Browsing by Author "Rowson, Steven"
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- Accounting for Variance in Concussion Tolerance Between Individuals: Comparing Head Accelerations Between Concussed and Physically Matched Control SubjectsRowson, Steven; Campolettano, Eamon T.; Duma, Stefan M.; Stemper, Brian D.; Shah, Alok S.; Harezlak, Jaroslaw; Riggen, Larry D.; Mihalik, Jason P.; Guskiewicz, Kevin M.; Giza, Christopher C.; Brooks, M. Alison; Cameron, Kenneth L.; McAllister, Thomas W.; Broglio, Steven P.; McCrea, Michael A. (Springer, 2019-10-01)Researchers have been collecting head impact data from instrumented football players to characterize the biomechanics of concussion for the past 15 years, yet the link between biomechanical input and clinical outcome is still not well understood. We have previously shown that even though concussive biomechanics might be unremarkable in large datasets of head impacts, the impacts causing injury are of high magnitude for the concussed individuals relative to their impact history. This finding suggests a need to account for differences in tolerance at the individual level. In this study, we identified control subjects for our concussed subjects who demonstrated traits we believed were correlated to factors thought to affect injury tolerance, including height, mass, age, race, and concussion history. A total of 502 college football players were instrumented with helmet-mounted accelerometer arrays and provided complete baseline assessment data, 44 of which sustained a total of 49 concussion. Biomechanical measures quantifying impact frequency and acceleration magnitude were compared between groups. On average, we found that concussed subjects experienced 93.8 more head impacts (p = 0.0031), 10.2 more high magnitude impacts (p = 0.0157), and 1.9 × greater risk-weighted exposure (p = 0.0175) than their physically matched controls. This finding provides further evidence that head impact data need to be considered at the individual level and that cohort wide assessments may be of little value in the context of concussion.
- Assessing the Efficacy of Bicycle Helmets in Reducing Risk of Head InjuryBland, Megan Lindsay (Virginia Tech, 2019-05-09)Although cycling offers many health and environmental benefits, it is not an activity free of injury risk. Increases in cycling popularity in the United States over the past 15 years have been paralleled by a 120% growth in cycling-related hospital admissions, with injuries to the head among the most common and debilitating injuries. Bicycle helmets can reduce head injury risk and are presently required to meet safety standard certification criteria specifying a minimal level of acceptable impact protection. However, the conditions surrounding cyclist head impacts are thought to be much more complex than the test conditions prescribed in standards and have important implications related to mechanisms of injury. The overarching aim of this dissertation was thus to investigate the protective capabilities of bicycle helmets in the context of real-world impact conditions and relevant head injury mechanisms. This aim was achieved through a series of studies, the objectives of which were to: compare helmet impact performance across standards impact testing and more realistic, oblique impact testing; to probe how changing boundary conditions of oblique impact testing may influence helmet test outcomes; to use this knowledge to inform the development of an objective helmet evaluation protocol reflective of realistic impact conditions and related head injury risks; and finally, to enhance the body of knowledge pertaining to cyclist head impact conditions via advanced helmet damage reconstruction techniques. The compilation of results across these studies serves to enhance cyclist safety by stimulating improved helmet evaluation and design while simultaneously providing objective, biomechanical data to consumers, enabling them to make safety-based purchasing decisions.
- Assessment of Blood Biomarker Profile After Acute Concussion During Combative Training Among US Military Cadets: A Prospective Study From the NCAA and US Department of Defense CARE ConsortiumGiza, Christopher C.; McCrea, Michael A.; Huber, Daniel L.; Cameron, Kenneth L.; Houston, Megan N.; Jackson, Jonathan C.; McGinty, Gerald T.; Pasquina, Paul; Broglio, Steven P.; Brooks, M. Alison; DiFiori, John P.; Duma, Stefan M.; Harezlak, Jaroslaw; Goldman, Joshua T.; Guskiewicz, Kevin M.; McAllister, Thomas W.; McArthur, David; Meier, Timothy B.; Mihalik, Jason P.; Nelson, Lindsay D.; Rowson, Steven; Gill, Jessica M. (2021-02-22)Importance Validation of protein biomarkers for concussion diagnosis and management in military combative training is important, as these injuries occur outside of traditional health care settings and are generally difficult to diagnose. Objective To investigate acute blood protein levels in military cadets after combative training-associated concussions. Design, Setting, and Participants This multicenter prospective case-control study was part of a larger cohort study conducted by the National Collegiate Athletic Association and the US Department of Defense Concussion Assessment Research and Education (CARE) Consortium from February 20, 2015, to May 31, 2018. The study was performed among cadets from 2 CARE Consortium Advanced Research Core sites: the US Military Academy at West Point and the US Air Force Academy. Cadets who incurred concussions during combative training (concussion group) were compared with cadets who participated in the same combative training exercises but did not incur concussions (contact-control group). Clinical measures and blood sample collection occurred at baseline, the acute postinjury point (<6 hours), the 24- to 48-hour postinjury point, the asymptomatic postinjury point (defined as the point at which the cadet reported being asymptomatic and began the return-to-activity protocol), and 7 days after return to activity. Biomarker levels and estimated mean differences in biomarker levels were natural log (ln) transformed to decrease the skewness of their distributions. Data were collected from August 1, 2016, to May 31, 2018, and analyses were conducted from March 1, 2019, to January 14, 2020. Exposure Concussion incurred during combative training. Main Outcomes and Measures Proteins examined included glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, neurofilament light chain, and tau. Quantification was conducted using a multiplex assay (Simoa; Quanterix Corp). Clinical measures included the Sport Concussion Assessment Tool-Third Edition symptom severity evaluation, the Standardized Assessment of Concussion, the Balance Error Scoring System, and the 18-item Brief Symptom Inventory. Results Among 103 military service academy cadets, 67 cadets incurred concussions during combative training, and 36 matched cadets who engaged in the same training exercises did not incur concussions. The mean (SD) age of cadets in the concussion group was 18.6 (1.3) years, and 40 cadets (59.7%) were male. The mean (SD) age of matched cadets in the contact-control group was 19.5 (1.3) years, and 25 cadets (69.4%) were male. Compared with cadets in the contact-control group, those in the concussion group had significant increases in glial fibrillary acidic protein (mean difference in ln values, 0.34; 95% CI, 0.18-0.50; P < .001) and ubiquitin C-terminal hydrolase-L1 (mean difference in ln values, 0.97; 95% CI, 0.44-1.50; P < .001) levels at the acute postinjury point. The glial fibrillary acidic protein level remained high in the concussion group compared with the contact-control group at the 24- to 48-hour postinjury point (mean difference in ln values, 0.22; 95% CI, 0.06-0.38; P = .007) and the asymptomatic postinjury point (mean difference in ln values, 0.21; 95% CI, 0.05-0.36; P = .01). The area under the curve for all biomarkers combined, which was used to differentiate cadets in the concussion and contact-control groups, was 0.80 (95% CI, 0.68-0.93; P < .001) at the acute postinjury point. Conclusions and Relevance This study's findings indicate that blood biomarkers have potential for use as research tools to better understand the pathobiological changes associated with concussion and to assist with injury identification and recovery from combative training-associated concussions among military service academy cadets. These results extend the previous findings of studies of collegiate athletes with sport-associated concussions.
- Association between Preseason/Regular Season Head Impact Exposure and Concussion Incidence in NCAA FootballStemper, Brian D.; Harezlak, Jaroslaw; Shah, Alok S.; Rowson, Steven; Mihalik, Jason P.; Riggen, Larry; Duma, Stefan; Pasquina, Paul; Broglio, Steven P.; McAllister, Thomas W.; McCrea, Michael A. (Lippincott Williams & Wilkins, 2022-06)Purpose: Contact sport athletes are exposed to a unique environment where they sustain repeated head impacts throughout the season and can sustain hundreds of head impacts over a few months. Accordingly, recent studies outlined the role that head impact exposure (HIE) has in concussion biomechanics and in the development of cognitive and brain-based changes. Those studies focused on time-bound effects by quantifying exposure leading up to the concussion, or cognitive changes after a season in which athletes had high HIE. However, HIE may have a more prolonged effect. This study identified associations between HIE and concussion incidence during different periods of the college football fall season. Methods: This study included 1120 athlete seasons from six National Collegiate Athletic Association Division I football programs across 5 yr. Athletes were instrumented with the Head Impact Telemetry System to record daily HIE. The analysis quantified associations of preseason/regular season/total season concussion incidence with HIE during those periods. Results: Strong associations were identified between HIE and concussion incidence during different periods of the season. Preseason HIE was associated with preseason and total season concussion incidence, and total season HIE was associated with total season concussion incidence. Conclusions: These findings demonstrate a prolonged effect of HIE on concussion risk, wherein elevated preseason HIE was associated with higher concussion risk both during the preseason and throughout the entire fall season. This investigation is the first to provide evidence supporting the hypothesis of a relationship between elevated HIE during the college football preseason and a sustained decreased tolerance for concussion throughout that season.
- Association of Blood Biomarkers With Acute Sport-Related Concussion in Collegiate Athletes: Findings From the NCAA and Department of Defense CARE ConsortiumMcCrea, Michael A.; Broglio, Steven P.; McAllister, Thomas W.; Gill, Jessica M.; Giza, Christopher C.; Huber, Daniel L.; Harezlak, Jaroslaw; Cameron, Kenneth L.; Houston, Megan N.; McGinty, Gerald T.; Jackson, Jonathan C.; Guskiewicz, Kevin M.; Mihalik, Jason P.; Brooks, M. Alison; Duma, Stefan M.; Rowson, Steven; Nelson, Lindsay D.; Pasquina, Paul; Meier, Timothy B.; Foroud, Tatiana; Katz, Barry P.; Saykin, Andrew J.; Campbell, Darren E.; Svoboda, Steven J.; Goldman, Joshua T.; DiFiori, John P. (2020-01-24)Question Is sport-related concussion associated with levels of traumatic brain injury biomarkers in collegiate athletes? Findings In this case-control study of 504 collegiate athletes with concussion, contact sport control athletes, and non-contact sport athletes, the athletes with concussion had significant elevations in multiple traumatic brain injury biomarkers compared with preseason baseline and with 2 groups of control athletes without concussion during the acute postinjury period. Meaning These results suggest that blood biomarkers can be used as research tools to inform the underlying pathophysiological mechanism of concussion and provide additional support for future studies to optimize and validate biomarkers for potential clinical use in sport-related concussion. This case-control study examines the association between sport-related concussion and levels of traumatic brain injury biomarkers in collegiate athletes. Importance There is potential scientific and clinical value in validation of objective biomarkers for sport-related concussion (SRC). Objective To investigate the association of acute-phase blood biomarker levels with SRC in collegiate athletes. Design, Setting, and Participants This multicenter, prospective, case-control study was conducted by the National Collegiate Athletic Association (NCAA) and the US Department of Defense Concussion Assessment, Research, and Education (CARE) Consortium from February 20, 2015, to May 31, 2018, at 6 CARE Advanced Research Core sites. A total of 504 collegiate athletes with concussion, contact sport control athletes, and non-contact sport control athletes completed clinical testing and blood collection at preseason baseline, the acute postinjury period, 24 to 48 hours after injury, the point of reporting being asymptomatic, and 7 days after return to play. Data analysis was conducted from March 1 to November 30, 2019. Main Outcomes and Measures Glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neurofilament light chain, and tau were quantified using the Quanterix Simoa multiplex assay. Clinical outcome measures included the Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom evaluation, Standardized Assessment of Concussion, Balance Error Scoring System, and Brief Symptom Inventory 18. Results A total of 264 athletes with concussion (mean [SD] age, 19.08 [1.24] years; 211 [79.9%] male), 138 contact sport controls (mean [SD] age, 19.03 [1.27] years; 107 [77.5%] male), and 102 non-contact sport controls (mean [SD] age, 19.39 [1.25] years; 82 [80.4%] male) were included in the study. Athletes with concussion had significant elevation in GFAP (mean difference, 0.430 pg/mL; 95% CI, 0.339-0.521 pg/mL; P < .001), UCH-L1 (mean difference, 0.449 pg/mL; 95% CI, 0.167-0.732 pg/mL; P < .001), and tau levels (mean difference, 0.221 pg/mL; 95% CI, 0.046-0.396 pg/mL; P = .004) at the acute postinjury time point compared with preseason baseline. Longitudinally, a significant interaction (group x visit) was found for GFAP (F-7,F-1507.36 = 16.18, P < .001), UCH-L1 (F-7,F-1153.09 = 5.71, P < .001), and tau (F-7,F-1480.55 = 6.81, P < .001); the interaction for neurofilament light chain was not significant (F-7,F-1506.90 = 1.33, P = .23). The area under the curve for the combination of GFAP and UCH-L1 in differentiating athletes with concussion from contact sport controls at the acute postinjury period was 0.71 (95% CI, 0.64-0.78; P < .001); the acute postinjury area under the curve for all 4 biomarkers combined was 0.72 (95% CI, 0.65-0.79; P < .001). Beyond SCAT-3 symptom score, GFAP at the acute postinjury time point was associated with the classification of athletes with concussion from contact controls (beta = 12.298; 95% CI, 2.776-54.481; P = .001) and non-contact sport controls (beta = 5.438; 95% CI, 1.676-17.645; P = .005). Athletes with concussion with loss of consciousness or posttraumatic amnesia had significantly higher levels of GFAP than athletes with concussion with neither loss of consciousness nor posttraumatic amnesia at the acute postinjury time point (mean difference, 0.583 pg/mL; 95% CI, 0.369-0.797 pg/mL; P < .001). Conclusions and Relevance The results suggest that blood biomarkers can be used as research tools to inform the underlying pathophysiological mechanism of concussion and provide additional support for future studies to optimize and validate biomarkers for potential clinical use in SRC.
- Bicycle Helmet STAR ProtocolBland, Megan L.; McNally, Craig; Rowson, Steven (Virginia Tech, 2018-06-25)This document details the protocol used to rate adult bicycle helmets based on concussion risk according to the Virginia Tech Helmet Ratings.
- Biomechanical Response of Human Volunteers and Surrogates in a Variety of Loading RegimesBeeman, Stephanie Marie (Virginia Tech, 2016-01-08)Unintentional injuries present a major threat to the health and welfare of humans. Over 120,000 deaths and over 30,000,000 non-fatal injuries are estimated annually in the United States. The leading causes of nonfatal injuries vary with age, but falls, motor vehicle collisions (occupants), and being struck by or against are among the top 4 leading causes of unintentional injury for all ages. The loading mechanism that cause forces to be transmitted to the body during these events can cause a wide assortment of injury types with a range of severities. Understanding the biomechanical response to loading in these environments can facilitate efforts in injury mitigation. Biomechanical responses can be quantified by performing controlled laboratory experiments with human volunteers and surrogates, such as anthropomorphic test devices (ATDs) and post mortem human surrogates (PMHSs). The overall objective of this dissertation is to quantify the biomechanical response to loading regimes present in motor vehicle collisions, falls, and when being struck by or against an object using human volunteers and surrogates. Specifically, the research will achieve the following: quantify the dynamic responses of human volunteers, Hybrid III ATD, and PMHSs in low-speed frontal sled tests; quantify the neck response of human volunteers and PMHSs in low-speed frontal sled tests; quantify the kinetic and kinematic responses of PMHSs and the Hybrid III ATD in high-speed frontal sled tests; characterize thoracic loading as a result of same level falls using a Hybrid III ATD; and quantify the ability of children to swing sword-like toys and the human kinematic response that could be anticipated as a result of forceful impact using a Hybrid III 6-year old head and neck.
- Biomechanics of Head Impacts in SoccerPress, Jaclyn Nicole (Virginia Tech, 2016-09-22)An estimated 3.8 million sports-related concussions occur every year. Little research has been collected on soccer players, despite women's soccer having the third highest rate of concussion among all popular collegiate sports. The objective of this work was to evaluate multiple interventions that have been introduced to address the high rate of concussions in this population. Wearable head impact sensors were evaluated on their ability to accurately count and measure head impacts during a collegiate women's soccer season. Head impact exposure was quantified using video analysis of this season as well. Sensors were unable to accurately count impacts and reported nonsensical head acceleration measurements, indicating that data reported from head impact sensors should be interpreted with caution. The ability of soccer headgear to reduce linear and rotational head accelerations during common soccer impacts was examined in the laboratory. Ball-to-head and head-to-head impacts were performed at a range of speeds and impact orientations. Headgear resulted in small reductions during ball-to-head tests, which are not likely to be clinically relevant. In head-to-head tests, use of headgear on the struck head provided an overall 35% reduction in linear head acceleration, and a 53% reduction when another headgear was added to the striking head. The ten headgear tested varied greatly in performance. These data suggest that the use of protective headgear could reduce concussion incidence significantly in this population. Research presented in this thesis will inform soccer organizations on best practices for player safety with regard to head impacts.
- Brain Injury Prediction: Assessing the Combined Probability of Concussion Using Linear and Rotational Head AccelerationRowson, Steven; Duma, Stefan M. (BMES, 2013-05)Recent research has suggested possible long term effects due to repetitive concussions, highlighting the importance of developing methods to accurately quantify concussion risk. This study introduces a new injury metric, the combined probability of concussion, which computes the overall risk of concussion based on the peak linear and rotational accelerations experienced by the head during impact. The combined probability of concussion is unique in that it determines the likelihood of sustaining a concussion for a given impact, regardless of whether the injury would be reported or not. The risk curve was derived from data collected from instrumented football players (63,011 impacts including 37 concussions), which was adjusted to account for the underreporting of concussion. The predictive capability of this new metric is compared to that of single biomechanical parameters. The capabilities of these parameters to accurately predict concussion incidence were evaluated using two separate datasets: the Head Impact Telemetry System (HITS) data and National Football League (NFL) data collected from impact reconstructions using dummies (58 impacts including 25 concussions). Receiver operating characteristic curves were generated, and all parameters were significantly better at predicting injury than random guessing. The combined probability of concussion had the greatest area under the curve for all datasets. In the HITS dataset, the combined probability of concussion and linear acceleration were significantly better predictors of concussion than rotational acceleration alone, but not different from each other. In the NFL dataset, there were no significant differences between parameters. The combined probability of concussion is a valuable method to assess concussion risk in a laboratory setting for evaluating product safety.
- Comparison of Head Impact Exposure Between Concussed Football Athletes and Matched Controls: Evidence for a Possible Second Mechanism of Sport-Related ConcussionStemper, Brian D.; Shah, Alok S.; Harezlak, Jaroslaw; Rowson, Steven; Mihalik, Jason P.; Duma, Stefan M.; Riggen, Larry D.; Brooks, M. Alison; Cameron, Kenneth L.; Campbell, Darren E.; DiFiori, John P.; Giza, Christopher C.; Guskiewicz, Kevin M.; Jackson, Jonathan C.; McGinty, Gerald T.; Svoboda, Steven J.; McAllister, Thomas W.; Broglio, Steven P.; McCrea, Michael A.; Hoy, April Marie Reed; Hazzard, Joseph B.; Kelly, Louise A.; Ortega, Justus D.; Port, Nicholas; Putukian, Margot; Langford, T. Dianne; Tierney, Ryan; Goldman, Joshua T.; Benjamin, Holly J.; Buckley, Thomas; Kaminski, Thomas W.; Clugston, James R.; Schmidt, Julianne D.; Feigenbaum, Luis A.; Eckner, James T.; Guskiewicz, Kevin M.; Miles, Jessica Dysart; Anderson, Scott; Master, Christina L.; Collins, Micky; Kontos, Anthony P.; Bazarian, Jeffrey J.; Chrisman, Sara P. O.; McGinty, Gerald T.; O'Donnell, Patrick; Cameron, Kenneth L.; Susmarski, Adam; Bullers, Christopher Todd; Miles, Christopher M.; Dykhuizen, Brian H.; Lintner, Laura (Springer, 2019-10-01)Studies of football athletes have implicated repetitive head impact exposure in the onset of cognitive and brain structural changes, even in the absence of diagnosed concussion. Those studies imply accumulating damage from successive head impacts reduces tolerance and increases risk for concussion. Support for this premise is that biomechanics of head impacts resulting in concussion are often not remarkable when compared to impacts sustained by athletes without diagnosed concussion. Accordingly, this analysis quantified repetitive head impact exposure in a cohort of 50 concussed NCAA Division I FBS college football athletes compared to controls that were matched for team and position group. The analysis quantified the number of head impacts and risk weighted exposure both on the day of injury and for the season to the date of injury. 43% of concussed athletes had the most severe head impact exposure on the day of injury compared to their matched control group and 46% of concussed athletes had the most severe head impact exposure for the season to the date of injury compared to their matched control group. When accounting for date of injury or season to date of injury, 72% of all concussed athletes had the most or second most severe head impact exposure compared to their matched control group. These trends associating cumulative head impact exposure with concussion onset were stronger for athletes that participated in a greater number of contact activities. For example, 77% of athletes that participated in ten or more days of contact activities had greater head impact exposure than their matched control group. This unique analysis provided further evidence for the role of repetitive head impact exposure as a predisposing factor for the onset of concussion. The clinical implication of these findings supports contemporary trends of limiting head impact exposure for college football athletes during practice activities in an effort to also reduce risk of concussive injury.
- Consensus Head Acceleration Measurement Practices (CHAMP): Study Design and Statistical AnalysisRowson, Steven; Mihalik, Jason; Urban, Jillian; Schmidt, Julianne; Marshall, Steve; Harezlak, Jaroslaw; Stemper, Brian D.; McCrea, Mike; Funk, Jim (Springer, 2022-11)Head impact measurement devices enable opportunities to collect impact data directly from humans to study topics like concussion biomechanics, head impact exposure and its effects, and concussion risk reduction techniques in sports when paired with other relevant data. With recent advances in head impact measurement devices and cost-effective price points, more and more investigators are using them to study brain health questions. However, as the field's literature grows, the variance in study quality is apparent. This brief paper aims to provide a high-level set of key considerations for the design and analysis of head impact measurement studies that can help avoid flaws introduced by sampling biases, false data, missing data, and confounding factors. We discuss key points through four overarching themes: study design, operational management, data quality, and data analysis.
- Cumulative Effects of Prior Concussion and Primary Sport Participation on Brain Morphometry in Collegiate Athletes: A Study From the NCAA-DoD CARE ConsortiumBrett, Benjamin L.; Bobholz, Samuel A.; Espana, Lezlie Y.; Huber, Daniel L.; Mayer, Andrew R.; Harezlak, Jaroslaw; Broglio, Steven P.; McAllister, Thomas W.; McCrea, Michael A.; Meier, Timothy B.; DiFiori, John P.; Saykin, Andrew J.; Wu, Yu-Chien; Nencka, Andrew S.; Giza, Christopher C.; Goldman, Joshua T.; Mihalik, Jason P.; Brooks, M. Alison; Duma, Stefan M.; Rowson, Steven (2020-07-28)Prior studies have reported long-term differences in brain structure (brain morphometry) as being associated with cumulative concussion and contact sport participation. There is emerging evidence to suggest that similar effects of prior concussion and contact sport participation on brain morphometry may be present in younger cohorts of active athletes. We investigated the relationship between prior concussion and primary sport participation with subcortical and cortical structures in active collegiate contact sport and non-contact sport athletes. Contact sport athletes (CS;N= 190) and matched non-contact sport athletes (NCS;N= 95) completed baseline clinical testing and participated in up to four serial neuroimaging sessions across a 6-months period. Subcortical and cortical structural metrics were derived using FreeSurfer. Linear mixed-effects (LME) models examined the effects of years of primary sport participation and prior concussion (0, 1+) on brain structure and baseline clinical variables. Athletes with prior concussion across both groups reported significantly more baseline concussion and psychological symptoms (allps < 0.05). The relationship between years of primary sport participation and thalamic volume differed between CS and NCS (p= 0.015), driven by a significant inverse association between primary years of participation and thalamic volume in CS (p= 0.007). Additional analyses limited to CS alone showed that the relationship between years of primary sport participation and dorsal striatal volume was moderated by concussion history (p= 0.042). Finally, CS with prior concussion had larger hippocampal volumes than CS without prior concussion (p= 0.015). Years of contact sport exposure and prior concussion(s) are associated with differences in subcortical volumes in young-adult, active collegiate athletes, consistent with prior literature in retired, primarily symptomatic contact sport athletes. Longitudinal follow-up studies in these athletes are needed to determine clinical significance of current findings.
- Development and Implementation of Laboratory Test Methods for the Evaluation of Wearable Head Impact SensorsTyson, Abigail M. (Virginia Tech, 2016-01-08)With a rise in wearable sensor technology and the desire to investigate head impacts in previously unstudied groups, wearable head impact sensors have reached nation-wide popularity for their promising benefits to consumers and researchers. However, there are risks in relying on such technology before proper validation of its performance has been completed. Preliminary tests have found that current sensors vary widely in performance. The objective of this work was to develop and implement a test method for evaluation of wearable sensors in an ideal laboratory environment. A custom pendulum was used to impact a NOCSAE headform mounted on a Hybrid III neck. Sensors were tested under helmeted and unhelmeted conditions, according to their prescribed use. The headform was impacted at four locations, each at four impact energies ranging from 25 g to 100 g. Peak and time series headform kinematics output by each sensor were compared to accelerometers and angular rate sensors inside the headform. Average and standard deviations of peak sensor error and normalized RMS error were evaluated at each test condition to describe sensor performance. Requirements were set in the slope and coefficient of determination from linear regressions constrained through the origin to describe adequate sensor performance under ideal conditions. Sensors that met the requirement in at least one kinematic variable will be further evaluated in more realistic on-field and cadaver tests. The combination of all testing phases will be used to provide an overall sensor evaluation for both researchers and consumers.
- Development of a Concussion Risk Function for a Youth Population Using Head Linear and Rotational AccelerationCampolettano, Eamon T.; Gellner, Ryan A.; Smith, Eric P.; Bellamkonda, Srinidhi; Tierney, Casey T.; Crisco, Joseph J.; Jones, Derek A.; Kelley, Mireille E.; Urban, Jillian E.; Stitzel, Joel D.; Genemaras, Amaris; Beckwith, Jonathan G.; Greenwald, Richard M.; Maerlender, Arthur C.; Brolinson, Per Gunnar; Duma, Stefan M.; Rowson, Steven (Springer, 2019-10-28)Physical differences between youth and adults, which include incomplete myelination, limited neck muscle development, and a higher head-body ratio in the youth population, likely contribute towards the increased susceptibility of youth to concussion. Previous research efforts have considered the biomechanics of concussion for adult populations, but these known age-related differences highlight the necessity of quantifying the risk of concussion for a youth population. This study adapted the previously developed Generalized Acceleration Model for Brian Injury Threshold (GAMBIT) that combines linear and rotational head acceleration to model the risk of concussion for a youth population with the Generalized Acceleration Model for Concussion in Youth (GAM-CY). Survival analysis was used in conjunction with head impact data collected during participation in youth football to model risk between individuals who sustained medically-diagnosed concussions (n = 15). Receiver operator characteristic curves were generated for peak linear acceleration, peak rotational acceleration, and GAM-CY, all of which were observed to be better injury predictors than random guessing. GAM-CY was associated with an area under the curve of 0.89 (95% confidence interval: 0.82–0.95) when all head impacts experienced by the concussed players were considered. Concussion tolerance was observed to be lower for youth athletes, with average peak linear head acceleration of 62.4 ± 29.7 g compared to 102.5 ± 32.7 g for adults and average peak rotational head acceleration of 2609 ± 1591 rad/s2 compared to 4412 ± 2326 rad/s2. These data provide further evidence of age-related differences in concussion tolerance and may be used for the development of youth-specific protective designs.
- Development of the STAR Evaluation System for Assessing Bicycle Helmet Protective PerformanceBland, Megan L.; McNally, Craig; Zuby, David S.; Mueller, Becky C.; Rowson, Steven (Biomedical Engineering Society, 2019-08-01)Cycling is a leading cause of mild traumatic brain injury in the US. While bicycle helmets help protect cyclists who crash, limited biomechanical data exist differentiating helmet protective capabilities. This paper describes the development of a bicycle helmet evaluation scheme based in real-world cyclist accidents and brain injury mechanisms. Thirty helmet models were subjected to oblique impacts at six helmet locations and two impact velocities. The summation of tests for the analysis of risk (STAR) equation, which condenses helmet performance from a range of tests into a single value, was used to summarize measured linear and rotational head kinematics in the context of concussion risk. STAR values varied between helmets (10.9–25.3), with lower values representing superior protection. Road helmets produced lower STAR values than urban helmets. Helmets with slip planes produced lower STAR values than helmets without. This bicycle helmet evaluation protocol can educate consumers on the relative impact performance of various helmets and stimulate safer helmet design.
- Do Infield Softball Masks Effectively Reduce Facial Fracture Risk?Morris, Tyler P.; Gellner, Ryan A.; Rowson, Steven (2019-02)Infield softball masks are intended to reduce facial fracture risk, but are rarely worn. The objective of this study was to evaluate the effectiveness of infield masks' ability to attenuate facial fracture risk over a range of designs and materials. To simulate batted ball impacts, a customized pitching machine was used to propel softballs at 24.6 +/- 0.51m/s. The balls impacted locations centered over the maxilla and zygoma bones of a FOCUS headform. The FOCUS headform was attached to a 50th percentile Hybrid III neck and secured to a slider table. Facial fracture risk of each facial bone was compared between masks and impact locations using peak resultant forces. Analysis of these data showed that the mask material and the distance between the mask and the impacted facial bone were key factors in determining a mask's performance. The effectiveness of masks varied. It was found that a metal mask with a separation distance 35mm away from the maxilla and 25mm away from the zygoma best reduced facial fracture risk for these test configurations. Plastic masks performed worse because they excessively deformed allowing ball contact with the face. This study assesses various mask designs for their ability to reduce facial fracture and suggests design recommendations based on the impact configurations tested.
- Dual-Task Gait Performance Following Head Impact Exposure in Male and Female Collegiate Rugby PlayersKieffer, Emily E.; Brolinson, Per Gunnar; Rowson, Steven (North American Sports Medicine Institute, 2022-04-01)Background: Gait impairments have been well-studied in concussed athletes. However, the sex-specific effect of cumulative head impacts on gait is not well understood. When a cognitive task is added to a walking task, dual-task gait assessments can help amplify deficits in gait and are representative of tasks in everyday life. Dual-task cost is the difference in performance from walking (single-task) to walking with a cognitive load (dual-task). Purpose: The objectives of this study were to explore the differences between sexes in 1) dual-task gait metrics, 2) gait metric changes from pre-season to post-concussion and post-season, and 3) the dual-task costs associated with gait metrics. Study Design: Cross-sectional study Methods: Over two seasons, 77 female athlete-seasons and 64 male athlete-seasons from collegiate club rugby teams participated in this study. Subjects wore inertial sensors and completed walking trials with and without a cognitive test at pre-season, post-season, and post-concussion (if applicable). Results: Females athletes showed improvement in cadence (mean = 2.7 step/min increase), double support time (mean = -0.8% gait cycle time decrease), gait speed (mean = 0.1 m/s increase), and stride length (mean = 0.2 m increase) in both task conditions over the course of the season (p < 0.030). Male athletes showed no differences in gait metrics over the course of the season, except for faster gait speeds and longer stride lengths in the dual-task condition (p < 0.034). In all four gait characteristics, at baseline and post-season, females had higher dual-task costs (mean difference = 4.4, p < 0.003) than the males. Conclusions: This results of this study showed little evidence suggesting a relationship between repetitive head impact exposure and gait deficits. However, there are sex-specific differences that should be considered during the diagnosis and management of sports-related concussion.
- Equestrian STAR MethodologyBegonia, Mark T.; Miller, Barry; Rowson, Steven; Duma, Stefan M. (2022-12-06)This document details the protocol used to rate equestrian helmets based on concussion risk according to the Virginia Tech Helmet Ratings.
- 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.
- Evaluating the Head Injury Risk Associated with Baseball and SoftballMorris, Tyler Pierce (Virginia Tech, 2018-06-07)More than 19 million children participate in youth baseball and softball annually. Although baseball and softball are not commonly depicted as contact sports in the, according to the U.S. CPSC baseball and softball were responsible for 11.6% of all head injuries treated in emergency rooms in 2009; third most behind only cycling and football. Ball impact has been identified as the leading cause of injury in baseball and softball, with the most frequent injury resulting from a ball impacting the head. Reduced injury factor balls, infield softball masks, batter's helmets, and catcher's masks have all been integrated into baseball and softball as a means for preventing serious head injury from ball impact. The research in this thesis had four objectives: to compare the responses of the Hybrid III and NOCSAE headforms during high velocity projectile impacts, to compare head injury risk across a range of baseball stiffness designed for different age groups, to evaluate the effectiveness of infielder softball masks' ability to attenuate facial fracture risk, and to describe a novel methodology to evaluate the performance of batter's helmets and catcher's masks. Results of these research objectives determined the most suitable ATD headform to evaluate head injury risk for high velocity projectile impacts, provided a framework for determining the optimal age-specific ball stiffness and optimal infield mask design, and disseminated STAR ratings for batter's helmets and catcher's masks to the public. The research presented in this thesis can be used to further improve safety in baseball and softball.