Browsing by Author "Kuehl, Damon R."
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- Eagle Syndrome: A Rare Case of Atraumatic, Painful Cervical Neck SwellingWorden, Cameron P.; Bhandari, Sanjeeb S.; Cable, Benjamin B.; Kuehl, Damon R. (Western Journal of Emergency Medicine, 2020-04-23)Introduction: Painful neck swelling is a common emergency complaint but can present diagnostic challenges. Eagle syndrome is a rare clinical entity in which a pathologically elongated styloid process or ossified stylohyoid ligament produces a constellation of symptoms in the head and neck region. Case Report: We present the case of a 50-year-old male with a spontaneous, atraumatic fracture of an elongated styloid process associated with hematoma formation and radiological findings of airway impingement. Discussion: The classic triad for Eagle syndrome consists of unilateral cervicofacial pain, globus sensation, and dysphagia. Diagnosis of Eagle syndrome should be made based on a combination of physical examination and radiological findings. Treatment options vary based on severity of symptoms. Conclusion: Although more likely to be an indolent and progressive complaint, providers in the acute care setting should be familiar with Eagle syndrome due to the potential for a spontaneous fracture of an elongated styloid process to cause acute, painful neck swelling and life-threatening airway compromise. [Clin Pract Cases Emerg Med. 2020;4(2):197–200.]
- Establishing Boundary Conditions for Optimized Reconstruction of Head ImpactsStark, Nicole Elizabeth (Virginia Tech, 2024-06-03)Traumatic brain injuries (TBIs) encompass an array of head trauma caused by diverse mechanisms, including falls, vehicular accidents, and sports-related incidents. These injuries vary from concussions to diffuse axonal injuries. TBIs are characterized by the linear and rotational accelerations of the head during an impact, which are influenced by various factors such as the velocity and location of the impact and the contact surface. Consequently, the accuracy of laboratory tests designed to evaluate protective technologies must closely mirror real-world conditions. This dissertation explores the boundary conditions essential for accurately replicating head impacts in laboratory settings. The research aims to improve the reconstruction of head impacts, concentrating on two main areas: 1) examining various aspects of friction during head impacts and 2) biomechanically characterizing the head impacts sustained by older adults during falls. This study provides insights into the overall influence of friction during head impacts. It investigates the friction coefficients between the helmet's shell and the impact surface, as well as between human heads, headforms, and helmets. Additionally, it assesses how these frictional interactions influence oblique impact kinematics. Defining static and dynamic friction coefficients of the human head and headforms is needed to develop more realistic head impact testing methods, define helmet-head boundary conditions for computer-aided simulations, and provide a framework for cross-comparative analysis between studies that use different headforms and headform alterations. This research also introduces and evaluates the accuracy of a model-based image mapping method to measure head impact speeds from single-view videos in un-calibrated environments. This measurement technique advances our comprehension of head impact kinematics derived from uncalibrated video data. By applying this method, videos of falls involving older adults were analyzed to determine head impact speeds and boundary conditions. The resulting data was used to construct headform impacts, capturing linear and rotational head impact kinematics. These reconstructions can inform the development of biomechanical testing protocols tailored to assess protective gear for older adults, with the goal of reducing fall-related head injuries.
- Neuroimaging after mild traumatic brain injury: Review and meta-analysisEierud, Cyrus; Craddock, R. Cameron; Fletcher, Sean; Aulakh, Manek; Casas, Brooks; Kuehl, Damon R.; LaConte, Stephen M. (Elsevier, 2014-01-04)This paper broadly reviews the study of mild traumatic brain injury (mTBI), across the spectrum of neuroimaging modalities. Among the range of imaging methods, however, magnetic resonance imaging (MRI) is unique in its applicability to studying both structure and function. Thus we additionally performed meta-analyses of MRI results to examine 1) the issue of anatomical variability and consistency for functional MRI (fMRI) findings, 2) the analogous issue of anatomical consistency for white-matter findings, and 3) the importance of accounting for the time post injury in diffusion weighted imaging reports. As we discuss, the human neuroimaging literature consists of both small and large studies spanning acute to chronic time points that have examined both structural and functional changes with mTBI, using virtually every available medical imaging modality. Two key commonalities have been used across the majority of imaging studies. The first is the comparison between mTBI and control populations. The second is the attempt to link imaging results with neuropsychological assessments. Our fMRI meta-analysis demonstrates a frontal vulnerability to mTBI, demonstrated by decreased signal in prefrontal cortex compared to controls. This vulnerability is further highlighted by examining the frequency of reported mTBI white matter anisotropy, in which we show a strong anterior-to-posterior gradient (with anterior regions being more frequently reported in mTBI). Our final DTI meta-analysis examines a debated topic arising from inconsistent anisotropy findings across studies. Our results support the hypothesis that acute mTBI is associated with elevated anisotropy values and chronic mTBI complaints are correlated with depressed anisotropy. Thus, this review and set of meta-analyses demonstrate several important points about the ongoing use of neuroimaging to understand the functional and structural changes that occur throughout the time course of mTBI recovery. Based on the complexity of mTBI, however, much more work in this area is required to characterize injury mechanisms and recovery factors and to achieve clinically-relevant capabilities for diagnosis.
- Using a human factors-centric approach to development and testing of a face shield designed for health care workers: A COVID-19 case study for process and outcomesKurtz, Camden E.; Peng, Yuhao; Jesso, Matthew; Sanghavi, Harsh; Kuehl, Damon R.; Parker, Sarah H. (Mosby-Elsevier, 2022-03-01)Background: Face shields are a critical piece of personal protective equipment and their comfort impacts compliant use and thus protectiveness. Optimal design criteria for face shield use in healthcare environments are limited. We attempt to identify factors affecting face shield usability and to test and optimize a face shield for comfort and function in health care settings. Methods: A broad range of workers in a large health care system were surveyed regarding face shield features and usability. Quantitative and qualitative analysis informed the development of iterative prototypes which were tested against existing shields. Iterative testing and redesign utilized expert insight and feedback from participant focus groups to inform subsequent prototype designs. Results: From 1,648 responses, 6 key elements were identified: ability to adjust tension, shifting load bearing from the temples, anti-fogging, ventilation, freedom of movement, and durability. Iterative prototypes received consistently excellent feedback based on use in the clinical environment, demonstrating incremental improvement. Conclusion: We defined elements of face shield design necessary for usability in health care and produced a highly functional face shield that satisfies frontline provider criteria and Emergency Use Authorization standards set by the Food and Drug Administration. Integrating human factors principles into rapid-cycle prototyping for personal protective equipment is feasible and valuable.