Investigation of Head Kinematics and Brain Strain Response During Soccer Heading Using a Custom-Fit Instrumented Mouthguard.

Association football, also known as soccer in some regions, is unique in encouraging its participants to intentionally use their head to gain a competitive advantage, including scoring a goal. Repetitive head impacts are now being increasingly linked to an inflated risk of developing long-term neurodegenerative disease. This study investigated the effect of heading passes from different distances, using head acceleration data and finite element modelling to estimate brain injury risk. Seven university-level participants wore a custom-fitted instrumented mouthguard to capture linear and angular acceleration-time data. They performed 10 headers within a laboratory environment, from a combination of short, medium, and long passes. Kinematic data was then used to calculate peak linear acceleration, peak angular velocity, and peak angular acceleration as well as two brain injury metrics: head injury criterion and rotational injury criterion. Six degrees of freedom acceleration-time data were also inputted into a widely accepted finite element brain model to estimate strain-response using mean peak strain and cumulative strain damage measure values. Five headers were considered to have a 25% concussion risk. Mean peak linear acceleration equalled 26 ± 7.9 g, mean peak angular velocity 7.20 ± 2.18 rad/s, mean peak angular acceleration 1730 ± 611 rad/s2, and 95th percentile mean peak strain 0.0962 ± 0.252. Some of these data were similar to brain injury metrics reported from American football, which supports the need for further investigation into soccer heading.

Brain trauma exposure for American tackle football players 5 to 9 and 9 to 14 years of age.

American football helmets used by youth players are currently designed and tested to the same standards as professionals. The National Operating Committee on Standard and Safety requested research aiming at understanding the differences in brain trauma in youth American football for players aged five to nine and nine to fourteen years old to inform a youth specific American football standard. Video analysis and laboratory reconstructions of head impacts were undertaken to measure differences in head impact frequency, event types, and magnitudes of maximum principal strain (MPS) for the two age groups. Overall frequencies and frequencies for five categories of MPS representing different magnitudes of risk were tabulated. The MPS categories were very low (<0.08), low (0.08-0.169), medium (0.17-0.259), high (0.26-0.349) and very high (>0.35). Both cohorts experienced a majority of head impacts (>56%) at very low magnitude of MPS. Youth American football players aged 9-14 yrs. sustained a greater frequency of head impacts at MPS between 0.08 and 0.169 % associated with changes in brain structure and function. There were no differences in overall frequency, or in frequency of head impacts in other categories of MPS. The proportion of impacts considered injurious (MPS > 0.08) was greater in the 5-9 group (44%), than the 9-14 group (39%), and impacts above 0.35 % were only reported for the younger age group. The larger helmet-to-shoulder ratio in the younger age groups may have contributed to this finding suggesting that youth American football players under the age of nine would benefit from a child-specific football helmet.

Correction to 'An empirical measure of nonlinear strain for soft tissue indentation'.

[This corrects the article DOI: 10.1098/rsos.170894.].

Indentation of heterogeneous soft tissue: Local constitutive parameter mapping using an inverse method and an automated rig.

In the domain of soft tissue biomechanics, the development of numerical simulations has raised the experimental challenge of identifying local internal mechanical constitutive data of heterogeneous organs (e.g. brain tissue). In this context, this paper presents an ex-vivo alternative characterization method to full-field imaging techniques. It is based on automated, multiple indentations of an organ section using a custom-built rig, effectively allowing to map the viscoelastic and hyperelastic constitutive parameters of the tissue at the millimetre scale, under dynamic conditions. In this paper, this technique is described and used to map the constitutive data of three sections from porcine liver, kidney and brain tissues. The results of this mapping present strong evidence of correlation between the organ constituents (e.g. white/grey matter distribution) and the identified constitutive parameters. It was also found that brain and kidney tissues are highly heterogeneous in terms of identified properties, suggesting that such a technique is essential for fully characterizing their mechanical behaviour. This method opens the way to 3D mapping of constitutive parameters to feed finite element models of the organs with region-specific properties.

Monodisperse polystyrene foams via polymerization of foamed emulsions: structure and mechanical properties.

Foamed styrene-in-water emulsions can serve as templates for solid polystyrene foams as the pore size dpore in the solid polystyrene foam matches the bubble size dbubble of the liquid foam template. By producing monodisperse foamed emulsions with a microfluidic device it is possible to adjust the pore size, the connectivity of the pores, as well as the density of the solid polystyrene foams. The pore size can be tuned either by varying the gas pressure used to form the emulsion or by varying the chip dimension. Using three different chip dimensions we are able to produce monodisperse polystyrene foams with pore sizes ranging from 115 µm up to 588 µm. The relative density can be varied easily in a range from 0.10 to 0.30. Increasing the liquid fraction leads initially to smaller interconnections and ultimately to a mainly closed cell foam. It is practically impossible to produce a fully closed cell foam since, even at high liquid fractions, two adjacent bubbles eventually touch and form a film that will rupture during polymerization. By closely investigating the structure of the polystyrene foams we noticed an additional porosity in the pore walls which matches the water content of the styrene-in-water emulsion. During polymerization, the styrene droplets in the aqueous matrix fuse and build up a continuous but porous structure which makes up the pore walls of the macropores. This additionally porosity also leads to lower Young's and shear moduli than expected, as predicted by Gibson and Ashby's model. The relationship between relative density and moduli is in good agreement with the model.

An empirical measure of nonlinear strain for soft tissue indentation.

Indentation is a primary tool in the investigation of the mechanical properties of very soft tissue such as the brain. However, the usual material characterization protocols are not applicable because the resulting deformation is inhomogeneous, with even the identification of the amount of strain ambiguous and uncertain. Focusing on spherical indentation only, a standard is needed to quantify the amount of strain in terms of the probe radius and displacement so that different indentation experiments can be compared and contrasted. It is shown here that the minimum axial value of the Eulerian logarithmic strain tensor has many desirable properties of such a standard, such as invariance under the choice of material model, and experimental conditions for a given probe displacement. The disadvantage of this measure is that sophisticated finite element techniques need to be used in its determination. An empirical relation is obtained between this strain and the probe radius and displacement to circumvent this problem, and it is shown that this relationship is an excellent predictor of the strain measure. Two essential features of this empirical measure for nonlinear strains are that the exact strain measure for the linear theory is recovered on restriction to infinitesimal deformations and that the simulations use models based on reliable and accurate indentation data obtained from freshly harvested murine brains using a bespoke micro-indentation device.

A new formulation of slight compressibility for arterial tissue and its Finite Element implementation.

In order to avoid the numerical difficulties in locally enforcing the incompressibility constraint using the displacement formulation of the Finite Element Method, slight compressibility is typically assumed when simulating the mechanical response of arterial tissue. The current standard method of accounting for slight compressibility of hyperelastic soft tissue assumes an additive decomposition of the strain-energy function into a volumetric and a deviatoric part. This has been shown, however, to be inconsistent with the linear theory and results in cubes retaining their cuboid shape under hydrostatic tension and compression, which seems at variance with the reinforcement of arterial tissue with two families of collagen fibres. A remedy for these defects is proposed here, a solution which generalises the current standard model of slight compressibility to include two additional terms, one of which is quadratic in the [Formula: see text] invariants and the other quadratic in [Formula: see text]. Experimental data are used to motivate typical values for the associated material constants of these additional terms. Some simulations are performed to allow contrasts and comparisons to be made between the current standard model of slight compressibility and its generalisation proposed here.

Finite element implementation of a new model of slight compressibility for transversely isotropic materials.

Modelling transversely isotropic materials in finite strain problems is a complex task in biomechanics, and is usually addressed by using finite element (FE) simulations. The standard method developed to account for the quasi-incompressible nature of soft tissues is to decompose the strain energy function (SEF) into volumetric and deviatoric parts. However, this decomposition is only valid for fully incompressible materials, and its use for slightly compressible materials yields an unphysical response during the simulation of hydrostatic tension/compression of a transversely isotropic material. This paper presents the FE implementation as subroutines of a new volumetric model solving this deficiency in two FE codes: Abaqus and FEBio. This model also has the specificity of restoring the compatibility with small strain theory. The stress and elasticity tensors are first derived for a general SEF. This is followed by a successful convergence check using a particular SEF and a suite of single-element tests showing that this new model does not only correct the hydrostatic deficiency but may also affect stresses during shear tests (Poynting effect) and lateral stretches during uniaxial tests (Poisson's effect). These FE subroutines have numerous applications including the modelling of tendons, ligaments, heart tissue, etc. The biomechanics community should be aware of specificities of the standard model, and the new model should be used when accurate FE results are desired in the case of compressible materials.

Dynamic mechanical properties of murine brain tissue using micro-indentation.

In the past 50 years significant advances have been made in determining the macro-scale properties of brain tissue in compression, tension, shear and indentation. There has also been significant work done at the nanoscale using the AFM method to characterise the properties of individual neurons. However, there has been little published work on the micro-scale properties of brain tissue using an appropriate indentation methodology to characterise the regional differences at dynamic strain rates. This paper presents the development and use of a novel micro-indentation device to measure the dynamic mechanical properties of brain tissue. The device is capable of applying up to 30/s strain rates with a maximum indentation area of 2500 µm(2). Indentation tests were carried out to determine the shear modulus of the cerebellum (2.11 ± 1.26 kPa, 3.15 ± 1.66 kPa, 3.71 ± 1.23 kPa) and cortex (4.06 ± 1.69 kPa, 6.14 ± 3.03 kPa, 7.05 ± 3.92 kPa) of murine brain tissue at 5, 15, and 30/s up to 14% strain. Numerical simulations were carried out to verify the experimentally measured force-displacement results.

Deficiencies in numerical models of anisotropic nonlinearly elastic materials.

Incompressible nonlinearly hyperelastic materials are rarely simulated in finite element numerical experiments as being perfectly incompressible because of the numerical difficulties associated with globally satisfying this constraint. Most commercial finite element packages therefore assume that the material is slightly compressible. It is then further assumed that the corresponding strain-energy function can be decomposed additively into volumetric and deviatoric parts. We show that this decomposition is not physically realistic, especially for anisotropic materials, which are of particular interest for simulating the mechanical response of biological soft tissue. The most striking illustration of the shortcoming is that with this decomposition, an anisotropic cube under hydrostatic tension deforms into another cube instead of a hexahedron with non-parallel faces. Furthermore, commercial numerical codes require the specification of a 'compressibility parameter' (or 'penalty factor'), which arises naturally from the flawed additive decomposition of the strain-energy function. This parameter is often linked to a 'bulk modulus', although this notion makes no sense for anisotropic solids; we show that it is essentially an arbitrary parameter and that infinitesimal changes to it result in significant changes in the predicted stress response. This is illustrated with numerical simulations for biaxial tension experiments of arteries, where the magnitude of the stress response is found to change by several orders of magnitude when infinitesimal changes in 'Poisson's ratio' close to the perfect incompressibility limit of 1/2 are made.

Investigation of the force associated with the formation of lacerations and skull fractures.

Post-mortem examination is often relied upon in order to determine whether a suspicious death was natural, accidental, suicidal or homicidal. However, in many cases the mechanism by which a single injury has been inflicted cannot be determined with certainty based on pathological examination alone. Furthermore the current method of assessing applied force relating to injury is restricted to an arbitrary and subjective scale (mild, moderate, considerable, or severe). This study investigates the pathophysiological nature of head injuries caused by blunt force trauma, specifically in relation to the incidence and formation of a laceration. An experimental model was devised to assess the force required to cause damage to the scalp and underlying skull of porcine specimens following a single fronto-parietal impact. This was achieved using a drop tower equipped with adapted instrumentation for data acquisition. The applied force and implement used could be correlated with resultant injuries and as such aid pathological investigation in the differentiation between falls and blows. Experimentation revealed prevalent patterns of injury specific to the reconstructed mechanism involved. It was found that the minimum force for the occurrence of a laceration was 4,000 N.

Motorcycle riders' perception of helmet use: complaints and dissatisfaction.

In accidents which involve two-wheeled vehicles the helmet plays a life-saving role, but very little is known about the motorcycle rider's perception of the helmet. We evaluated the relationships between having been involved in an accident and dissatisfaction with the helmet, and between the perception of motorcycle riders and the objective features of the helmet. This was a case-control study: riders of motorized two-wheelers who had been involved in accidents (accident cases) were compared against a similarly interviewed sample of riders that had not been in accidents (control cases). Information about the driver, the vehicle and the helmet was collected in all interviews. To evaluate the relationships, logistic regressions were carried out. The majority of drivers were dissatisfied with their helmets, but no evidence was found to link this dissatisfaction with having been involved in an accident. The two most common complaints related to noisiness, followed by the helmet visor. Complaints did not seem to be statistically associated with physical features of the helmet.

Finite element modelling of equestrian helmet impacts exposes the need to address rotational kinematics in future helmet designs.

Jockey head injuries, especially concussions, are common in horse racing. Current helmets do help to reduce the severity and incidences of head injury, but the high concussion incidence rates suggest that there may be scope to improve the performance of equestrian helmets. Finite element simulations in ABAQUS/Explicit were used to model a realistic helmet model during standard helmeted rigid headform impacts and helmeted head model University College Dublin Brain Trauma Model (UCDBTM) impacts. Current helmet standards for impact determine helmet performance based solely on linear acceleration. Brain injury-related values (stress and strain) from the UCDBTM showed that a performance improvement based on linear acceleration does not imply the same improvement in head injury-related brain tissue loads. It is recommended that angular kinematics be considered in future equestrian helmet standards, as angular acceleration was seen to correlate with stress and strain in the brain.

Comparative multibody dynamics analysis of falls from playground climbing frames.

This paper shows the utility of multibody dynamics in evaluating changes in injury related parameters of the head and lower limbs of children following falls from playground climbing frames. A particular fall case was used as a starting point to analyze the influence of surface properties, posture of the body at impact, and intermediate collisions against the climbing frame before impacting the ground. Simulations were made using the 6-year-old pedestrian MADYMO rigid body model and scaled head contact characteristics. Energy absorbing surfaces were shown to reduce injury severity parameters by up to 30-80% of those of rigid surfaces, depending on impact posture and surface. Collisions against components of a climbing frame during a fall can increase injury severity of the final impact of the head with the ground by more than 90%. Negligible changes are associated with lower limb injury risks when different surfacing materials are used. Computer reconstructions of actual falls that are intended to quantify the severity of physical injuries rely on accurate knowledge of initial conditions prior to falling, intermediate kinematics of the fall and the orientation of the body when it impacts against the ground. Multibody modelling proved to be a valuable tool to analyze the quality of eyewitness information and analyze the relative injury risk associated with changes in components influencing fall injuries from playground climbing frames. Such simulations can also support forensic investigations by evaluating alternative hypotheses for the sequence of kinematic motion of falls which result in known injuries.

Head impact biomechanics simulations: a forensic tool for reconstructing head injury?

This paper describes a computer simulation method, which is used widely in engineering design and accident investigation reconstructions, which could constitute a valuable forensic tool for investigating cases of head impact injury and skull fracture. This method, the finite element method, relies on knowing the physical properties and strength of biological materials, including cranial bone and neural tissue, and on having evidence of the extent of head injuries in order to deduce causative forces. This method could help forensic pathologists to infer causes of skull fracture and to determine whether probable causes of fracture were accidental or intentional.

Surface instability of sheared soft tissues.

When a block made of an elastomer is subjected to a large shear, its surface remains flat. When a block of biological soft tissue is subjected to a large shear, it is likely that its surface in the plane of shear will buckle (appearance of wrinkles). One factor that distinguishes soft tissues from rubberlike solids is the presence--sometimes visible to the naked eye--of oriented collagen fiber bundles, which are stiffer than the elastin matrix into which they are embedded but are nonetheless flexible and extensible. Here we show that the simplest model of isotropic nonlinear elasticity, namely, the incompressible neo-Hookean model, suffers surface instability in shear only at tremendous amounts of shear, i.e., above 3.09, which corresponds to a 72 deg angle of shear. Next we incorporate a family of parallel fibers in the model and show that the resulting solid can be either reinforced or strongly weakened with respect to surface instability, depending on the angle between the fibers and the direction of shear and depending on the ratio Emu between the stiffness of the fibers and that of the matrix. For this ratio we use values compatible with experimental data on soft tissues. Broadly speaking, we find that the surface becomes rapidly unstable when the shear takes place "against" the fibers and that as E/mu increases, so does the sector of angles where early instability is expected to occur.

Measuring knife stab penetration into skin simulant using a novel biaxial tension device.

This paper describes the development and use of a biaxial measurement device to analyse the mechanics of knife stabbings. In medicolegal situations it is typical to describe the consequences of a stabbing incident in relative terms that are qualitative and descriptive without being numerically quantitative. Here, the mechanical variables involved in the possible range of knife-tissue penetration events are considered so as to determine the necessary parameters that would need to be controlled in a measurement device. These include knife geometry, in-plane mechanical stress state of skin, angle and speed of knife penetration, and underlying fascia such as muscle or cartilage. Four commonly available household knives with different geometries were used: the blade tips in all cases were single-edged, double-sided and without serrations. Appropriate synthetic materials were used to simulate the response of skin, fat and cartilage, namely polyurethane, compliant foam and ballistic soap, respectively. The force and energy applied by the blade of the knife and the out of plane displacement of the skin were all used successfully to identify the occurrence of skin penetration. The skin tension is shown to have a direct effect on both the force and energy for knife penetration and the depth of out of plane displacement of the skin simulant prior to penetration: larger levels of in-plane tension in the skin are associated with lower penetration forces, energies and displacements. Less force and energy are also required to puncture the skin when the plane of the blade is parallel to a direction of greater skin tension than when perpendicular. This is consistent with the observed behaviour when cutting biological skin: less force is required to cut parallel to the Langer lines than perpendicularly and less force is required to cut when the skin is under a greater level of tension. Finally, and perhaps somewhat surprisingly, evidence is shown to suggest that the quality control processes used to manufacture knives fail to produce consistently uniform blade points in knives that are nominally identical. The consequences of this are that the penetration forces associated with nominally identical knives can vary by as much as 100%.

The use of accident reconstruction for the analysis of traumatic brain injury due to head impacts arising from falls.

Brain injury is the leading cause of death in those aged under 45 years in both Europe and the USA. The objective of this research is to reconstruct and analyse real world cases of accidental head injury, thereby providing accurate data, which can be used subsequently to develop clinical tolerance levels associated with particular traumatic injuries and brain lesions. This paper looks at using numerical modelling techniques, namely multibody body dynamics and finite element methods, to reconstruct two real-life accident cases arising from falls. Preliminary results show the levels of acceleration of the head and deformation of brain tissue correspond well to those found by other researchers, suggesting that this method is suitable for modeling head-injury accidents.

Reconstruction of real world head injury accidents resulting from falls using multibody dynamics.

OBJECTIVE: To reconstruct real life head injury accidents resulting from falls using multibody modelling software, with the aim of comparing simulation output to injuries sustained. BACKGROUND: Much previous research on head injury biomechanics has focussed on animals and cadavers. However, focus is increasingly turning towards the examination of real life head injury. Falls are a major cause of head injury and, in general, are simpler to model than other accident types. DESIGN AND METHODS: Five cases of simple falling accidents resulting in focal head injury were examined, and reconstructions were performed using a multibody model of the human body. Each case was reconstructed a number of times, varying the initial conditions and using two different sets of properties for head contact. RESULTS: Results obtained included velocities, accelerations and forces on the head during impact. This output appeared more sensitive to changes in head contact characteristics than to changes in initial conditions. Depending on the contact characteristics used, results were consistent with proposed tolerance limits from the literature for various lesion types. CONCLUSIONS: Provided it is used with caution, this method could prove a useful source of biomechanical data for the investigation of head injury biomechanics. RELEVANCE: Biomechanical investigation of real-life cases of head injury is very important, yet not as prevalent as work with animals and cadavers. Reconstruction of real life accidents is a good method of obtaining data that will aid in the investigation of mechanisms of head injury and human tolerance to head injury.