Kinematic response of the spine during simulated aircraft ejections.

INTRODUCTION: Military aviators are susceptible to spinal injuries during high-speed ejection scenarios. These injuries commonly arise as a result of strains induced by extreme flexion or compression of the spinal column. This study characterizes the vertebral motion of two postmortem human surrogates (PMHS) during a simulated catapult phase of ejection on a horizontal decelerator sled. METHODS: During testing, the PMHS were restrained supinely to a mock ejection seat and subjected to a horizontal deceleration profile directed along the local z-axis. Two midsized males (175.3 cm, 77.1 kg; 185.4 cm, 72.6 kg) were tested. High-rate motion capture equipment was used to measure the three-dimensional displacement of the head, vertebrae, and pelvis during the ejection event. RESULTS: The two PMHS showed generally similar kinematic motion. Head injury criterion (HIC) results were well below injury threshold levels for both specimens. The specimens both showed compression of the spine, with a reduction in length of 23.9 mm and 45.7 mm. Post-test autopsies revealed fractures in the C5, T1, and L1 vertebrae. DISCUSSION: This paper provides an analysis of spinal motion during an aircraft ejection.The injuries observed in the test subjects were consistent with those seen in epidemiological studies. Future studies should examine the effects of gender, muscle tensing, out-of-position (of head from neutral position) occupants, and external forces (e.g., windblast) on spinal kinematics during aircraft ejection.

Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League.

BACKGROUND: On-field visible signs (VS) are used to help identify sport-related concussion (SRC) in the National Football League (NFL). However, the predictive utility of a VS checklist for SRC is unknown. OBJECTIVE: To report the frequency, sensitivity, specificity, and predictive value of VS in a cohort of NFL athletes. METHODS: On-field VS ratings from 2 experts who independently reviewed video footage of a cohort of 251 injury plays that resulted in an SRC diagnosis (n = 211) and no diagnosis (n = 40) from the 2017 NFL season were examined. The frequency, sensitivity, specificity, and a receiver operating characteristic (ROC) curve with area under the curve (AUC) were calculated for each VS. RESULTS: Slow to get up (65.9%) and motor incoordination (28.4%) were the most frequent VS in concussed athletes, and slow to get up (60.0%) was the most common VS among nonconcussed athletes. The most sensitive VS was slow to get up (66%); the most specific signs in concussed NFL athletes were blank/vacant look and impact seizure (both 100%). Approximately 26% of concussed NFL players did not exhibit a VS, and the overall sensitivity and specificity for the VS checklist to detect SRC were 73% and 65%, respectively. The VS checklist demonstrated "poor" ability to discriminate between SRC and non-SRC groups (AUC = 0.66). CONCLUSION: In the NFL, the diagnosis of concussion cannot be made from on-field VS alone. The VS checklist is one part of the comprehensive sideline/acute evaluation of concussion, and the diagnosis remains a multimodal clinical decision.

Position-Specific Circumstances of Concussions in the NFL: Toward the Development of Position-Specific Helmets.

Consideration of position-specific features of the NFL concussion environment could enable improved risk mitigation through the design of position-specific helmets to improve self-protection as well as protection for the other player with whom the contact occurs. The purpose of this paper is to quantify position-specific features of scenarios resulting in concussions to NFL players, and the players they contact, by reviewing all game footage (broadcast and non-broadcast) over 4 seasons. Position-specific features were documented for 647 concussions in which a primary exposure could be visualized, including impact source, helmet impact location, activity, and the other player with whom the contact occurred. Findings include the over-representation of helmet-to-ground impacts to the rear of the quarterback's helmet, the high frequency of impacts to the side (upper) location of both concussed players and the players they contacted regardless of position, and distinct differences in the circumstances of concussions to cornerbacks and safeties. The study shows that some features of concussion scenarios are common to all positions, but several position-specific features exist and can inform the design of position-specific helmets for NFL players.

On-Field Performance of an Instrumented Mouthguard for Detecting Head Impacts in American Football.

Wearable sensors that accurately record head impacts experienced by athletes during play can enable a wide range of potential applications including equipment improvements, player education, and rule changes. One challenge for wearable systems is their ability to discriminate head impacts from recorded spurious signals. This study describes the development and evaluation of a head impact detection system consisting of a mouthguard sensor and machine learning model for distinguishing head impacts from spurious events in football games. Twenty-one collegiate football athletes participating in 11 games during the 2018 and 2019 seasons wore a custom-fit mouthguard instrumented with linear and angular accelerometers to collect kinematic data. Video was reviewed to classify sensor events, collected from instrumented players that sustained head impacts, as head impacts or spurious events. Data from 2018 games were used to train the ML model to classify head impacts using kinematic data features (127 head impacts; 305 non-head impacts). Performance of the mouthguard sensor and ML model were evaluated using an independent test dataset of 3 games from 2019 (58 head impacts; 74 non-head impacts). Based on the test dataset results, the mouthguard sensor alone detected 81.6% of video-confirmed head impacts while the ML classifier provided 98.3% precision and 100% recall, resulting in an overall head impact detection system that achieved 98.3% precision and 81.6% recall.

Concussions in the National Football League: the evolution of video review for assessing the frequency and reliability of visible signs.

Background: The use of video review to document visible signs (VS) of sport-related concussion in the National Football League (NFL) is a novel method to recognize head injuries. Hypothesis/Purpose: The current pilot studies used varying methodologies to (1) examine the frequency of VS in concussed NFL players using the Australian Football League's (AFL) checklist, and (2) assess the reliability of VS between non-expert and expert raters. Study design: Cohort study Methods: In the first pilot study, two non-expert raters rated VS of SRC occurring in the 2015 NFL season (n = 96) using a single VS from the AFL checklist. Based on this pilot study, two expert raters then rated VS of SRC during the 2017 NFL season (n = 211) using all VS from the AFL checklist. The frequency, total percent agreement (TPA), and reliability (kappa coefficients) were calculated for all VS of concussion for the two seasons. Kappa agreement was classified as fair (.41-.60), moderate (.61-.80), or substantial (.81-1.00). Significance was set at p < .05. Results: The most frequent VS of concussion identified by both non-expert and expert raters were no behavior observed, slow to get up, and motor incoordination. The least frequent VS were impact seizure, blank/vacant look, and facial injury. For non-expert raters, the average TPA for VS ranged from 84% to 100% and kappa coefficients ranged from .52 to .68. For expert raters, the average TPA ranged from 83% to 100%, and kappa coefficients ranged from .56 to .86. Conclusion: In these preliminary analyses, use of multiple VS was a superior methodology, and the reliability of VS rating was stronger for experts. Due to the inherent differences in gameplay and protective equipment used in the NFL compared to other professional sports, it is our hope these data can generate new ways to improve existing practices and identify potentially novel VS of SRC.

Video Analysis of Reported Concussion Events in the National Football League During the 2015-2016 and 2016-2017 Seasons.

BACKGROUND: Concussions in American football remain a high priority of sports injury prevention programs. Detailed video review provides important information on causation, the outcomes of rule changes, and guidance on future injury prevention strategies. PURPOSE: Documentation of concussions sustained in National Football League games played during the 2015-2016 and 2016-2017 seasons, including consideration of video views unavailable to the public. STUDY DESIGN: Descriptive epidemiology study. METHODS: All reported concussions were reviewed with all available video footage. Standardized terminology and associated definitions were developed to describe and categorize the details of each concussion. RESULTS: Cornerbacks sustained the most concussions, followed by wide receivers, then linebackers and offensive linemen. Half (50%) of concussions occurred during a passing play, 28% during a rushing play, and 21% on a punt or kickoff. Tackling was found to be the most common activity of concussed players, with the side of the helmet the most common helmet impact location. The distribution of helmet impact source-the object that contacted the concussed player's helmet-differed from studies of earlier seasons, with a higher proportion of helmet-to-body impacts (particularly shoulder) and helmet-to-ground impacts and with a lower proportion of helmet-to-helmet impacts. Helmet-to-ground concussive impacts were notable for the high prevalence of impacts to the back of the helmet and their frequency during passing plays. CONCLUSION: Concussion causation scenarios in the National Football League have changed over time. CLINICAL RELEVANCE: The results of this study suggest the need for expanded evaluation of concussion countermeasures beyond solely helmet-to-helmet test systems, including consideration of impacts with the ground and with the body of the opposing player. It also suggests the possibility of position-specific countermeasures as part of an ongoing effort to improve safety.

Whole-body Response for Pedestrian Impact with a Generic Sedan Buck.

To serve as tools for assessing injury risk, the biofidelity of whole-body pedestrian impact dummies should be validated against reference data from full-scale pedestrian impact tests. To facilitate such evaluations, a simplified generic vehicle-buck has been recently developed that is designed to have characteristics representative of a generic small sedan. Three 40 km/h pedestrian-impact tests have been performed, wherein Post Mortem Human Surrogates (PMHS) were struck laterally in a mid-gait stance by the buck. Corridors for select trajectory measures derived from these tests have been published previously. The goal of this study is to act as a companion dataset to that study, describing the head velocities, body region accelerations (head, spine, pelvis, lower extremities), angular velocities, and buck interaction forces, and injuries observed during those tests. Scaled, transformed head accelerations exceeded 80 g prior to head contact with the windshield for two of the three tests. Head xaxis angular velocity exceeded 40 rad/s prior to head contact for all three tests. In all cases the peak resultant head velocity relative to the vehicle was greater than the initial impact speed of the vehicle. Corridors of resultant head velocity relative to the vehicle were also developed, bounded by the velocities observed in these tests combined with those predicted to occur if the PMHS necks were perfectly rigid. These results, along with the other kinematic and kinetic data presented, provide a resource for future pedestrian dummy development and evaluation.

Side impact PMHS thoracic response with large-volume air bag.

OBJECTIVE: The objective of this study is to assess the response of postmortem human subjects (PMHS) to a large-volume side air bag in a fully instrumented and well-controlled side impact test condition. METHODS: Three adult male PMHS were subjected to right-side pure lateral impacts. Each stationary seated subject was struck at 4.3 ± 0.1 m/s by a rigid wall installed on a 1700-kg rail-mounted sled. Each subject was held stationary by a system of tethers until immediately prior to being impacted by the moving wall. A large side air bag was mounted to the wall and deployed so that it was fully inflated at the time it contacted the subject's right side. The load wall consisted of an adjustable matrix of 15 individual plates, each supported by a 5-axis load cell that recorded the interaction between the subject and impacting wall. Two-dimensional (external) torso deformation was provided by a chest band that encircled the torso at the level of the sixth rib laterally. Triaxial acceleration was measured at the head, spine, and sacrum via 3 orthogonal accelerometers mounted to the same bone-mounted hardware that held the marker clusters used for kinematic analysis. RESULTS: Peak pelvic load normal to the wall averaged 6.8 kN, which was over 5 times that recorded for the shoulder (1.3 kN) and the thorax (1.2 kN). Lateral chest deflection ranged from 9 to 21 mm. Two of the 3 subjects sustained 2 and 9 fractures, respectively. CONCLUSIONS: Two of the 3 PMHS sustained rib fractures despite low levels of thorax deflection. We attribute this finding to individual variability in subject injury tolerance. Other response parameters exhibited lower levels of variability and characterize PMHS response to a potentially beneficial side impact countermeasure. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Occupant Kinematics in Laboratory Rollover Tests: PMHS Response.

The objective of the current study was to characterize the whole-body kinematic response of restrained PMHS in controlled laboratory rollover tests. A dynamic rollover test system (DRoTS) and a parametric vehicle buck were used to conduct 36 rollover tests on four adult male PMHS with varied test conditions to study occupant kinematics during the rollover event. The DRoTS was used to drop/catch and rotate the test buck, which replicated the occupant compartment of a typical mid-sized SUV, around its center of gravity without roof-to-ground contact. The studied test conditions included a quasi-static inversion (4 tests), an inverted drop and catch that produced a 3 g vertical deceleration (4 tests), a pure dynamic roll at 360 degrees/second (11 tests), and a roll with a superimposed drop and catch produced vertical deceleration (17 tests). Each PMHS was restrained with a three-point belt and was tested in both leading-side and trailing-side front-row seating positions. Whole-body kinematics were measured using a 3D motion capture system that quantified occupant displacement relative to the vehicle buck for the X-axis (longitudinal), Y-axis (lateral), and Z-axis (vertical) directions. Additionally the spine was divided into five segments to describe intrasegmental kinematics of the spine, including segment rotations as well as spinal extension and compression. The reported data represent the most complete set of kinematic response targets for a restrained occupant in a variety of dynamic rollover conditions, and are immediately useful for efforts to evaluate and improve existing ATDs and computational models for use in the rollover crash environment.

The Contribution of Pre-impact Spine Posture on Human Body Model Response in Whole-body Side Impact.

The objective of the study was to analyze independently the contribution of pre-impact spine posture on impact response by subjecting a finite element human body model (HBM) to whole-body, lateral impacts. Seven postured models were created from the original HBM: one matching the standard driving posture and six matching pre-impact posture measured for each of six subjects tested in previously published experiments. The same measurements as those obtained during the experiments were calculated from the simulations, and biofidelity metrics based on signals correlation were established to compare the response of HBM to that of the cadavers. HBM responses showed good correlation with the subject response for the reaction forces, the rib strain (correlation score=0.8) and the overall kinematics. The pre-impact posture was found to greatly alter the reaction forces, deflections and the strain time histories mainly in terms of time delay. By modifying only the posture of HBM, the variability in the impact response was found to be equivalent to that observed in the experiments performed with cadavers with different anthropometries. The patterns observed in the responses of the postured HBM indicate that the inclination of the spine in the frontal plane plays a major role. The postured HBM sustained from 2 to 5 bone fractures, including the scapula in some cases, confirming that the pre-impact posture influences the injury outcome predicted by the simulation.

Occupant kinematics and shoulder belt retention in far-side lateral and oblique collisions: a parametric study.

In far-side impacts, head contact with interior components is a key injury mechanism. Restraint characteristics have a pronounced influence on head motion and injury risk. This study performed a parametric examination of restraint, positioning, and collision factors affecting shoulder belt retention and occupant kinematics in far-side lateral and oblique sled tests with post mortem human subjects (PMHS). Seven PMHS were subjected to repeated tests varying the D-ring position, arm position, pelvis restraint, pre-tensioning, and impact severity. Each PMHS was subjected to four low-severity tests (6.6 g sled acceleration pulse) in which the restraint or position parameters were varied and then a single higher-severity test (14 g) with a chosen restraint configuration (total of 36 tests). Three PMHS were tested in a purely lateral (90° from frontal) impact direction; 4 were tested in an oblique impact (60° from frontal). All subjects were restrained by a 3-point seatbelt. Occupant motion was tracked with a 3D optoelectric high speed motion capture system. For all restraint configurations, the 60° oblique impact angle was associated with greater lateral head excursion than the 90° impact angle. This unexpected result reflects the increased axial rotation of the torso in the oblique impacts, which allowed the shoulder to displace more relative to the shoulder belt and thus the head to displace more relative to the sled buck. Restraint engagement of the torso and shoulder was actually greater in the purely lateral impacts than in the oblique impacts. Pretensioning significantly reduced lateral head excursion (175 mm average in the low-severity tests across all restraint configurations).

Analysis of spinal motion and loads during frontal impacts. Comparison between PMHS and ATD.

Quantifying the kinematics of the human spine during a frontal impact is a challenge due to the multi-degree-of-freedom structure of the vertebral column. This papers reports on a series of six frontal impacts sled tests performed on three Post Mortem Human Surrogates (PMHS). Each subject was exposed first to a low-speed, non-injurious frontal impact (9 km/h) and then to a high-speed one (40 km/h). Five additional tests were performed using the Hybrid III 50(th) percentile male ATD for comparison with the PMHS. A 3D motion capture system was used to record the 6-degree-of-freedom motion of body segments (head, T1, T8, L2, L4 and pelvis). The 3D trajectories of individual bony structures in the PMHS were determined using bone-mounted marker arrays, thus avoiding skin-attached markers and their potential measurements artifacts. The PMHS spines showed different behavior between low and high speed. While at low speed the head and upper spinal segments lagged the lower portion of the spine and pelvis in reaching their maximum forward displacement (time for maximum forward head excursion was 254.3±31.9 ms and 140.3±9 ms for the pelvis), these differences were minimal at high speed (127±2.6 ms for the head vs. 116.7±3.5 ms for the pelvis). The ATD did not exhibit this speed-dependant behavior. Furthermore, the ATD's forward displacements were consistently less than those exhibited by the PMHS, regardless of the speed. Neck loads at the atlanto-occipital joint were estimated for the PMHS using inverse dynamics techniques and compared to those measured in the ATD. It was found that the axial and shear forces and the flexion moment at the upper neck of the PMHS were higher than those measured in the ATD.