Evaluating child helmet protection and testing standards: A study using PIPER child head models aged 1.5, 3, 6, and 18 years.

The anatomy of children's heads is unique and distinct from adults, with smaller and softer skulls and unfused fontanels and sutures. Despite this, most current helmet testing standards for children use the same peak linear acceleration threshold as for adults. It is unclear whether this is reasonable and otherwise what thresholds should be. To answer these questions, helmet-protected head responses for different ages are needed which is however lacking today. In this study, we apply continuously scalable PIPER child head models of 1.5, 3, and 6 years old (YO), and an upgraded 18YO to study child helmet protection under extensive linear and oblique impacts. The results of this study reveal an age-dependence trend in both global kinematics and tissue response, with younger children experiencing higher levels of acceleration and velocity, as well as increased skull stress and brain strain. These findings indicate the need for better protection for younger children, suggesting that youth helmets should have a lower linear kinematic threshold, with a preliminary value of 150g for 1.5-year-old helmets. However, the results also show a different trend in rotational kinematics, indicating that the threshold of rotational velocity for a 1.5YO is similar to that for adults. The results also support the current use of small-sized adult headforms for testing child helmets before new child headforms are available.

Oblique impact responses of Hybrid III and a new headform with more biofidelic coefficient of friction and moments of inertia.

New oblique impact methods for evaluating head injury mitigation effects of helmets are emerging, which mandate measuring both translational and rotational kinematics of the headform. These methods need headforms with biofidelic mass, moments of inertia (MoIs), and coefficient of friction (CoF). To fulfill this need, working group 11 of the European standardization head protection committee (CEN/TC158) has been working on the development of a new headform with realistic MoIs and CoF, based on recent biomechanics research on the human head. In this study, we used a version of this headform (Cellbond) to test a motorcycle helmet under the oblique impact at 8 m/s at five different locations. We also used the Hybrid III headform, which is commonly used in the helmet oblique impact. We tested whether there is a difference between the predictions of the headforms in terms of injury metrics based on head kinematics, including peak translational and rotational acceleration, peak rotational velocity, and BrIC (brain injury criterion). We also used the Imperial College finite element model of the human head to predict the strain and strain rate across the brain and tested whether there is a difference between the headforms in terms of the predicted strain and strain rate. We found that the Cellbond headform produced similar or higher peak translational accelerations depending on the impact location (-3.2% in the front-side impact to 24.3% in the rear impact). The Cellbond headform, however, produced significantly lower peak rotational acceleration (-41.8% in a rear impact to -62.7% in a side impact), peak rotational velocity (-29.5% in a side impact to -47.6% in a rear impact), and BrIC (-29% in a rear-side impact to -45.3% in a rear impact). The 90th percentile values of the maximum brain strain and strain rate were also significantly lower using this headform. Our results suggest that MoIs and CoF have significant effects on headform rotational kinematics, and consequently brain deformation, during the helmeted oblique impact. Future helmet standards and rating methods should use headforms with realistic MoIs and CoF (e.g., the Cellbond headform) to ensure more accurate representation of the head in laboratory impact tests.

Ranking and Rating Bicycle Helmet Safety Performance in Oblique Impacts Using Eight Different Brain Injury Models.

Bicycle helmets are shown to offer protection against head injuries. Rating methods and test standards are used to evaluate different helmet designs and safety performance. Both strain-based injury criteria obtained from finite element brain injury models and metrics derived from global kinematic responses can be used to evaluate helmet safety performance. Little is known about how different injury models or injury metrics would rank and rate different helmets. The objective of this study was to determine how eight brain models and eight metrics based on global kinematics rank and rate a large number of bicycle helmets (n=17) subjected to oblique impacts. The results showed that the ranking and rating are influenced by the choice of model and metric. Kendall's tau varied between 0.50 and 0.95 when the ranking was based on maximum principal strain from brain models. One specific helmet was rated as 2-star when using one brain model but as 4-star by another model. This could cause confusion for consumers rather than inform them of the relative safety performance of a helmet. Therefore, we suggest that the biomechanics community should create a norm or recommendation for future ranking and rating methods.

High-speed helmeted head impacts in motorcycling: A computational study.

The motorcyclist is exposed to the risk of falling and impacting ground head-first at a wide range of travelling speeds - from a speed limit of less than 50 km/h on the urban road to the race circuit where speed can reach well above 200 km/h. However, motorcycle helmets today are tested at a single and much lower impact speed, i.e. 30 km/h. There is a knowledge gap in understanding the dynamics and head impact responses at high travelling speeds due to the limitation of existing laboratory rigs. This study used a finite element head model coupled with a motorcycle helmet model to simulate head-first falls at travelling speed (or tangential velocity at impact) from 0 to 216 km/h. The effect of different falling heights (1.6 m and 0.25 m) and coefficient of frictions (0.20 and 0.45) between the helmet outer shell and ground were also examined. The simulation results were analysed together with the analytical model to better comprehend rolling and/or sliding phenomena that are often observed in helmet oblique impacts. Three types of helmet-to-ground interactions are found when the helmet impacts ground from low to high tangential velocities: (1) helmet rolling without slipping; (2) a combination of sliding and rolling; and (3) continuous sliding. The tangential impulse transmitted to the head-helmet system, peak angular head kinematics and brain strain increase almost linearly with the tangential velocity when the helmet rolls but plateaus when the helmet slides. The critical tangential velocity at which the motion transit from the rolling regime to the sliding regime depends on both the falling height and friction coefficient. Typically, for a fall height of 1.63 m and a friction coefficient of 0.45, the rolling/sliding transition occurs at a tangential velocity of 10.8 m/s (38.9 km/h). Low sliding resistance in helmet design, i.e. by the means of a lower friction coefficient between the helmet outer shell and ground, has shown a higher reduction of brain tissue strain in the sliding regime than in the rolling regime. This study uncovers the underlying dynamics of rolling and sliding phenomena in high-speed oblique impacts, which largely affect head impact biomechanics. Besides, the study highlights the importance of testing helmets at speeds covering both the rolling and sliding regime since potential designs for improved head protection at high-speed impacts can be more distinguishable in the sliding regime than in the rolling regime.

Finite Element Analysis of Long Posterior Transpedicular Instrumentation for Cervicothoracic Fractures Related to Ankylosing Spondylitis.

STUDY DESIGN: Biomechanical finite element model analysis. OBJECTIVES: Spinal fractures related to ankylosing spondylitis (AS) are often treated by long posterior stabilization. The objective of this study is to develop a finite element model (FEM) for spinal fractures related to AS and to establish a biomechanical foundation for long posterior stabilization of cervicothoracic fractures related to AS. METHODS: An existing FEM (consisting of 2 separately developed models) including the cervical and thoracic spine were adapted to the conditions of AS (all discs fused, C0-C1 and C1-C2 mobile). A fracture at the level C6-C7 was simulated. Besides a normal spine (no AS, no fracture) and the uninstrumented fractured spine 4 different posterior transpedicular instrumentations were tested. Three loads (1.5g, 3.0g, 4.5g) were applied according to a specific load curve. RESULTS: All posterior stabilization methods could normalize the axial stability at the fracture site as measured with gap distance. The maximum stress at the cranial instrumentation end (C3-C4) was slightly greater if every level was instrumented, than in the skipped level model. The skipped level instrumentation achieved similar rotatory stability as the long multilevel instrumentation. CONCLUSIONS: Skipping instrumentation levels without giving up instrumentation length reduced stresses in the ossified tissue within the range of the instrumentation and did not decrease the stability in a FEM of a cervicothoracic fracture related to AS. Considering the risks associated with every additional screw placed, the skipped level instrumentation has advantages regarding patient safety.

The protective effect of a helmet in three bicycle accidents--A finite element study.

There is some controversy regarding the effectiveness of helmets in preventing head injuries among cyclists. Epidemiological, experimental and computer simulation studies have suggested that helmets do indeed have a protective effect, whereas other studies based on epidemiological data have argued that there is no evidence that the helmet protects the brain. The objective of this study was to evaluate the protective effect of a helmet in single bicycle accident reconstructions using detailed finite element simulations. Strain in the brain tissue, which is associated with brain injuries, was reduced by up to 43% for the accident cases studied when a helmet was included. This resulted in a reduction of the risk of concussion of up to 54%. The stress to the skull bone went from fracture level of 80 MPa down to 13-16 MPa when a helmet was included and the skull fracture risk was reduced by up to 98% based on linear acceleration. Even with a 10% increased riding velocity for the helmeted impacts, to take into account possible increased risk taking, the risk of concussion was still reduced by up to 46% when compared with the unhelmeted impacts with original velocity. The results of this study show that the brain injury risk and risk of skull fracture could have been reduced in these three cases if a helmet had been worn.

Comparison of multibody and finite element human body models in pedestrian accidents with the focus on head kinematics.

OBJECTIVE: The objective of this study was to compare and evaluate the difference in head kinematics between the TNO and THUMS models in pedestrian accident situations. METHODS: The TNO pedestrian model (version 7.4.2) and the THUMS pedestrian model (version 1.4) were compared in one experiment setup and 14 different accident scenarios where the vehicle velocity, leg posture, pedestrian velocity, and pedestrian's initial orientation were altered. In all simulations, the pedestrian model was impacted by a sedan. The head trajectory, head rotation, and head impact velocity were compared, as was the trend when various different parameters were altered. RESULTS: The multibody model had a larger head wrap-around distance for all accident scenarios. The maximum differences of the head's center of gravity between the models in the global x-, y-, and z-directions at impact were 13.9, 5.8, and 5.6 cm, respectively. The maximum difference between the models in head rotation around the head's inferior-superior axis at head impact was 36°. The head impact velocity differed up to 2.4 m/s between the models. The 2 models showed similar trends for the head trajectory when the various parameters were altered. CONCLUSIONS: There are differences in kinematics between the THUMS and TNO pedestrian models. However, these model differences are of the same magnitude as those induced by other uncertainties in the accident reconstructions, such as initial leg posture and pedestrian velocity.

Correlation between injury pattern and Finite Element analysis in biomechanical reconstructions of Traumatic Brain Injuries.

At present, Finite Element (FE) analyses are often used as a tool to better understand the mechanisms of head injury. Previously, these models have been compared to cadaver experiments, with the next step under development being accident reconstructions. Thus far, the main focus has been on deriving an injury threshold and little effort has been put into correlating the documented injury location with the response displayed by the FE model. Therefore, the purpose of this study was to introduce a novel image correlation method that compares the response of the FE model with medical images. The injuries shown on the medical images were compared to the strain pattern in the FE model and evaluated by two indices; the Overlap Index (OI) and the Location Index (LI). As the name suggests, OI measures the area which indicates both injury in the medical images and high strain values in the FE images. LI evaluates the difference in center of mass in the medical and FE images. A perfect match would give an OI and LI equal to 1. This method was applied to three bicycle accident reconstructions. The reconstructions gave an average OI between 0.01 and 0.19 for the three cases and between 0.39 and 0.88 for LI. Performing injury reconstructions are a challenge as the information from the accidents often is uncertain. The suggested method evaluates the response in an objective way which can be used in future injury reconstruction studies.

The Influence of Neck Muscle Tonus and Posture on Brain Tissue Strain in Pedestrian Head Impacts.

Pedestrians are one of the least protected groups in urban traffic and frequently suffer fatal head injuries. An important boundary condition for the head is the cervical spine, and it has previously been demonstrated that neck muscle activation is important for head kinematics during inertial loading. It has also been shown in a recent numerical study that a tensed neck musculature also has some influence on head kinematics during a pedestrian impact situation. The aim of this study was to analyze the influence on head kinematics and injury metrics during the isolated time of head impact by comparing a pedestrian with relaxed neck and a pedestrian with increased tonus. The human body Finite Element model THUMS Version 1.4 was connected to head and neck models developed at KTH and used in pedestrian-to-vehicle impact simulations with a generalized hood, so that the head would impact a surface with an identical impact response in all simulations. In order to isolate the influence of muscle tonus, the model was activated shortly before head impact so the head would have the same initial position prior to impact among different tonus. A symmetric and asymmetric muscle activation scheme that used high level of activation was used in order to create two extremes to investigate. It was found that for the muscle tones used in this study, the influence on the strain in the brain was very minor, in general about 1-14% change. A relatively large increase was observed in a secondary peak in maximum strains in only one of the simulated cases.

Training diagnosis and treatment of cervical spine trauma using a new educational program for visualization through imaging and simulation (VIS): a first evaluation by medical students.

In this pilot study we investigated how medical students evaluated a VIS practice session. Immediately after training 43 students answered a questionnaire on the training session. They evaluated VIS as a good interactive scenario based educational tool.

Neck muscle load distribution in lateral, frontal, and rear-end impacts: a three-dimensional finite element analysis.

STUDY DESIGN: A finite element (FE) model of the human neck was used to study the distribution of neck muscle loads during multidirectional impacts. The computed load distributions were compared to experimental electromyography (EMG) recordings. OBJECTIVE: To quantify passive muscle loads in nonactive cervical muscles during impacts of varying direction and energy, using a three-dimensional (3D) continuum FE muscle model. SUMMARY OF BACKGROUND DATA: Experimental and numerical studies have confirmed the importance of muscles in the impact response of the neck. Although EMG has been used to measure the relative activity levels in neck muscles during impact tests, this technique has not been able to measure all neck muscles and cannot directly quantify the force distribution between the muscles. A numerical model can give additional insight into muscle loading during impact. METHODS: An FE model with solid element musculature was used to simulate frontal, lateral, and rear-end vehicle impacts at 4 peak accelerations. The peak cross-sectional forces, internal energies, and effective strains were calculated for each muscle and impact configuration. The computed load distribution was compared with experimental EMG data. RESULTS: The load distribution in the cervical muscles varied with load direction. Peak sectional forces, internal energies, and strains increased in most muscles with increasing impact acceleration. The dominant muscles identified by the model for each direction were splenius capitis, levator scapulae, and sternocleidomastoid in lateral impacts, splenius capitis, and trapezoid in frontal impacts, and sternocleidomastoid, rectus capitis posterior minor, and hyoids in rear-end impacts. This corresponded with the most active muscles identified by EMG recordings, although within these muscles the distribution of forces and EMG levels were not the same. CONCLUSION: The passive muscle forces, strains, and energies computed using a continuum FE model of the cervical musculature distinguished between impact directions and peak accelerations, and on the basis of prior studies, isolated the most important muscles for each direction.

How does a three-dimensional continuum muscle model affect the kinematics and muscle strains of a finite element neck model compared to a discrete muscle model in rear-end, frontal, and lateral impacts.

STUDY DESIGN: A finite element (FE) model of the human neck with incorporated continuum or discrete muscles was used to simulate experimental impacts in rear, frontal, and lateral directions. OBJECTIVE: The aim of this study was to determine how a continuum muscle model influences the impact behavior of a FE human neck model compared with a discrete muscle model. SUMMARY OF BACKGROUND DATA: Most FE neck models used for impact analysis today include a spring element musculature and are limited to discrete geometries and nodal output results. A solid-element muscle model was thought to improve the behavior of the model by adding properties such as tissue inertia and compressive stiffness and by improving the geometry. It would also predict the strain distribution within the continuum elements. METHODS: A passive continuum muscle model with nonlinear viscoelastic materials was incorporated into the KTH neck model together with active spring muscles and used in impact simulations. The resulting head and vertebral kinematics was compared with the results from a discrete muscle model as well as volunteer corridors. The muscle strain prediction was compared between the 2 muscle models. RESULTS: The head and vertebral kinematics were within the volunteer corridors for both models when activated. The continuum model behaved more stiffly than the discrete model and needed less active force to fit the experimental results. The largest difference was seen in the rear impact. The strain predicted by the continuum model was lower than for the discrete model. CONCLUSION: The continuum muscle model stiffened the response of the KTH neck model compared with a discrete model, and the strain prediction in the muscles was improved.

The effect of muscle activation on neck response.

Prevention of neck injuries due to complex loading, such as occurs in traffic accidents, requires knowledge of neck injury mechanisms and tolerances. The influence of muscle activation on outcome of the injuries is not clearly understood. Numerical simulations of neck injury accidents can contribute to increase the understanding of injury tolerances. The finite element (FE) method is suitable because it gives data on stress and strain of individual tissues that can be used to predict injuries based on tissue level criteria. The aim of this study was to improve and validate an anatomically detailed FE model of the human cervical spine by implement neck musculature with passive and active material properties. Further, the effect of activation time and force on the stresses and strains in the cervical tissues were studied for dynamic loading due to frontal and lateral impacts. The FE model used includes the seven cervical vertebrae, the spinal ligaments, the facet joints with cartilage, the intervertebral disc, the skull base connected to a rigid head, and a spring element representation of the neck musculature. The passive muscle properties were defined with bilinear force-deformation curves and the active properties were defined using a material model based on the Hill equation. The FE model's responses were compared to volunteer experiments for frontal and lateral impacts of 15 and 7 g. Then, the active muscle properties where varied to study their effect on the motion of the skull, the stress level of the cortical and trabecular bone, and the strain of the ligaments. The FE model had a good correlation to the experimental motion corridors when the muscles activation was implemented. For the frontal impact a suitable peak muscle force was 40 N/cm2 whereas 20 N/cm2 was appropriate for the side impact. The stress levels in the cortical and trabecular bone were influenced by the point forces introduced by the muscle spring elements; therefore a more detailed model of muscle insertion would be preferable. The deformation of each spinal ligament was normalized with an appropriate failure deformation to predict soft tissue injury. For the frontal impact, the muscle activation turned out to mainly protect the upper cervical spine ligaments, while the musculature shielded all the ligaments disregarding spinal level for lateral impacts. It is concluded that the neck musculature does not have the same protective properties during different impacts loadings.

Development of a finite element model of the upper cervical spine and a parameter study of ligament characteristics.

STUDY DESIGN: Numeric techniques were used to study the upper cervical spine. OBJECTIVES: To develop and validate an anatomic detailed finite element model of the ligamentous upper cervical spine and to analyze the effect of material properties of the ligaments on spinal kinematics. SUMMARY OF BACKGROUND DATA: Cervical spinal injuries may be prevented with an increased knowledge of spinal behavior and injury mechanisms. The finite element method is tempting to use because stresses and strains in the different tissues can be studied during the course of loading. The authors know of no published results so far of validated finite element models that implement the complex geometry of the upper cervical spine. METHODS: The finite element model was developed with anatomic detail from computed tomographic images of the occiput to the C3. The ligaments were modeled with nonlinear spring elements. The model was validated for axial rotation, flexion, extension, lateral bending, and tension for 1.5 Nm, 10 Nm, and 1500 N. A material property sensitivity study was conducted for the ligaments. RESULTS: The model correlated with experimental data for all load cases. Moments of 1.5 Nm produced joint rotations of 3 degrees to 23 degrees depending on loading direction. The parameter study confirmed that the mechanical properties of the upper cervical ligaments play an important role in spinal kinematics. The capsular ligaments had the largest impact on spinal kinematics (40% change). CONCLUSIONS: The anatomic detailed finite element model of the upper cervical spine realistically simulates the complex kinematics of the craniocervical region. An injury that changes the material characteristics of any spinal ligament will influence the structural behavior of the upper cervical spine.

A new laboratory rig for evaluating helmets subject to oblique impacts.

Current requirements and regulations governing motorcycle helmets around the world are based on test results of purely radial impacts, which are statistically rare in real accidents. This study presents a new impact rig for subjecting test helmets to oblique impacts, which therefore is able to test impacts of increased statistical relevance to real motorcycle accidents. A number of different head-helmet interfaces have been investigated. A test rig was constructed to produce oblique impacts to helmets simulating those occurring in real motorcycle accidents. A Hybrid III dummy head was fitted with accelerometers to measure the accelerations arising during impact testing. The equipment used for data collection was validated in both translational and rotational acceleration. In order to better resemble the human head, an artificial scalp was fitted to the hybrid dummy. The same test rig was used to investigate the performance of a number of different helmets. Impact velocities ranging from 7.3 to 9.9 m/s were tested using a number of different impact angles and impact areas. This study shows that the new test rig can be used to provide useful data at speeds of up to 50 km/h and with impact angles varying from purely tangential to purely radial. The rotational accelerations observed differ greatly depending on both helmet and scalp designs. For example, a helmet with a sliding outer shell placed on an experimental head fitted with an artificial scalp (made to resemble the human scalp) reduces rotational accelerations of the head by up to 56%, compared with those of an experimental head fitted with a fixed scalp and conventional helmet. The degree of slippage between the skull and the scalp, and between the scalp and the helmet, leads to considerable variation in the results. This innovative test rig appears to provide an accurate method for measuring accelerations in an oblique impact to a helmet. In order to obtain a good level of repeatability in oblique impact testing, it is crucial that the helmet be fixed to the head in the exact same way in each individual test. Both the position and the angle of impact must be reproduced identically in each test. The test rig used here has shown that this type of rig can be used to compare different helmet designs, and it therefore is able to contribute to achieving safer helmets.