Influence of Friction at the Head-Helmet Interface on Advanced Combat Helmet (ACH) Blunt Impact Kinematic Performance.

INTRODUCTION: The purpose of this study was to compare the rotational blunt impact performance of an anthropomorphic test device (ATD: male 50% Hybrid III head and neck) headform donning an Advanced Combat Helmet (ACH) between conditions in which the coefficient of static friction (µs) at the head-to-helmet pad interface varied. MATERIALS AND METHODS: Two ACHs (size large) were used in this study and friction was varied using polytetrafluoroethylene (PTFE), human hair, skullcap, and the native vinyl skin of the ATD. A condition in which hook and loop material adhered the headform to the liner system was also tested, resulting in a total of five conditions: PTFE, Human Hair, Skullcap, Vinyl, and Hook. Blunt impact tests with each helmet in each of the five conditions were conducted on a pneumatic linear impactor at 4.3 m/s. The ATD donning the ACH was impacted in seven locations (Crown, Front, Rear, Left Side, Right Side, Left Nape, and Right Nape). The peak resultant angular acceleration (PAA), velocity (PAV), and the Diffuse Axonal Multi-Axis, General Evaluation (DAMAGE) metric were compared between conditions. RESULTS: No pairwise differences were observed between conditions for PAA. A positive correlation was observed between mean µs and PAA at the Front (τ = 0.28; P = .044) and Rear (τ = 0.31; P = .024) impact locations. The Hook condition had a mean PAV value that was often less than the other conditions (P ≤ .024). A positive correlation was observed between mean µs and PAV at the Front (τ = 0.32; P = .019) and Right Side (τ = 0.57; P < .001) locations. The Hook condition tended to have the lowest DAMAGE value compared to the other conditions (P ≤ .032). A positive correlation was observed between the mean µs and DAMAGE at the Rear (τ = 0.60; P < .001) location. A negative correlation was observed at the Left Side (τ = -0.28; P = .040), Right Side (τ = -0.58; P < .001) and Left Nape (τ = -0.56; P < .001) locations. CONCLUSIONS: The results of this study indicate that at some impact locations kinematic responses can vary as a function of the friction at the head-to-helmet pad interface. However, a reduction in the coupling of the head-helmet pad interface did not consistently reduce head angular kinematics or measures of brain strain across impact locations. Thus, for the ACH during collision-type impacts, impact location as opposed to µs seems to have a greater influence on head kinematics and rotational-based measures of brain strain.

Influence of foam thickness on the control of EMG activity during a step-down task in females.

Compliant foams can be used to mitigate ground reaction forces. However, it is unknown how foam surfaces influence the modulation of leg muscle activity. Thus, the current study aimed to investigate how the neuromuscular system managed changes in expected loading due to various thickness of foam placed on the landing surface during a step down task. The surface electromyographic signal (sEMG) pre-activation duration and the root mean square (RMS) amplitude of tibialis anterior (TA), lateral gastrocnemius (LG), and vastus medialis (VM) of 10 active females were measured as they stepped-down with a single leg onto polyurethane foam slabs of varying thickness (0-50 mm). Pre-activation duration was not affected by the thickness of the foam padding. LG RMS amplitude was less in the foam conditions than the control (no- foam) condition, with the greatest reduction observed for the 50 mm foam condition. In some trials, the muscles remained active throughout the step-down task. In such instances, a sEMG onset time and thus a pre-activation duration could not be determined. All foam conditions significantly increased the odds of continuous muscle activity above that of the no-foam condition. The results indicate that foam surfaces may alter the modulation of muscle activity during step-down tasks.

Describing headform pose and impact location for blunt impact testing.

Reproduction of anthropomorphic test device (ATD) head impact test methods is a critical element needed to develop guidance and technologies that reduce the risk for brain injury in sport. However, there does not appear to be a consensus for reporting ATD pose and impact location for industry and researchers to follow. Thus, the purpose of this article is to explore the various methods used to report impact location and ATD head pose for sport-related head impact testing and provide recommendations for standardizing these descriptions. A database search and exclusion process identified 137 articles that met the review criteria. Only 4 of the 137 articles provided a description similar to the method we propose to describe ATD pose and impact location. We thus propose a method to unambiguously convey the impact location and pose of the ATD based on the sequence, quantifiable design, and articulation of ATD mount joints. This reporting method has been used to a limited extent in the literature, but we assert that adoption of this method will help to standardize the reporting of ATD headform pose and impact location as well as aid in the replication of impact test protocols across laboratories.

National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries.

OBJECTIVE: To provide athletic trainers, health care professionals, and all those responsible for the care of athletes with clinical recommendations for preventing and managing sport-related dental and oral injuries. BACKGROUND: Participation in competitive sports continues to grow at both the interscholastic and intercollegiate levels. Therefore, exposure to, and the incidence of athletic-related injury, including orofacial injury, will also likely increase. At the time of this writing, the leading governing agencies for interscholastic (National Federation of State High School Associations) and intercollegiate (National Collegiate Athletic Association) sports require only protective orofacial equipment (eg, mouthguards) for 5 and 4, respectively, of their sanctioned sports. Although orofacial injuries represent a small percentage of all sport-related injuries, the financial burden associated with these injuries (eg, tooth avulsion) can exceed $15 000 over an adult life. Therefore, effective management of sport-related dental injuries is critical to the long-term financial, physical, and emotional health of people who have experienced dental trauma. RECOMMENDATIONS: Based upon the current evidence regarding sport-related orofacial injury, we provide recommendations related to planning considerations, education, and mouthguard efficacy, material, fabrication, and care considerations. Additionally, suggested best practices for managing sport-related dental injury are also given for athletic trainers and other health care professionals.

Characterizations of a quality certified athletic trainer.

CONTEXT: Didactic proficiency does not ensure clinical aptitude. Quality athletic health care requires clinical knowledge and affective traits. OBJECTIVE: To develop a grounded theory explaining the constructs of a quality certified athletic trainer (AT). DESIGN: Delphi study. SETTING: Interviews in conference rooms or business offices and by telephone. PATIENTS OR OTHER PARTICIPANTS: Thirteen ATs (men = 8, women = 5) stratified across the largest employment settings (high school, college, clinical) in the 4 largest districts of the National Athletic Trainers? Association (2, 3, 4, 9). DATA COLLECTION AND ANALYSIS: Open-ended interview questions were audio recorded, transcribed, and reviewed before condensing. Two member checks ensured trustworthiness. Open coding reduced text to descriptive adjectives. RESULTS: We grouped adjectives into 5 constructs (care, communication, commitment, integrity, knowledge) and grouped these constructs into 2 higher-order constructs (affective traits, effective traits). CONCLUSIONS: According to participants, ATs who demonstrate the ability to care, show commitment and integrity, value professional knowledge, and communicate effectively with others can be identified as quality ATs. These abilities facilitate the creation of positive relationships. These relationships allow the quality AT to interact with patients and other health care professionals on a knowledgeable basis that ultimately improves health care delivery. Our resulting theory supported the examination of characteristics not traditionally assessed in an athletic training education program. If researchers can show that these characteristics develop ATs into quality ATs (eg, those who work better with others, relate meaningfully with patients, and improve the standard of health care), they must be cultivated in the educational setting.

Investigation of baseline self-report concussion symptom scores.

CONTEXT: Self-reported symptoms (SRS) scales comprise one aspect of a multifaceted assessment of sport-related concussion. Obtaining SRS assessments before a concussion occurs assists in determining when the injury is resolved. However, athletes may present with concussion-related symptoms at baseline. Thus, it is important to evaluate such reports to determine if the variables that are common to many athletic environments are influencing them. OBJECTIVE: To evaluate the influence of a history of concussion, sex, acute fatigue, physical illness, and orthopaedic injury on baseline responses to 2 summative symptom scales; to investigate the psychometric properties of all responses; and to assess the factorial validity of responses to both scales in the absence of influential variables. DESIGN: Cross-sectional study. SETTING: Athletic training facilities of 6 National Collegiate Athletic Association institutions. PATIENTS OR OTHER PARTICIPANTS: The sample of 1065 was predominately male (n = 805) collegiate athletes with a mean age of 19.81 +/- 1.53 years. MAIN OUTCOME MEASURE(S): Participants completed baseline measures for duration and severity of concussion-related SRS and a brief health questionnaire. RESULTS: At baseline, respondents reporting a previous concussion had higher composite scores on both scales (P

Characterization of mouthguard materials: thermal properties of commercialized products.

OBJECTIVES: Several mechanisms have been purported to describe how mouthguards protect the orofacial complex against injury. As the properties needed for these mechanisms to be effective are temperature and frequency dependent, the specific aim of this study was to provide a comprehensive thermal characterization of commercial mouthguard materials. METHODS: Five commercially representative thermoplastic mouthguard materials (Essix Resin, Erkoflex, Proform-regular, Proform-laminate, and Polyshok) were tested. Differential scanning calorimetry (DSC) and dynamic mechanical analysis (DMA) techniques were implemented to measure thermal transitions and mechanical properties. Measurements were conducted three times per sample. One-way ANOVA and one-sample t-tests were used to test for differences between commercial products on selected mean thermal property values. RESULTS: The DSC measurements indicated no differences between commercial materials for mean glass transition (p=0.053), onset melt (p=0.973), or peak melt (p=0.436) temperatures. Likewise, DMA measurements revealed no differences between commercial materials for the mean glass transition (p=0.093), storage modulus (p=0.257), or loss modulus (p=0.172) properties, respectively. The one-sample t-tests revealed that glass transition temperatures were different from intra-oral temperature (p<0.005) for all materials. SIGNIFICANCE: Commercialized mouthguard materials are sensitive to repetitive heating and cooling cycles, prolonged thermal treatment, and have glass transitions well below their end-use intra-oral temperature. As such, these materials are functioning as elastomers and not optimal mechanical damping materials. Dental clinicians, healthcare practitioners, or end-users should be aware that these materials are at best problematic with respect to this protective mechanism.

Characterization of mouthguard materials: physical and mechanical properties of commercialized products.

OBJECTIVES: Contemporary mouthguard materials need to perform consistently over a wide range of possible temperatures (-20 to 40 degrees C). Therefore the specific aim of this study was to characterize commercialized mouthguard materials' properties and investigate the effect of temperature on these properties. METHODS: Five commercially representative thermoplastic mouthguard materials (Essix Resin, Erkoflex, Proform-regular, Proform-laminate, and Polyshok) were tested. The durometer hardness, water absorption, tear strength, and impact attenuation of the mouthguard materials were measured according to ASTM D2240-05, D570-98 (2005), D624-00, and ASTM D6110-06f (modified) guidelines. Tests were conducted on five separate specimens at both room 23+/-2 degrees C and intra-oral 37+/-2 degrees C temperatures. Independent t-tests (alpha=0.05) were used to test for differences between room and intra-oral temperatures. RESULTS: Material hardness decreased (p<0.05) from room to intra-oral temperatures for all mouthguard materials. Water absorption increased (p<0.05) from room to intra-oral temperatures for all mouthguard materials. Tear strength decreased (p<0.05) from room to intra-oral temperatures for all mouthguard materials. Impact attenuation between room and intra-oral temperatures was different (p<0.05) for the Erkoflex, Proform-laminate, and Polyshok material respectfully. However, there was no difference between temperatures for the Essix Resin (p=.058) or Proform-regular (p=.275) materials. SIGNIFICANCE: Temperature measureably affects the physical and mechanical properties of mouthguard materials. It is particularly noteworthy that none of the commercialized products met current ANSI and SAI standards for impact attenuation.

Structural validity of a self-report concussion-related symptom scale.

PURPOSE: This study evaluated the factorial validity of a self-report measure of concussion-related symptom severity among a large sample of male, high-school athletes. METHODS: Participants (N = 1089) were nonconcussed, male, high-school football players. All participants completed a single baseline self-report measure of concussion-related symptom severity, namely the graded symptom checklist (GSC). We tested the factorial validity of the measure with confirmatory factor analysis using LISREL 8.50. RESULTS: The analysis indicated that a theoretically derived, three-factor model provided a good, but not excellent, fit for the 16-item GSC. Excellent model-data fit was demonstrated for the three-factor model for a 9-item version of the GSC. In both instances, the three factors were best described by a single second-order factor, namely concussion symptomatology. CONCLUSIONS: This study provides additional evidence for the factorial validity of a summative self-reported measure of concussion-related symptoms. The factor structure represents a cohesive group of nine symptoms that can be explained by three underlying latent variables, namely somatic symptoms, neurobehavioral symptoms, and "cognitive" symptoms, subsumed under a single higher-order factor, namely concussion symptoms.

Evidence for the Factorial and Construct Validity of a Self-Report Concussion Symptoms Scale.

OBJECTIVE: To evaluate the factorial and construct validity of the Head Injury Scale (HIS) among a sample of male and female collegiate athletes. DESIGN AND SETTING: Using a cross-sectional design, we established the factorial validity of the HIS scale with confirmatory factor analysis and the construct validity of the HIS with Pearson product moment correlation analyses. Using an experimental design, we compared scores on the HIS between concussed and nonconcussed groups with a 2 (groups) x 5 (time) mixed-model analysis of variance. SUBJECTS: Participants (N = 279) in the cross-sectional analyses were predominately male (n = 223) collegiate athletes with a mean age of 19.49 +/- 1.63 years. Participants (N = 33) in the experimental analyses were concussed (n = 17) and nonconcussed control (n = 16) collegiate athletes with a mean age of 19.76 +/- 1.49 years. MEASUREMENTS: All participants completed baseline measures for the 16-item HIS, neuropsychological testing battery, and posturography. Concussed individuals and paired controls were evaluated on days 1, 2, 3, and 10 postinjury on the same testing battery. RESULTS: Confirmatory factor analysis indicated that a theoretically derived, 3-factor model provided a good but not excellent fit to the 16-item HIS. Hence, the 16-item HIS was modified on the basis of substantive arguments about item-content validity. The subsequent analysis indicated that the 3-factor model provided an excellent fit to the modified 9-item HIS. The 3 factors were best described by a single second-order factor: concussion symptoms. Scores from the 16-item HIS and 9-item HIS were strongly correlated, but there were few significant correlations between HIS scores and scores from the neuropsychological and balance measures. A significant group-by-day interaction was noted on both the 9-item HIS and 16-item HIS, with significant differences seen between groups on days 1 and 2 postconcussion. CONCLUSIONS: We provide evidence for the factorial and construct validity of the HIS among collegiate athletes. This scale might aid in return-to-play decisions by physicians and athletic trainers.