact directions were 34° for HITS and 16° for X2. PLA, PAA and HIC were simultaneously valid at 2 sites for HITS (side, oblique) and one site for X2 (side). At least one kinematic parameter was valid at 2 and 7 other sites for HITS and X2 respectively. Median relative errors for PLA were 7% for HITS and -7% for X2. Although sensor validity may differ for other helmets and headforms, our analyses show that data generated by these two sensors need careful interpretation.

Total knee arthroplasty designed to accommodate the presence or absence of the posterior cruciate ligament.

Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96 ± 7) and function (92 ± 13) scores and radiographic outcomes were good to excellent for 84% of patients after 5-10 years in vivo. Range of motion averaged 124° ± 9°, with 126 knees exhibiting ≥120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.

A headform for testing helmet and mouthguard sensors that measure head impact severity in football players.

A headform is needed to validate and compare helmet- and mouthguard-based sensors that measure the severity and direction of football head impacts. Our goal was to quantify the dynamic response of a mandibular load-sensing headform (MLSH) and to compare its performance and repeatability to an unmodified Hybrid III headform. Linear impactors in two independent laboratories were used to strike each headform at six locations at 5.5 m/s and at two locations at 3.6 and 7.4 m/s. Impact severity was quantified using peak linear acceleration (PLA) and peak angular acceleration (PAA), and direction was quantified using the azimuth and elevation of the PLA. Repeatability was quantified using coefficients of variation (COV) and standard deviations (SD). Across all impacts, PLA was 1.6±1.8 g higher in the MLSH than in the Hybrid III (p=0.002), but there were no differences in PAA (p=0.25), azimuth (p=0.43) and elevation (p=0.11). Both headforms exhibited excellent or acceptable repeatability for PLA (HIII:COV=2.1±0.8%, MLSH:COV=2.0±1.2%, p=0.98), but site-specific repeatability ranging from excellent to poor for PAA (HIII:COV=7.2±4.0%, MLSH:COV=8.3±5.8%, p=0.58). Direction SD were generally <1° and did not vary between headforms. Overall, both headforms are similarly suitable for validating PLA in sensors that measure head impact severity in football players, however their utility for validating sensor PAA values varies with impact location.

Conversion of fused hip to total hip arthroplasty with presurgical and postsurgical gait studies.

This case study presents a subject with a fused hip converted to total hip arthroplasty. Kinematic gait analysis was conducted on 3 occasions, presurgery, 4 months postsurgery, and 2.5 years postsurgery. Presurgery data showed decreased cadence and shorter step length; sound limb possessed increased hip, knee range of motion (ROM), and increased knee flexion during stance; the affected limb had minimal hip motion and normal knee ROM with abnormal pattern. At 4 months postsurgery, the sound limb showed decreased step length, whereas the affected limb showed increased knee extension during stance and increased hip ROM. Data obtained at 2.5 years postsurgery indicated decreased cadence and speed and increased ROM in both limbs. The total hip arthroplasty had provided relief of chronic back and affected hip pain and improved mobility. Gait-specific training is recommended.

Kinematics of the equine temporomandibular joint.

OBJECTIVE: To develop a method of measuring 3-dimensional kinematics of the temporomandibular joint (TMJ) in horses chewing sweet feed. ANIMALS: 4 mature horses that had good dental health. PROCEDURE: Markers attached to the skin over the skull and mandible were tracked by an optical tracking system. Movements of the mandible relative to the skull were described in terms of 3 rotations and 3 translations. A virtual marker was created on the midline between the rami of the mandibles at the level of the rostral end of the facial crest to facilitate observation of mandibular movements. RESULTS: During the opening stroke, the virtual midline mandibular marker moved ventrally, laterally toward the chewing side, and slightly caudally. During the closing stroke, the marker moved dorsally, medially, and slightly rostrally. During the power stroke, the mandible slid medially and dorsally as the mandibular cheek teeth moved across the occlusal surface of the maxillary cheek teeth. The 4 horses had similar chewing patterns, but the amplitudes varied among horses. CONCLUSIONS AND CLINICAL RELEVANCE: The TMJ allows considerable mobility of the mandible relative to the skull during chewing. The method presented in this report can be used to compare the range of motion of the TMJ among horses with TMJ disease or dental irregularities or within an individual horse before and after dental procedures.