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Haag S, Kepros J. Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation. JMIR Hum Factors 2024; 11:e54854. [PMID: 38502170 PMCID: PMC10988374 DOI: 10.2196/54854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities. OBJECTIVE We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance. METHODS A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test. RESULTS Of the 26 patients enrolled, 12 (46%) were female, 18 (69%) were on anticoagulants, and 25 (96%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age (χ12=4.27; P=.04) but not sex (χ12=1.58; P=.23) or race (χ12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit. CONCLUSIONS The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population.
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Affiliation(s)
- Susan Haag
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
| | - John Kepros
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
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Delteil C, Manlius T, Marle O, Godio-Raboutet Y, Bailly N, Piercecchi-Marti MD, Tuchtan L, Thollon L. Head injury: Importance of the deep brain nuclei in force transmission to the brain. Forensic Sci Int 2024; 356:111952. [PMID: 38350415 DOI: 10.1016/j.forsciint.2024.111952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/20/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Finite element modeling provides a digital representation of the human body. It is currently the most pertinent method to study the mechanisms of head injury, and is becoming a scientific reference in forensic expert reports. Improved biofidelity is a recurrent aim of research studies in biomechanics in order to improve earlier models whose mechanical properties conformed to simplified elastic behavior and mechanic laws. We aimed to study force transmission to the brain following impacts to the head, using a finite element head model with increased biofidelity. To the model developed by the Laboratory of Applied Biomechanics of Marseille, we added new brain structures (thalamus, central gray nuclei and ventricular systems) as well as three tracts involved in the symptoms of head injury: the corpus callosum, uncinate tracts and corticospinal tracts. Three head impact scenarios were simulated: an uppercut with the prior model and an uppercut with the improved model in order to compare the two models, and a lateral impact with an impact velocity of 6.5 m/s in the improved model. In these conditions, in uppercuts the maximum stress values did not exceed the injury risk threshold. On the other hand, the deep gray matter (thalamus and central gray nuclei) was the region at highest risk of injury during lateral impacts. Even if injury to the deep gray matter is not immediately life-threatening, it could explain the chronic disabling symptoms of even low-intensity head injury.
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Affiliation(s)
- Clémence Delteil
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Thais Manlius
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Oceane Marle
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | | | - Nicolas Bailly
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Marie-Dominique Piercecchi-Marti
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lucile Tuchtan
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
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Goutnik M, Goeckeritz J, Sabetta Z, Curry T, Willman M, Willman J, Thomas TC, Lucke-Wold B. Neurotrauma Prevention Review: Improving Helmet Design and Implementation. BIOMECHANICS (BASEL, SWITZERLAND) 2022; 2:500-512. [PMID: 36185779 PMCID: PMC9521172 DOI: 10.3390/biomechanics2040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neurotrauma continues to contribute to significant mortality and disability. The need for better protective equipment is apparent. This review focuses on improved helmet design and the necessity for continued research. We start by highlighting current innovations in helmet design for sport and subsequent utilization in the lay community for construction. The current standards by sport and organization are summarized. We then address current standards within the military environment. The pathophysiology is discussed with emphasis on how helmets provide protection. As innovative designs emerge, protection against secondary injury becomes apparent. Much research is needed, but this focused paper is intended to serve as a catalyst for improvement in helmet design and implementation to provide more efficient and reliable neuroprotection across broad arenas.
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Affiliation(s)
- Michael Goutnik
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Joel Goeckeritz
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Zackary Sabetta
- College of Medicine-Phoenix, University of Arizona, Child Health, Phoenix, AZ 85721, USA
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Tala Curry
- College of Medicine-Phoenix, University of Arizona, Child Health, Phoenix, AZ 85721, USA
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Matthew Willman
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Jonathan Willman
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Theresa Currier Thomas
- College of Medicine-Phoenix, University of Arizona, Child Health, Phoenix, AZ 85721, USA
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- Phoenix VA Healthcare System, Phoenix, AZ 85012, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
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A Review of Validation Methods for the Intracranial Response of FEHM to Blunt Impacts. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10207227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The following is a review of the processes currently employed when validating the intracranial response of Finite Element Head Models (FEHM) against blunt impacts. The authors aim to collate existing validation tools, their applications and findings on their effectiveness to aid researchers in the validation of future FEHM and potential efforts in improving procedures. In this vain, publications providing experimental data on the intracranial pressure, relative brain displacement and brain strain responses to impacts in human subjects are surveyed and key data are summarised. This includes cases that have previously been used in FEHM validation and alternatives with similar potential uses. The processes employed to replicate impact conditions and the resulting head motion are reviewed, as are the analytical techniques used to judge the validity of the models. Finally, publications exploring the validation process and factors affecting it are critically discussed. Reviewing FEHM validation in this way highlights the lack of a single best practice, or an obvious solution to create one using the tools currently available. There is clear scope to improve the validation process of FEHM, and the data available to achieve this. By collecting information from existing publications, it is hoped this review can help guide such developments and provide a point of reference for researchers looking to validate or investigate FEHM in the future, enabling them to make informed choices about the simulation of impacts, how they are generated numerically and the factors considered during output assessment, whilst being aware of potential limitations in the process.
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Kerr ZY, Campbell KR, Fraser MA, Currie DW, Pierpoint LA, Kaminski TW, Mihalik JP. Head Impact Locations in U.S. High School Boys' and Girls' Soccer Concussions, 2012/13-2015/16. J Neurotrauma 2019; 36:2073-2082. [PMID: 29092652 DOI: 10.1089/neu.2017.5319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study describes concussions and concussion-related outcomes sustained by high school soccer players by head impact location, sex, and injury mechanism. Data were obtained for the 2012/13-2015/16 school years from the National High School Sports-Related Injury Surveillance System, High School RIO™. This Internet-based sports injury surveillance system captures data reported by athletic trainers from an annual average of 162 U.S. high schools. Data were analyzed to describe circumstances of soccer concussion (e.g., symptomology, symptom resolution, and return-to-play time) by impact location (i.e., front- [face included], back-, side-, and top-of-the-head) and sex. Most concussions were from front-of-the-head impacts (boys, 30.5%; girls, 34.0%). Overall, 4.1 ± 2.2 and 4.6 ± 2.3 symptoms were reported in boys and girls, respectively. In boys, symptom frequency was not associated with head impact location (p = 0.66); an association was found in girls (p = 0.02), with the highest symptom frequency reported in top-of-the-head impacts (5.4 ± 2.2). Head impact location was not associated with symptom resolution time (boys, p = 0.21; girls, p = 0.19) or return-to-play time (boys, p = 0.18; girls, p = 0.07). Heading was associated with 28.0% and 26.5% of concussions in boys and girls, respectively. Most player-player contact concussions during heading occurred from side-of-the-head impacts (boys, 49.4%; girls, 43.2%); most heading-related ball contact concussions occurred from front-of-the-head (boys, 41.4%; girls, 42.6%) and top-of-the-head (boys, 34.5%; girls, 36.9%) impacts. Head impact location was generally independent of symptom resolution time, return-to-play time, and recurrence among high school soccer concussions. However, impact location may be associated with reported symptom frequency. Further, many of these clinical concussion descriptors were associated with sex.
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Affiliation(s)
- Zachary Y Kerr
- 1 Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina.,2 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina
| | - Kody R Campbell
- 2 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina.,3 Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa A Fraser
- 4 Department of Health and Human Performance, Texas State University, San Marcos, Texas
| | - Dustin W Currie
- 5 Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Lauren A Pierpoint
- 5 Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Thomas W Kaminski
- 6 Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Deleware
| | - Jason P Mihalik
- 1 Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina.,2 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina
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Alhaddad AY, Cabibihan JJ, Bonarini A. Head Impact Severity Measures for Small Social Robots Thrown During Meltdown in Autism. Int J Soc Robot 2018. [DOI: 10.1007/s12369-018-0494-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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