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A Review of Cyclist Head Injury, Impact Characteristics and the Implications for Helmet Assessment Methods. Ann Biomed Eng 2023; 51:875-904. [PMID: 36918438 PMCID: PMC10122631 DOI: 10.1007/s10439-023-03148-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/11/2023] [Indexed: 03/15/2023]
Abstract
Head injuries are common for cyclists involved in collisions. Such collision scenarios result in a range of injuries, with different head impact speeds, angles, locations, or surfaces. A clear understanding of these collision characteristics is vital to design high fidelity test methods for evaluating the performance of helmets. We review literature detailing real-world cyclist collision scenarios and report on these key characteristics. Our review shows that helmeted cyclists have a considerable reduction in skull fracture and focal brain pathologies compared to non-helmeted cyclists, as well as a reduction in all brain pathologies. The considerable reduction in focal head pathologies is likely to be due to helmet standards mandating thresholds of linear acceleration. The less considerable reduction in diffuse brain injuries is likely to be due to the lack of monitoring head rotation in test methods. We performed a novel meta-analysis of the location of 1809 head impacts from ten studies. Most studies showed that the side and front regions are frequently impacted, with one large, contemporary study highlighting a high proportion of occipital impacts. Helmets frequently had impact locations low down near the rim line. The face is not well protected by most conventional bicycle helmets. Several papers determine head impact speed and angle from in-depth reconstructions and computer simulations. They report head impact speeds from 5 to 16 m/s, with a concentration around 5 to 8 m/s and higher speeds when there was another vehicle involved in the collision. Reported angles range from 10° to 80° to the normal, and are concentrated around 30°-50°. Our review also shows that in nearly 80% of the cases, the head impact is reported to be against a flat surface. This review highlights current gaps in data, and calls for more research and data to better inform improvements in testing methods of standards and rating schemes and raise helmet safety.
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Abayazid F, Ding K, Zimmerman K, Stigson H, Ghajari M. A New Assessment of Bicycle Helmets: The Brain Injury Mitigation Effects of New Technologies in Oblique Impacts. Ann Biomed Eng 2021; 49:2716-2733. [PMID: 33973128 PMCID: PMC8109224 DOI: 10.1007/s10439-021-02785-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/24/2021] [Indexed: 01/04/2023]
Abstract
New helmet technologies have been developed to improve the mitigation of traumatic brain injury (TBI) in bicycle accidents. However, their effectiveness under oblique impacts, which produce more strains in the brain in comparison with vertical impacts adopted by helmet standards, is still unclear. Here we used a new method to assess the brain injury prevention effects of 27 bicycle helmets in oblique impacts, including helmets fitted with a friction-reducing layer (MIPS), a shearing pad (SPIN), a wavy cellular liner (WaveCel), an airbag helmet (Hövding) and a number of conventional helmets. We tested whether helmets fitted with the new technologies can provide better brain protection than conventional helmets. Each helmeted headform was dropped onto a 45° inclined anvil at 6.3 m/s at three locations, with each impact location producing a dominant head rotation about one anatomical axes of the head. A detailed computational model of TBI was used to determine strain distribution across the brain and in key anatomical regions, the corpus callosum and sulci. Our results show that, in comparison with conventional helmets, the majority of helmets incorporating new technologies significantly reduced peak rotational acceleration and velocity and maximal strain in corpus callosum and sulci. Only one helmet with MIPS significantly increased strain in the corpus collosum. The helmets fitted with MIPS and WaveCel were more effective in reducing strain in impacts producing sagittal rotations and a helmet fitted with SPIN in coronal rotations. The airbag helmet was effective in reducing brain strain in all impacts, however, peak rotational velocity and brain strain heavily depended on the analysis time. These results suggest that incorporating different impact locations in future oblique impact test methods and designing helmet technologies for the mitigation of head rotation in different planes are key to reducing brain injuries in bicycle accidents.
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Affiliation(s)
- Fady Abayazid
- Dyson School of Design Engineering, Imperial College, London, UK.
| | - Ke Ding
- Dyson School of Design Engineering, Imperial College, London, UK
| | - Karl Zimmerman
- Dyson School of Design Engineering, Imperial College, London, UK
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Helena Stigson
- Folksam Insurance Group, Stockholm, Sweden
- Vehicle Safety Division, Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College, London, UK
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Bland ML, McNally C, Cicchino JB, Zuby DS, Mueller BC, McCarthy ML, Newgard CD, Kulie PE, Arnold BN, Rowson S. Laboratory Reconstructions of Bicycle Helmet Damage: Investigation of Cyclist Head Impacts Using Oblique Impacts and Computed Tomography. Ann Biomed Eng 2020; 48:2783-2795. [PMID: 32974755 DOI: 10.1007/s10439-020-02620-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/11/2020] [Indexed: 12/01/2022]
Abstract
Although head injuries are common in cycling, exact conditions associated with cyclist head impacts are difficult to determine. Previous studies have attempted to reverse engineer cyclist head impacts by reconstructing bicycle helmet residual damage, but they have been limited by simplified damage assessment and testing. The present study seeks to enhance knowledge of cyclist head impact conditions by reconstructing helmet damage using advanced impact testing and damage quantification techniques. Damage to 18 helmets from cyclists treated in emergency departments was quantified using computed tomography and reconstructed using oblique impacts. Damage metrics were related to normal and tangential velocities from impact tests as well as peak linear accelerations (PLA) and peak rotational velocities (PRV) using case-specific regression models. Models then allowed original impact conditions and kinematics to be estimated for each case. Helmets were most frequently damaged at the front and sides, often near the rim. Concussion was the most common, non-superficial head injury. Normal velocity and PLA distributions were similar to previous studies, with median values of 3.4 m/s and 102.5 g. Associated tangential velocity and PRV medians were 3.8 m/s and 22.3 rad/s. Results can inform future oblique impact testing conditions, enabling improved helmet evaluation and design.
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Affiliation(s)
- Megan L Bland
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 343 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
| | - Craig McNally
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 343 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Jessica B Cicchino
- Insurance Institute for Highway Safety, 988 Dairy Road, Ruckersville, VA, 22968, USA
| | - David S Zuby
- Insurance Institute for Highway Safety, 988 Dairy Road, Ruckersville, VA, 22968, USA
| | - Becky C Mueller
- Insurance Institute for Highway Safety, 988 Dairy Road, Ruckersville, VA, 22968, USA
| | - Melissa L McCarthy
- George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA
| | - Craig D Newgard
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, 3181 SW Jackson Park Road, CR-114, Portland, OR, 97239, USA
| | - Paige E Kulie
- Department of Emergency Medicine, George Washington University Medical Center, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA
| | - Brittany N Arnold
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, 3181 SW Jackson Park Road, CR-114, Portland, OR, 97239, USA
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 343 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
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