Pediatric head and neck dynamics in frontal impact: analysis of important mechanical factors and proposed neck performance corridors for 6- and 10-year-old ATDs.

OBJECTIVE: Traumatic injuries are the leading cause of death of children aged 1-19 in the United States and are principally caused by motor vehicle collisions, with the head being the primary region injured. The neck, though not commonly injured, governs head kinematics and thus influences head injury. Vehicle improvements necessary to reduce these injuries are evaluated using anthropomorphic testing devices (ATDs). Current pediatric ATD head and neck properties were established by scaling adult properties using the size differences between adults and children. Due to the limitations of pediatric biomechanical research, computational models are the only available methods that combine all existing data to produce injury-relevant biofidelity specifications for ATDs. The purpose of this study is to provide the first frontal impact biofidelity corridors for neck flexion response of 6- and 10-year-olds using validated computational models, which are compared to the Hybrid III (HIII) ATD neck responses and the Mertz flexion corridors. METHODS: Our virtual 6- and 10-year-old head and neck multibody models incorporate pediatric biomechanical properties obtained from pediatric cadaveric and radiological studies, include the effect of passive and active musculature, and are validated with data including pediatric volunteer 3 g dynamic frontal impact responses. We simulate ATD pendulum tests-used to calibrate HIII neck bending stiffness-to compare the pediatric model and HIII ATD neck bending stiffness and to compare the model flexion bending responses with the Mertz scaled neck flexion corridors. Additionally, pediatric response corridors for pendulum calibration tests and high-speed (15 g) frontal impacts are estimated through uncertainty analyses on primary model variables, with response corridors calculated from the average ± SD response over 650 simulations. RESULTS AND CONCLUSIONS: The models are less stiff in dynamic anterioposterior bending than the ATDs; the secant stiffness of the 6- and 10-year-old models is 53 and 67 percent less than that of the HIII ATDs. The ATDs exhibit nonlinear stiffening and the models demonstrate nonlinear softening. Consequently, the models do not remain within the Mertz scaled flexion bending corridors. The more compliant model necks suggest an increased potential for head impact via larger head excursions. The pediatric anterioposterior bending corridors developed in this study are extensible to any frontal loading condition through calculation and sensitivity analysis. The corridors presented in this study are the first based on pediatric cadaveric data and provide the basis for future, more biofidelic, designs of 6- and 10-year-old ATD necks.

Importance of muscle activations for biofidelic pediatric neck response in computational models.

OBJECTIVE: During dynamic injury scenarios, such as motor vehicle crashes, neck biomechanics contribute to head excursion and acceleration, influencing head injuries. One important tool in understanding head and neck dynamics is computational modeling. However, realistic and stable muscle activations for major muscles are required to realize meaningful kinematic responses. The objective was to determine cervical muscle activation states for 6-year-old, 10-year-old, and adult 50th percentile male computational head and neck models. Currently, pediatric models including muscle activations are unable to maintain the head in an equilibrium position, forcing models to begin from nonphysiologic conditions. Recent work has realized a stationary initial geometry and cervical muscle activations by first optimizing responses against gravity. Accordingly, our goal was to apply these methods to Duke University's head-neck model validated using living muscle response and pediatric cadaveric data. METHODS: Activation schemes maintaining an upright, stable head for 22 muscle pairs were found using LS-OPT. Two optimization problems were investigated: a relaxed state, which minimized muscle fatigue, and a tensed activation state, which maximized total muscle force. The model's biofidelity was evaluated by the kinematic response to gravitational and frontal impact loading conditions. Model sensitivity and uncertainty analyses were performed to assess important parameters for pediatric muscle response. Sensitivity analysis was conducted using multiple activation time histories. These included constant activations and an optimal muscle activation time history, which varied the activation level of flexor and extensor groups, and activation initiation and termination times. RESULTS: Relaxed muscle activations decreased with increasing age, maintaining upright posture primarily through extensor activation. Tensed musculature maintained upright posture through coactivation of flexors and extensors, producing up to 32 times the force of the relaxed state. Without muscle activation, the models fell into flexion due to gravitational loading. Relaxed musculature produced 28.6-35.8 N of force to the head, whereas tensed musculature produced 450-1023 N. Pediatric model stiffnesses were most sensitive to muscle physiological cross-sectional area. CONCLUSIONS: Though muscular loads were not large enough to cause vertebral compressive failure, they would provide a prestressed state that could protect the vertebrae during tensile loading but might exacerbate risk during compressive loading. For example, in the 10-year-old, a load of 602 N was produced, though estimated compressive failure tolerance is only 2.8 kN. Including muscles and time-variant activation schemes is vital for producing biofidelic models because both vary by age. The pediatric activations developed represent physiologically appropriate sets of initial conditions and are based on validated adult cadaveric data.

Tension and combined tension-extension structural response and tolerance properties of the human male ligamentous cervical spine.

Tensile loading of the human cervical spine results from noncontact inertial loading of the head as well as mandibular and craniofacial impacts. Current vehicle safety standards include a neck injury criterion based on beam theory that uses a linear combination of the normalized upper cervical axial force and sagittal plane moment. This study examines this criterion by imposing combined axial tension and bending to postmortem human subject (PMHS) ligamentous cervical spines. Tests were conducted on 20 unembalmed PMHSs. Nondestructive whole cervical spine tensile tests with varying cranial end condition and anteroposterior loading location were used to generate response corridors for computational model development and validation. The cervical spines were sectioned into three functional spinal segments (Occiput-C2, C4-C5, and C6-C7) for measurement of tensile structural response and failure testing. The upper cervical spine (Occiput-C2) was found to be significantly less stiff, absorb less strain energy, and fail at higher loads than the lower cervical spine (C4-C5 and C6-C7). Increasing the moment arm of the applied tensile load resulted in larger head rotations, larger moments, and significantly higher tensile ultimate strengths in the upper cervical spine. The strength of the upper cervical spine when loaded through the head center of gravity (2417+/-215 N) was greater than when loaded over the occipital condyles (2032+/-250 N), which is not predicted by beam theory. Beam theory predicts that increased tensile loading eccentricity results in decreased axial failure loads. Analyses of the force-deflection histories suggest that ligament loading in the upper cervical spine depends on the amount of head rotation orientation, which may explain why the neck is stronger in combined tension and extension.

Tensile mechanical properties of the perinatal and pediatric PMHS osteoligamentous cervical spine.

Pediatric cervical spine biomechanics have been under-researched due to the limited availability of pediatric post-mortem human subjects (PMHS). Scaled data based on human adult and juvenile animal studies have been utilized to augment the limited pediatric PMHS data that exists. Despite these efforts, a significant void in pediatric cervical spine biomechanics remains. Eighteen PMHS osteoligamentous head-neck complexes ranging in age from 20 weeks gestational to 14 years were tested in tension. The tests were initially conducted on the whole cervical spine and then the spines were sectioned into three segments that included two lower cervical spine segments (C4-C5 and C6-C7) and one upper cervical spine segment (O-C2). After non-destructive tests were conducted, each segment was failed in tension. The tensile stiffness of the whole spines ranged from 5.3 to 70.1 N/mm. The perinatal and neonatal specimens had an ultimate strength for the upper cervical spine of 230.9 +/- 38.0 N and for the lower cervical spine of 212.8 +/- 60.9 and 187.1 +/- 39.4 N for the C4-C5 and C6-C7 segments, respectively. The lower cervical segments were significantly weaker and stiffer than the upper cervical spine segments in the older cohort. For the entire cohort of specimens, the stiffness of the upper cervical spine ranged from 7.1 to 199.0 N/mm. The tolerance ranged from 173.6 to 2960 N for the upper cervical spine and from 142 to 1757 N for the lower. There was a statistically significant increase in stiffness and strength with age. The results also suggest that juvenile animal surrogates estimate the stiffness of the human cervical spine fairly well; however, they may not provide accurate estimates of pediatric cervical spine strength.

Comparative structural neck responses of the THOR-NT, Hybrid III, and human in combined tension-bending and pure bending.

This study evaluated the biofidelity of both the Hybrid III and the THOR-NT anthropomorphic test device (ATD) necks in quasistatic tension-bending and pure-bending by comparing the responses of both the ATDs with results from validated computational models of the living human neck. This model was developed using post-mortem human surrogate (PMHS) osteoligamentous response corridors with effective musculature added (Chancey, 2005). Each ATD was tested using a variety of end-conditions to create the tension-bending loads. The results were compared using absolute difference, RMS difference, and normalized difference metrics. The THOR-NT was tested both with and without muscle cables. The THOR-NT was also tested with and without the central safety cable to test the effect of the cable on the behavior of the ATD. The Hybrid III was stiffer than the model for all tension-bending end conditions. Quantitative measurement of the differences in response showed more close agreement between the THOR-NT and the model than the Hybrid III and the model. By contrast, no systematic differences were observed in the head kinematics. The muscle cables significantly stiffened the THOR-NT by effectively reducing the laxity from the occipital condyle (OC) joint. The cables also shielded the OC upper neck load cell from a significant portion of the applied loads. The center safety significantly stiffened the response and decreased the fidelity, particularly in modes of loading in which tensile forces were large and bending moments small. This study compares ATD responses to computational models in which the models include PMHS response corridors while correcting for problems associated with cadaveric muscle. While controversial and requiring considerable diligence, these kinds of approaches show promise in assessing ATD biofidelity.