Strain Response of an Anatomically Accurate Nonhuman Primate Finite Element Brain Model Under Sagittal Loading.

INTRODUCTION: Prevention and treatment of traumatic brain injuries is critical to preserving soldier brain health. Laboratory studies are commonly used to reproduce injuries, understand injury mechanisms, and develop tolerance limits; however, this approach has limitations for studying brain injury, which requires a physiological response. The nonhuman primate (NHP) has been used as an effective model for investigating brain injury for many years. Prior research using the NHP provides a valuable resource to leverage using modern analysis and modeling techniques to improve our understanding of brain injury. The objectives of the present study are to develop an anatomically accurate finite element model of the NHP and determine regional brain responses using previously collected NHP data. MATERIALS AND METHODS: The finite element model was developed using a neuroimaging-based anatomical atlas of the rhesus macaque that includes both cortical and subcortical structures. Head kinematic data from 10 sagittal NHP experiments, four +Gx (rearward) and six -Gx (frontal), were used to test model stability and obtain brain strain responses from multiple severities and vectors. RESULTS: For +Gx tests, the whole-brain cumulative strain damage measure exceeding a strain threshold of 0.15 (CSDM15) ranged from 0.28 to 0.89, and 95th percentile of the whole-brain maximum principal strain (MPS95) ranged from 0.21 to 0.59. For -Gx tests, whole-brain CSDM15 ranged from 0.02 to 0.66, and whole-brain MPS95 ranged from 0.08 to 0.39. CONCLUSIONS: Recognizing that NHPs are the closest surrogate to humans combined with the limitations of conducting brain injury research in the laboratory, a detailed anatomically accurate finite element model of an NHP was developed and exercised using previously collected data from the Naval Biodynamics Laboratory. The presently developed model can be used to conduct additional analyses to act as pilot data for the design of newer experiments with statistical power because of the sensitivity and resources needed to conduct experiments with NHPs.

Regional Strain Response of an Anatomically Accurate Human Finite Element Head Model Under Frontal Versus Lateral Loading.

INTRODUCTION: Because brain regions are responsible for specific functions, regional damage may cause specific, predictable symptoms. However, the existing brain injury criteria focus on whole brain response. This study developed and validated a detailed human brain computational model with sufficient fidelity to include regional components and demonstrate its feasibility to obtain region-specific brain strains under selected loading. METHODS: Model development used the Simulated Injury Monitor (SIMon) model as a baseline. Each SIMon solid element was split into 8, with each shell element split into 4. Anatomical regions were identified from FreeSurfer fsaverage neuroimaging template. Material properties were obtained from literature. The model was validated against experimental intracranial pressure, brain-skull displacement, and brain strain data. Model simulations used data from laboratory experiments with a rigid arm pendulum striking a helmeted head-neck system. Data from impact tests (6 m/s) at 2 helmet sites (front and left) were used. RESULTS: Model validation showed good agreement with intracranial pressure response, fair to good agreement with brain-skull displacement, and good agreement for brain strain. CORrelation Analysis scores were between 0.72 and 0.93 for both maximum principal strain (MPS) and shear strain. For frontal impacts, regional MPS was between 0.14 and 0.36 (average of left and right hemispheres). For lateral impacts, MPS was between 0.20 and 0.48 (left hemisphere) and between 0.22 and 0.51 (right hemisphere). For frontal impacts, regional cumulative strain damage measure (CSDM20) was between 0.01 and 0.87. For lateral impacts, CSDM20 was between 0.36 and 0.99 (left hemisphere) and between 0.09 and 0.93 (right hemisphere). CONCLUSIONS: Recognizing that neural functions are related to anatomical structures and most model-based injury metrics focus on whole brain response, this study developed an anatomically accurate human brain model to capture regional responses. Model validation was comparable with current models. The model provided sufficient anatomical detail to describe brain regional responses under different impact conditions.

Measurement of Head Kinematics Using Instrumented Mouthguards During Introductory Boxing Courses in U.S. Military Academy Cadets.

INTRODUCTION: Use of wearable impact sensor devices to quantitatively measure head impact exposure remains largely unstudied in military-style martial arts training and combat sports, particularly at the beginner levels. The baseline frequency and severity of head impact exposure during introductory military-style martial arts trainings, such as combatives training, is valuable information for developing future programs of instruction and exposure monitoring programs. The purpose of this study was to describe head impact exposures experienced during introductory combatives training (a boxing course) at U.S. Military Academy. METHODS: This study used instrumented mouthguards to measure head impact exposure in U.S. Military Academy cadets during a compulsory boxing course. Summary exposures from a preliminary dataset are presented. RESULTS: Twenty-two male subjects (19.9 ± 1.1 years, 86.6 ± 11.7 kg) participated in 205 analyzed player-bouts (full contact sparring sessions) with 809 video verified impacts (average 3.9 impacts per player-bout). The mean peak linear acceleration was 16.5 ±7.1 G, with a maximum of 70.8 G. There was a right-skewed distribution, with 640/809 (79.1%) events falling between 10 and 20 G. The mean peak angular acceleration was 1.52 ± 0.96 krad/s2, with a maximum of 8.85 krad/s2. CONCLUSIONS: Compared to other high-risk sports at Service Academies, head impacts from beginner boxing were of similar magnitude to those reported for Service Academy football and slightly lower than those reported for Service Academy rugby. Based on these preliminary data, the risk profile for introductory military-style martial arts training, such as boxing or combatives, may be similar to other contact sports like football and rugby, but further research is required to confirm these findings and understand the effects of the exposures in a shorter duration.

Head Impacts in the Top 1% by Peak Linear Acceleration and/or Work Cause Immediate Concussion Signs and 'Check Engine' Responses in Military Service Members and Civilian Athletes.

PURPOSE: Historically, head impact monitoring sensors have suffered from single impact measurement errors, leading to their data described by clinical experts as 'clinically irrelevant.' The purpose of this study was to use an accurate impact monitoring mouthguard system and (1) define head impact distributions for military service members and civilians and (2) determine if there was a dose-response relationship between accurately measured head impact magnitudes versus observations of concussion signs. METHODS: A laboratory-calibrated commercial impact monitoring mouthguard system, along with video and hardware to confirm the sensor was on the teeth during impacts, was used to acquire 54,602 head acceleration events (HAE) in 973 military and civilian subjects over 3,449 subject days. RESULTS: There were 17,551 head impacts (32% of HAE) measured with peak linear acceleration (PLA) > 10 g and 37,051 low-g events (68% of HAE) in the range of activities of daily living < 10 g PLA. The median of all HAE and of all head impacts was 8 g/15 g PLA and 1 J/4 J Work, respectively. The top 1% of head impacts were above 47 g and 32 J, respectively. There were fifty-six (56) head impacts where at least one clinical indicator of a concussion sign was observed. All the clinical indicator impacts were in the top 1% by magnitude of PLA, Work, or both. The median magnitude of these 'check engine' impacts was 58 g and 48 J. This median magnitude was substantially larger than the median of all HAE as well as the median of all head impacts. CONCLUSION: This study shows a correlation between single head impacts in the top 1% by peak linear acceleration and/or Work and clinical indicators of concussion signs in civilians and military service members.

Regional brain strain dependance on direction of head rotation.

Brain injuries in automated vehicles during crash events are likely to include mechanisms of head impact in non-standard positions and postures (i.e., occupants not facing forward in an upright position). Federal regulations currently focus on impact conditions in primary planes of motion, such as frontal or rear impacts (sagittal plane of motion) or side impact (coronal plane of motion) and do not account for out of position occupants or non-standard postures. The objective of the present study was to develop and use the anatomically accurate brain finite element model to parametrically determine the injury metrics under different vectors with head rotation. A custom developed brain finite element model with anatomical accuracy and several anatomical regions defined was used to evaluate whole-brain strain as well as regional brain strain. Cumulative Strain Damage Measure (CSDM) at a threshold of 20% strain and the 95th percentile of the maximum principal strain (MPS95) were calculated for the whole brain and each brain region under multiple rotational directions. The model was exposed to a sinusoidal angular acceleration pulse of 5000 rad per second squared (rad/s2-) over 12.5 ms. The same pulse was used in the primary axes of motion and (lateral bending, flexion, extension, axial rotation) and combined axes representing oblique flexion and oblique extension. Whole brain CSDM20 was highest for lateral bending. Whole brain MPS95 was highest for axial rotation. The rCSDM20 was more susceptible to impact direction, with several brain regions having substantial accumulation of strain for oblique flexion and lateral bending. Comparatively, rMPS95 was more consistent across all rotation directions. The present study quantified the regional brain strain response under multiple rotational vectors identifying a high amount of variability in the accumulation of strain (i.e., CSDM20) in the hypothalamus, hippocampus, and midbrain specifically. While there was a high amount of variability in the accumulation of strain for multiple regions, the maximum strain measured (i.e., MPS95) in the regions was more consistent.

Fracture Injury Risk of the Restrained Mandible to Anterior-Posterior Blunt Impacts.

This study describes the results of anterior-posterior impacts conducted on the mandibles of 22 male postmortem human subjects (PMHSs). The objective of this study was to develop an injury criterion for the mandible based on blunt impact while the jaw was restrained. Previous studies have attempted to characterize the injury risk of blunt impact to the mandible; however, due to the translation of the mandible during impact and a limited number of fractured specimens, previous studies were not able to produce an injury criterion. Blunt impact to a restrained mandible is relevant to a wide array of helmeted individuals, including the military population and sports that require helmets with chinstraps. Therefore, in this study, specimens were positioned with restrained jaws and impacted using a monorail drop tower with a gravity-driven cylindrical impactor. Nineteen of 22 specimens sustained at least one fracture during testing. Injury cases had an average impact energy of 15.0 ± 5.7 J (11.1 ± 4.2 ft-lb) and a fracture force of 2684 ± 726 N (603 ± 163 lbf). Results were used to generate an impactor force based injury criterion through survival analysis. Risk of injury was modeled using a Weibull distribution and a 50% risk of injury was found to occur at approximately 2834 N (637 lbf). The developed injury risk curve can be used to characterize injury to the restrained mandible for future testing and research studies, especially in the development of maxillofacial protective equipment.

Pelvic Injury Risk Curves for the Military Populations From Lateral Impact.

INTRODUCTION: Current methods for transporting military troops include nonstandard seating orientations, which may result in novel injuries because of different types/directions of loading impact. The objective of this study is to develop pelvic injury risk curves (IRCs) under lateral impacts from human cadaver tests using survival analysis for application to military populations. METHODS: Published data from lateral impacts applied to whole-body cadaver specimens were analyzed. Forces were treated as response variables. Demographics and body mass index (BMI) were covariates. Injury risk curves were developed for forces without covariates, for males, females, 83 kg body mass, and 25 kg/m2 BMI. Mean and ± 95% confidence interval IRCs, normalized confidence interval sizes at discrete risk levels, and quality indices were obtained for each metric-covariate combination curve. RESULTS: Mean age, stature, total body mass, and BMI were 70.1 ± 8.6 years, 1.67 ± 0.1 m, 67.0 ± 14.4 kg, and 23.9 ± 3.97 kg/m2, respectively. For a total body mass of 83 kg, peak forces at 10%, 25%, and 50% probability levels were 5.7 kN, 7.4 kN, and 9.6 kN, respectively. For males, peak forces at the 10%, 25%, and 50% probability levels were 4.8 kN, 6.4 kN, and 8.4 kN, respectively. For females, peak forces at the 10%, 25%, and 50% probability levels were 3.0 kN, 4.0 kN, and 5.2 kN, respectively. Other data and risk curves are given. CONCLUSIONS: The IRCs developed in this study can be used as injury criteria for the crashworthiness of future generation military vehicles. The introduction of BMI, sex, and total body mass as covariates quantified their contributions. These IRCs can be used with finite element models to assess and predict injury in impact environments to advance Soldier safety. Manikins specific to relevant military anthropometry may be designed and/or evaluated with the present IRCs to assess and mitigate musculoskeletal injuries associated with this posture and impact direction.

Evaluation of Head and Body Kinematics Experienced During Parachute Opening Shock.

INTRODUCTION: The U.S. Army conducts airborne operations in order to insert soldiers into combat. Military airborne operations are physically demanding activities with a unique loading environment compared with normal duties. A significant amount of research surrounding airborne operations has focused on assessing the incidence and type of associated injuries as well as the potential risk factors for injuries. During parachute opening shock and other high-acceleration events (e.g., fixed wing flight or vehicle crashes), the neck may be vulnerable to injury if inertial loads overcome the voluntary muscular control of the cervical spine and soft tissue structures. A recent epidemiological survey of sport skydivers showed that the neck, shoulders, and back were the most frequently reported sites of musculoskeletal pain. In addition, the survey indicated that wing loading (a measure of the jumper's weight divided by the size of the parachute canopy) was a potential contributing factor for developing musculoskeletal pain. Recently, there have been efforts to measure the severity of parachute opening shock as an additional potential risk factor for injury; however, no studies have measured both head and body accelerations and no studies have measured head or body angular rate during parachute opening shock. The purpose of this study was to measure and characterize the accelerations and angular rates of both the head and body during parachute opening shock as well as investigate potential factors contributing to higher severity opening shock, which may link to the development of musculoskeletal pain or injury. MATERIALS AND METHODS: Data were collected from the U.S. Army Parachute Team, The Golden Knights, under an approved Medical Research and Material Command Institutional Review Board protocol. Subjects were instrumented with a helmet- and body-mounted sensor package, which included three angular rate sensors and three single-axis accelerometers each. Data were collected at 2,500 samples per second. Kruskal-Wallis tests were used to determine if helmet-mounted equipment (e.g., cameras), neck length, neck circumference, or wing loading (the ratio of jump weight to the size of the main parachute canopy) affected the accelerations or angular rates of the head or body. RESULTS: A total of 54 jumps conducted by 19 experienced free-fall jumpers were analyzed. For the head, the mean (± SD) resultant accelerations and angular rates were 5.8 (± 1.6) g and 255.9 (± 74.2) degrees per second (deg/s), respectively. For the body, the resultant accelerations and angular rates were 4.3 (± 1.5) g and 181.3 (± 61.2) deg/s, respectively. A wing loading above 1.4 pounds per square foot (lb/ft2) was found to have a significant effect on head (P = .001) and body (P = .001) resultant acceleration as well as body angular rate about the Y-axis (P = .001). CONCLUSIONS: There is evidence to suggest that wing loading has an influence on individual head and body resultant accelerations. However, no significant effects were found for the other variables (e.g., neck length and circumference, helmet-mounted equipment, etc.). Future research should focus on identifying additional factors that result in changes in accelerations and angular rates of the head and body during parachute opening shock events.

Development of an injury risk curve for pelvic fracture in vertical loading environments.

OBJECTIVE: Pelvis injury mechanisms are dependent upon loading direction (frontal, lateral, and vertical). Studies exist on the frontal and lateral modes; however, similar studies in the vertical mode are relatively sparse. Injury risk curves and response corridors are needed to delineate the biomechanical responses. The objective of the study was to derive risk curves for pelvis injuries using postmortem human subjects (PMHSs). METHODS: Published data from whole-body PMHSs loaded axially through the pelvis were analyzed. Accelerometers were placed on the pelvis/sacrum and seat. Specimens were loaded along the inferior to superior direction using a horizontal sled or a vertical accelerator device. Specimens were positioned supine in the horizontal sled and seated upright on the vertical accelerator. Pre- and posttest images were obtained and autopsies were completed to document the pathology. Variables used in the development of risk curves included velocity, acceleration, time to peak acceleration, pulse duration of acceleration, and jerk for the seat and sacrum. Survival analysis was used for risk curves. To determine the best predictor of pelvis injury, the Brier Score metric (BSM) was used. The best parametric distribution was determined using the corrected Akaike information criterion (AICc). Injury data points were treated as either uncensored or left/interval censored. Noninjury data points were treated as right censored. RESULTS: Twenty-four PMHS specimens were identified from 3 published data sets. Fifteen PMHS specimens sustained injuries and 9 remained intact. The BSM ranged from 1.24 to 24.75 and, in general, the BSMs for the seat metric-related scores were greater than the sacrum data. The sacrum acceleration was the optimal metric for predicting pelvis tolerance (lowest BSM). The Weibull distribution had the lowest AICc, with right and left/interval-censored data. This was also true when injury data were treated as exact (uncensored) observations. The 50% probability of injury was associated with 229 G for the uncensored analysis and 139 G for the censored analysis, and the quality indices in both cases were in the "good" range. CONCLUSIONS: Statistical determination of the best injury metric will help improve the accuracy of injury prediction, prioritize instrumentation choice in dummy development, and improve design criteria for crash mitigation. The present study showed that injury risk curves using response data are better biomechanical descriptors of human responses than exposure data. These data are important in automotive safety because complex loading of the pelvis, including submarining, occurs in frontal car crashes.