The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries.

Sports related head injuries can cause transient neurological events including loss of consciousness and dystonic posturing. However, it is unknown why head impacts that appear similar produce distinct neurological effects. The biomechanical effect of impacts can be estimated using computational models of strain within the brain. Here, we investigate the strain and strain rates produced by professional American football impacts that led to loss of consciousness, posturing or no neurological signs. We reviewed 1280 National Football League American football games and selected cases where the team's medical personnel made a diagnosis of concussion. Videos were then analysed for signs of neurological events. We identified 20 head impacts that showed clear video signs of loss of consciousness and 21 showing clear abnormal posturing. Forty-one control impacts were selected where there was no observable evidence of neurological signs, resulting in 82 videos of impacts for analysis. Video analysis was used to guide physical reconstructions of these impacts, allowing us to estimate the impact kinematics. These were then used as input to a detailed 3D high-fidelity finite element model of brain injury biomechanics to estimate strain and strain rate within the brain. We tested the hypotheses that impacts producing loss of consciousness would be associated with the highest biomechanical forces, that loss of consciousness would be associated with high forces in brainstem nuclei involved in arousal and that dystonic posturing would be associated with high forces in motor regions. Impacts leading to loss of consciousness compared to controls produced higher head acceleration (linear acceleration; 81.5 g ± 39.8 versus 47.9 ± 21.4; P = 0.004, rotational acceleration; 5.9 krad/s2 ± 2.4 versus 3.5 ± 1.6; P < 0.001) and in voxel-wise analysis produced larger brain deformation in many brain regions, including parts of the brainstem and cerebellum. Dystonic posturing was also associated with higher deformation compared to controls, with brain deformation observed in cortical regions that included the motor cortex. Loss of consciousness was specifically associated with higher strain rates in brainstem regions implicated in maintenance of consciousness, including following correction for the overall severity of impact. These included brainstem nuclei including the locus coeruleus, dorsal raphé and parabrachial complex. The results show that in head impacts producing loss of consciousness, brain deformation is disproportionately seen in brainstem regions containing nuclei involved in arousal, suggesting that head impacts produce loss of consciousness through a biomechanical effect on key brainstem nuclei involved in the maintenance of consciousness.

Evaluation of two rotational helmet technologies to decrease peak rotational acceleration in cycling helmets.

The risk of brain trauma has been associated with the rotational kinematics leading to the development of helmets with a variety rotational management technologies. The purpose of this paper was to employ a rotation specific test protocol to evaluate the effectiveness of two of these technologies. Dynamic response of the head was measured to assess the performance of each technology. Three cycling helmets with identical construction were included in this study. One helmet with no rotational technology, an established, commercial technology and a novel helmet rotational technology designed and assembled by the authors were tested. A drop test onto a 45° anvil was used to measure the ability of each helmet to manage the dynamic response of the head form during a series of impacts. The results revealed both rotational helmet technologies resulted in lower peak rotational acceleration and brain strain, however each technology demonstrated unique performance characteristics depending on the impact condition.

Brain trauma characteristics for lightweight and heavyweight fighters in professional mixed martial arts.

Mixed martial arts (MMA) is a sport where the fighters are at high risk of brain trauma, with characteristics, such as the frequency, magnitude, and interval of head impacts influencing the risk of developing short- and long-term negative brain health outcomes. These characteristics may be influenced by weight class as they may have unique fighting styles. The purpose of this research was to compare frequency, magnitude, and interval of head impacts between lightweight and heavyweight fighters in professional MMA. Frequency, interval, event type, velocity, and location of head impacts were documented for 60 fighters from 15 Lightweight and 15 Heavyweight professional MMA fights. Head impact reconstructions of these events were performed using physical and finite element modelling methods to determine the strain in the brain tissues. The results found that LW and HW fighters sustained similar head impact frequencies and intervals. The LW fighters sustained a significantly higher frequency of very low and high magnitude impacts to the head from punches; HW a larger frequency of high category strains from elbow strikes. These brain trauma profiles reflect different fight strategies and may inform methods to manage and mitigate the long-term effects of repetitive impacts to the head.

Evaluation of amplitude- and frequency-based techniques for attenuating inertia-based movement artifact during surface translation perturbations.

BACKGROUND: Surface translations are a method of perturbing an individual's balance to evoke balance control responses. However, the force plates used to measure kinetic responses often contain artifacts due to inertial properties coupled with the dynamics of surface translation perturbations. Techniques to attenuate these movement artifacts are not well established within the literature. RESEARCH QUESTION: Are amplitude- or frequency-based subtraction processing techniques effective at attenuating inertia-based movement artifacts in kinetic signals during surface translations? METHODS: One-hundred and two backward surface translations were analyzed from five participants. Perturbation-matched unloaded pre-trials were collected to characterize force plate movement artifacts. For each trial, baseline data was processed to account for inertial artifacts using both amplitude- and frequency-based subtraction methods producing 3 datasets. Root mean square error (RMSE) between the datasets and expected tracings of an unloaded force plate were calculated. The effects of these processes on calculated knee flexion/extension (FE) moment were characterized using an inverse dynamics model which incorporated ground reaction forces and participant kinematics. RESULTS: Both amplitude- and frequency-based processing methods resulted in near identical changes and substantially reduced RMSE values compared to original data. An RMSE reduction of 91.4 % was observed for the unloaded force channel which aligned with the direction of translation. Peak stance knee FE moments decreased by an average of 3.7 Nm and the average largest difference between the original data and both processing techniques across all trials was 30.4 Nm. SIGNIFICANCE: The results provide quantitative evidence that both data processing methods can successfully attenuate the presence of movement artifact found within force plate signals during surface translations. This study provides recommendations to researchers on effective methods for improving data processing techniques to attenuate force plate movement artifacts introduced by surface translations, towards more accurate estimates of joint kinetics during balance reactions.

Biomechanics of Sport-Related Neurological Injury.

As awareness on the short-term and long-term consequences of sports-related concussions and repetitive head impacts continues to grow, so too does the necessity to establish biomechanical measures of risk that inform public policy and risk mitigation strategies. A more precise exposure metric is central to establishing relationships among the traumatic experience, risk, and ultimately clinical outcomes. Accurate exposure metrics provide a means to support evidence-informed decisions accelerating public policy mandating brain trauma management through sport modification and safer play.

The reliability of surface EMG derived motor unit variables.

Motor unit (MU) recordings obtained from surface electromyography (sEMG) decomposition are used to investigate the neural control of muscle in response to interventions, but our understanding of the longer-term reliability of MU variables is limited. This study examined the reliability of MU variables in the flexor carpi radialis (FCR) and tibialis anterior (TA) over a three-month period. Forty college-aged participants completed isometric wrist flexion (n = 20) and dorsiflexion (n = 20). There were 3 maximal isometric voluntary contractions (MVC) and 3 ramp contractions to 60% of MVC on four separate sessions separated by a total of 13 weeks. Intraclass correlation coefficients (ICC) were calculated from a fully nested ANOVA model. Maximal force was highly reliable (ICC = 0.94-0.99). The ICC values ranged from 0.49 to 0.92 for the FCR MU variables and from 0.58 to 0.96 for the TA MU variables. All MU variables exhibited a high degree of stability of means across test session and consistency within subjects, with the exception of the number of MUs detected in the TA. Poor ICC values did not reflect poor reliability but rather, convergence towards a narrow range of physiologically normal values. Surface EMG decomposition of a large population of MUs showed no differences in common drive between FCR (0.273) and for the TA (0.267) across test sessions. Forty percent of the sampled MUs in both muscles had a common drive of 0.30 or greater, which provides indirect support for the validity of the decompositions. MU variables may be used to monitor adaptations to a longer-term intervention study.

Simulated brain strains resulting from falls differ between concussive events of young children and adults.

Compared to adults, it has been documented that children are at elevated risk for concussion, repeated concussions, and experience longer recovery times. What is unknown, is whether the developing brain may be injured at differing strain levels. This study examined peak and cumulative brain strain from 20 cases of concussion in both young children and adults using physical reconstructions and finite element modelling of the brain response to impacts. The child group showed lower impact kinematics as well as strain metrics. Results suggest children may suffer concussive injuries with lower brain strains compared to adults.

Defining the effective impact mass of elbow and shoulder strikes in ice hockey.

Reconstruction of real-life events can be used to investigate the relationship between the mechanical parameters of the impact and concussion risk. Striking mass has typically been approximated as being the mass of the body part coming into contact with the head without accounting for the force applied by the striking athlete. Thus, the purpose of this study was to measure the effective impact mass of three common striking techniques in ice hockey. Fifteen participants were instructed to strike a suspended 50th percentile Hybrid III headform at least three times with their elbow or shoulder. Effective impact mass was calculated by measuring the change in velocity of the player and the headform. Mean effective impact mass for the extended elbow, tucked-in elbow, and shoulder check conditions were 4.8, 3.0, and 12.9 kg, respectively. Peak linear accelerations were lower than the values associated with concussion in American football which could be a reflection of the methodology used in this study as well as inherent differences between both sports.

The evaluation of speed skating helmet performance through peak linear and rotational accelerations.

OBJECTIVE: Like many sports involving high speeds and body contact, head injuries are a concern for short track speed skating athletes and coaches. While the mandatory use of helmets has managed to nearly eliminate catastrophic head injuries such as skull fractures and cerebral haemorrhages, they may not be as effective at reducing the risk of a concussion. The purpose of this study was to evaluate the performance characteristics of speed skating helmets with respect to managing peak linear and peak rotational acceleration, and to compare their performance against other types of helmets commonly worn within the speed skating sport. MATERIALS AND METHODS: Commercially available speed skating, bicycle and ice hockey helmets were evaluated using a three-impact condition test protocol at an impact velocity of 4 m/s. RESULTS AND DISCUSSION: Two speed skating helmet models yielded mean peak linear accelerations at a low-estimated probability range for sustaining a concussion for all three impact conditions. Conversely, the resulting mean peak rotational acceleration values were all found close to the high end of a probability range for sustaining a concussion. A similar tendency was observed for the bicycle and ice hockey helmets under the same impact conditions. CONCLUSION: Speed skating helmets may not be as effective at managing rotational acceleration and therefore may not successfully protect the user against risks associated with concussion injuries.