Subdural hemorrhage in two high-school football players: post-injury helmet testing.

The incidence of catastrophic head injury in American football is at a 30-year high; over 90% of these injuries are secondary to subdural hemorrhage (SDH). At the present time, it is unknown why the incidence of this devastating injury complex continues to rise. Because previous investigations have documented deficiencies in the process of equipment certification at youth and high-school levels, we sought to investigate the adequacy of headgear worn by two athletes who suffered contact-related SDH on the football field and presented to Vanderbilt Children's Hospital between 2009 and 2011. Helmets worn by the struck players at the time of collision (Medium Schutt Air Advantage 7888 and Large Schutt Air XP 7890) were obtained for formal biomechanical testing at a National Operating Committee on the Safety of Athletic Equipment (NOCSAE)-certified facility. Both helmets were found to be compliant with a modified version of the NOCSAE standard ND002-11m12. Based on the aforementioned tests, it can be concluded that headgear worn by both players who suffered SDH was not substandard, as defined by contemporary helmet quality assurance criteria. To the authors' knowledge, this is the first published report of helmet testing following sports-related helmeted collisions resulting in severe traumatic intracranial injuries.

An investigation of the NOCSAE linear impactor test method based on in vivo measures of head impact acceleration in American football.

The performance characteristics of football helmets are currently evaluated by simulating head impacts in the laboratory using a linear drop test method. To encourage development of helmets designed to protect against concussion, the National Operating Committee for Standards in Athletic Equipment recently proposed a new headgear testing methodology with the goal of more closely simulating in vivo head impacts. This proposed test methodology involves an impactor striking a helmeted headform, which is attached to a nonrigid neck. The purpose of the present study was to compare headform accelerations recorded according to the current (n=30) and proposed (n=54) laboratory test methodologies to head accelerations recorded in the field during play. In-helmet systems of six single-axis accelerometers were worn by the Dartmouth College men's football team during the 2005 and 2006 seasons (n=20,733 impacts; 40 players). The impulse response characteristics of a subset of laboratory test impacts (n=27) were compared with the impulse response characteristics of a matched sample of in vivo head accelerations (n=24). Second- and third-order underdamped, conventional, continuous-time process models were developed for each impact. These models were used to characterize the linear head/headform accelerations for each impact based on frequency domain parameters. Headform linear accelerations generated according to the proposed test method were less similar to in vivo head accelerations than headform accelerations generated by the current linear drop test method. The nonrigid neck currently utilized was not developed to simulate sport-related direct head impacts and appears to be a source of the discrepancy between frequency characteristics of in vivo and laboratory head/headform accelerations. In vivo impacts occurred 37% more frequently on helmet regions, which are tested in the proposed standard than on helmet regions tested currently. This increase was largely due to the addition of the facemask test location. For the proposed standard, impactor velocities as high as 10.5 m/s were needed to simulate the highest energy impacts recorded in vivo. The knowledge gained from this study may provide the basis for improving sports headgear test apparatuses with regard to mimicking in vivo linear head accelerations. Specifically, increasing the stiffness of the neck is recommended. In addition, this study may provide a basis for selecting appropriate test impact energies for the standard performance specification to accompany the proposed standard linear impactor test method.

Measurement of impact acceleration: mouthpiece accelerometer versus helmet accelerometer.

CONTEXT: Instrumented helmets have been used to estimate impact acceleration imparted to the head during helmet impacts. These instrumented helmets may not accurately measure the actual amount of acceleration experienced by the head due to factors such as helmet-to-head fit. OBJECTIVE: To determine if an accelerometer attached to a mouthpiece (MP) provides a more accurate representation of headform center of gravity (HFCOG) acceleration during impact than does an accelerometer attached to a helmet fitted on the headform. DESIGN: Single-factor research design in which the independent variable was accelerometer position (HFCOG, helmet, MP) and the dependent variables were g and Severity Index (SI). SETTING: Independent impact research laboratory. INTERVENTION(S): The helmeted headform was dropped (n = 168) using a National Operating Committee on Standards for Athletic Equipment (NOCSAE) drop system from the standard heights and impact sites according to NOCSAE test standards. Peak g and SI were measured for each accelerometer position during impact. MAIN OUTCOME MEASURES: Upon impact, the peak g and SI were recorded for each accelerometer location. RESULTS: Strong relationships were noted for HFCOG and MP measures, and significant differences were seen between HFCOG and helmet g measures and HFCOG and helmet SI measures. No statistically significant differences were noted between HFCOG and MP g and SI measures. Regression analyses showed a significant relationship between HFCOG and MP measures but not between HFCOG and helmet measures. CONCLUSIONS: Upon impact, MP acceleration (g) and SI measurements were closely related to and more accurate in measuring HFCOG g and SI than helmet measurements. The MP accelerometer is a valid method for measuring head acceleration.

Concussion in professional football: helmet testing to assess impact performance--part 11.

OBJECTIVE: National Football League (NFL) concussions occur at an impact velocity of 9.3 +/- 1.9 m/s (20.8 +/- 4.2 mph) oblique on the facemask, side, and back of the helmet. There is a need for new testing to evaluate helmet performance for impacts causing concussion. This study provides background on new testing methods that form a basis for supplemental National Operating Committee on Standards for Athletic Equipment (NOCSAE) helmet standards. METHODS: First, pendulum impacts were used to simulate 7.4 and 9.3 m/s impacts causing concussion in NFL players. An instrumented Hybrid III head was helmeted and supported on the neck, which was fixed to a sliding table for frontal and lateral impacts. Second, a linear pneumatic impactor was used to evaluate helmets at 9.3 m/s and an elite impact condition at 11.2 m/s. The upper torso of the Hybrid III dummy was used. It allowed interactions with shoulder pads and other equipment. The severity of the head responses was measured by a severity index, translational and rotational acceleration, and other biomechanical responses. High-speed videos of the helmet kinematics were also recorded. The tests were evaluated for their similarity to conditions causing NFL concussions. Finally, a new linear impactor was developed for use by NOCSAE. RESULTS: The pendulum test closely simulated the conditions causing concussion in NFL players. Newer helmet designs and padding reduced the risk of concussion in 7.4 and 9.3 m/s impacts oblique on the facemask and lateral on the helmet shell. The linear impactor provided a broader speed range for helmet testing and more interactions with safety equipment. NOCSAE has prepared a draft supplemental standard for the 7.4 and 9.3 m/s impacts using a newly designed pneumatic impactor. No helmet designs currently address the elite impact condition at 11.2 m/s, as padding bottoms out and head responses dramatically increase. CONCLUSIONS: The proposed NOCSAE standard is the first to address helmet performance in reducing concussion risks in football. Helmet performance has improved with thicker padding and fuller coverage by the shell. However, there remains a challenge for innovative designs that reduce risks in the 11.2 m/s elite impact condition.