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Yang F, Wang Z, Zhang H, Xie B, Zhao H, Gan L, Li T, Zhang J, Chen Z, Li T, Huang X, Chen Y, Du J. Prevalence and risk factors of occupational neck pain in Chinese male fighter pilots: a cross-sectional study based on questionnaire and cervical sagittal alignment. Front Public Health 2023; 11:1226930. [PMID: 38026361 PMCID: PMC10643867 DOI: 10.3389/fpubh.2023.1226930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Neck pain (NP) is a common musculoskeletal disorder among fighter pilots and has become a rising concern due to its detrimental impact on military combat effectiveness. The occurrence of NP is influenced by a variety of factors, but less attention has been paid to the association of NP with demographic, occupational, and cervical sagittal characteristics in this group. This study aimed to investigate the prevalence and risk factors of NP in Chinese male fighter pilots using a questionnaire and cervical sagittal measurements. Methods Demographic and flight-related data, as well as musculoskeletal pain information, were gathered from Chinese male fighter pilots via a self-report questionnaire. Cervical sagittal parameters were measured and subtypes were classified using standardized lateral cervical radiographs. Differences in various factors between the case and control groups were analyzed using t-tests or chi-square tests. Binary logistic regressions were conducted to explore potential risk factors contributing to NP. Predictors were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), along with their respective 95% confidence intervals (CIs). Results A total of 185 male fighter pilots were included in this cross-sectional study. Among them, 96 (51.9%) reported experiencing NP within the previous 12 months. The multivariate regression analysis revealed that continuous flight training (AOR: 4.695, 95% CI: 2.226-9.901, p < 0.001), shoulder pain (AOR: 11.891, 95% CI: 4.671-30.268, p < 0.001), and low back pain (AOR: 3.452, 95% CI: 1.600-7.446, p = 0.002) were significantly associated with NP. Conclusion The high 12-month prevalence of NP among Chinese male fighter pilots confirms the existence of this growing problem. Continuous flight training, shoulder pain, and low back pain have significant negative effects on pilots' neck health. Effective strategies are necessary to establish appropriate training schedules to reduce NP, and a more holistic perspective on musculoskeletal protection is needed. Given that spinal integrated balance and compensatory mechanisms may maintain individuals in a subclinical state, predicting the incidence of NP in fighter pilots based solely on sagittal characteristics in the cervical region may be inadequate.
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Affiliation(s)
- Fengyuan Yang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Zhong Wang
- Department of Spine Surgery, Central Hospital of Dalian University of Technology, Dalian, China
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Hongxing Zhang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Bowen Xie
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Air Force Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Lu Gan
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Tengfei Li
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Jing Zhang
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Zhiqiang Chen
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Tianqi Li
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Xiaogang Huang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Yufei Chen
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Junjie Du
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
- Air Force Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
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Mo F, Meng Q, Wu K, Zhang Q, Li K, Liao Z, Zhao H. A neuromuscular human body model for lumbar injury risk analysis in a vibration loading environment. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 232:107442. [PMID: 36905749 DOI: 10.1016/j.cmpb.2023.107442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Long-term intensive exposure to whole-body vibration substantially increases the risk of low back pain and degenerative diseases in special occupational groups, like motor vehicle drivers, military vehicle occupants, aircraft pilots, etc. This study aims to establish and validate a neuromuscular human body model focusing on improvement of the detailed description of anatomic structures and neural reflex control, for lumbar injury analysis in vibration loading environments. METHODS A whole-body musculoskeletal in Opensim codes was first improved by including a detailed anatomic description of spinal ligaments, non-linear intervertebral disc, and lumbar facet joints, and coupling a proprioceptive feedback closed-loop control strategy with GTOs and muscle spindles modeling in Python codes. Then, the established neuromuscular model was multi-levelly validated from sub-segments to the whole model, from regular movements to dynamic responses to vibration loadings. Finally, the neuromuscular model was combined with a dynamic model of an armored vehicle to analyze occupant lumbar injury risk in vibration loadings due to different road conditions and traveling velocities. RESULT Based on a series of biomechanical indexes, including lumbar joint rotation angles, the lumbar intervertebral pressures, the displacement of the lumbar segments, and the lumbar muscle activities, the validation results show that the present neuromuscular model is available and feasible in predicting lumbar biomechanical responses in normal daily movement and vibration loading environments. Furthermore, the combined analysis with the armored vehicle model predicted similar lumbar injury risk to the experimental or epidemiologic studies. The preliminary analysis results also showed that road types and travelling velocities have substantial combined effects on lumbar muscle activities, and indicated that intervertebral joint pressure and muscle activity indexes can need to be jointly considered for lumbar injury risk evaluation. CONCLUSION In conclusion, the established neuromuscular model is an effective tool to evaluate vibration loading effects on injury risk of the human body and assist vehicle design vibration comfort by directly concerning the human body injury itself.
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Affiliation(s)
- Fuhao Mo
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Qingnan Meng
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Ke Wu
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Qiang Zhang
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, Hunan 410082, China
| | - Kui Li
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Zhikang Liao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China.
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Patterson FM, Miralami R, Olivier AK, McNulty K, Wood JW, Prabhu RK, Priddy LB. Increase in serum nerve growth factor but not intervertebral disc degeneration following whole-body vibration in rats. Clin Biomech (Bristol, Avon) 2022; 100:105823. [PMID: 36427488 PMCID: PMC9742305 DOI: 10.1016/j.clinbiomech.2022.105823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low back pain is a leading cause of disability and is frequently associated with whole-body vibration exposure in industrial workers and military personnel. While the pathophysiological mechanisms by which whole-body vibration causes low back pain have been studied in vivo, there is little data to inform low back pain diagnosis. Using a rat model of repetitive whole-body vibration followed by recovery, our objective was to determine the effects of vibration frequency on hind paw withdrawal threshold, circulating nerve growth factor concentration, and intervertebral disc degeneration. METHODS Male Sprague-Dawley rats were vibrated for 30 min at an 8 Hz or 11 Hz frequency every other day for two weeks and then recovered (no vibration) for one week. Von Frey was used to determine hind paw mechanical sensitivity every two days. Serum nerve growth factor concentration was determined every four days. At the three-week endpoint, intervertebral discs were graded histologically for degeneration. FINDINGS The nerve growth factor concentration increased threefold in the 8 Hz group and twofold in the 11 Hz group. The nerve growth factor concentration did not return to baseline by the end of the one-week recovery period for the 8 Hz group. Nerve growth factor serum concentration did not coincide with intervertebral disc degeneration, as no differences in degeneration were observed among groups. Mechanical sensitivity generally decreased over time for all groups, suggesting a habituation (desensitization) effect. INTERPRETATION This study demonstrates the potential of nerve growth factor as a diagnostic biomarker for low back pain due to whole-body vibration.
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Affiliation(s)
- Folly M Patterson
- Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS, 39762, USA; Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS 39759, USA.
| | - Raheleh Miralami
- Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS, 39762, USA; Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS 39759, USA.
| | - Alicia K Olivier
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, MS 39762, USA.
| | - Kaylin McNulty
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, 240 Wise Center Drive, Mississippi State, MS 39762, USA.
| | - John W Wood
- Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS, 39762, USA; Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS 39759, USA.
| | - R K Prabhu
- Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS, 39762, USA; Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS 39759, USA.
| | - Lauren B Priddy
- Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS, 39762, USA; Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS 39759, USA.
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Damato EG, Fillioe SJ, Margevicius SP, Mayes RS, Somogyi JE, Vannix IS, Abdollahifar A, Turner AM, Ilcus LS, Decker MJ. Increased Serum Levels of Proinflammatory Cytokines Are Accompanied by Fatigue in Military T-6A Texan II Instructor Pilots. Front Physiol 2022; 13:876750. [PMID: 35574470 PMCID: PMC9097024 DOI: 10.3389/fphys.2022.876750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 12/01/2022] Open
Abstract
Tactical aviation imposes unprecedented physical challenges including repetitive exposure to hypergravity, hyperoxia, increased work of breathing, and profound cognitive workloads. Each stressor evokes outcomes ranging from musculoskeletal duress and atelectasis to physical and cognitive fatigue, the latter among the foremost threats to aviators. Whereas sleep loss is traditionally considered the primary cause of fatigue in aviators, converging experimental, observational, and medical studies have identified biochemical mechanisms promoting onset of fatigue. Those mechanisms, which fundamentally differ from sleep loss, revolve around increased proinflammatory cytokines, produced and released in response to tissue injury, chronic inflammatory disorders, allergens, or physical duress. This study’s objective was to inform our understanding of potential relationships between serum levels of proinflammatory cytokines and onset of fatigue within a cohort of aviators who experience multiple high-performance sorties on a daily basis. Methods: Active duty and reservist T-6A Texan II instructor pilots were studied on three separate days across their week-long flying schedule. Data collected included a physical assessment, subjective fatigue levels, venous blood samples for measures of chemistry and serum analytes, and urine samples for specific gravity. Results: Twenty-three persons were studied, of which 22 fulfilled minimum study requirements of completing two sorties. The study cohort was comprised of primarily males, age 37.95 ± 4.73 years with a BMI of 26.63 ± 3.15 kg/m2. Of 37 measurable serum analytes, 20 differed significantly (p < 0.05) between baseline values with those measured at the study endpoint. Thirteen of the aviators reported increased fatigue scores across their flying schedule whereas nine did not. Eleven blood serum analytes were associated with increasing levels of fatigue. Discussion: Fatigue in aviators has been attributed almost solely to sleep loss, nocturnal sorties, or disrupted circadian rhythmicity. In contrast, our study findings suggest an alternative mechanism that can promote onset of fatigue: increased blood levels of proinflammatory cytokines. Specific mechanisms triggering synthesis and release of those cytokines and other analytes are yet to be determined. However, their expression patterns suggest responses to both chronic and acute inflammation, hyperoxia, or bronchopulmonary responses to inspiration of dry gas, positive airway pressure, or perhaps atelectasis.
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Affiliation(s)
- Elizabeth G. Damato
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Naval Medical Research Unit Dayton, Dayton, OH, United States
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Seth J. Fillioe
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Seunghee P. Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Ryan S. Mayes
- 711th Human Performance Wing, U. S. Air Force School of Aerospace Medicine, Dayton, OH, United States
| | | | - Ian S. Vannix
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Alireza Abdollahifar
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Anthony M. Turner
- 711th Human Performance Wing, U. S. Air Force School of Aerospace Medicine, Dayton, OH, United States
| | | | - Michael J. Decker
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Naval Medical Research Unit Dayton, Dayton, OH, United States
- *Correspondence: Michael J. Decker,
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Yang Y, Liu S, Ling M, Ye C. Prevalence and Potential Risk Factors for Occupational Low Back Pain Among Male Military Pilots: A Study Based on Questionnaire and Physical Function Assessment. Front Public Health 2022; 9:744601. [PMID: 35059371 PMCID: PMC8764305 DOI: 10.3389/fpubh.2021.744601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
Objectives: Low back pain (LBP) has negative implications for the military's combat effectiveness. This study was conducted to determine the prevalence and risk factors of LBP among pilots through a questionnaire and physical function assessments. Methods: Data on the demographic and occupational characteristics, health habits, physical activity, and musculoskeletal injuries of 217 male pilots (114 fighter, 48 helicopter, and 55 transport pilots) were collected using a self-reported questionnaire and physical function assessments. Results: LBP prevalence was 37.8% in the total cohort and 36.0, 45.8, and 34.5% among fighter, helicopter, and transport pilots, respectively. Multivariate regression analysis revealed that the risk factors significantly associated with LBP were neck pain [odds ratio (OR): 3.559, 95% confidence interval (CI): 1.827–6.934], transversus abdominis activation (OR: 0.346, 95% CI: 0.172–0.698), and hip external rotator strength (OR: 0.001, 95% CI: 0.000–0.563) in the total cohort; neck pain (OR: 3.586, 95% CI: 1.365–9.418), transversus abdominis activation (OR: 0.268, 95% CI: 0.094–0.765), hip external rotator strength (OR: 0.000, 95% CI: 0.000–0.949), and weekly flying hours (OR: 3.889, 95% CI: 1.490–10.149) in fighter pilots; irregular strength training (OR: 0.036, 95% CI: 0.003–0.507) and hip external rotator strength (OR: 0.000, 95% CI: 0.000–0.042) in helicopter pilots; and neck pain (OR: 6.417, 95% CI: 1.424–28.909) in transport pilots. Conclusions: High volume flight schedules and weak core muscle functions have significant negative effects on pilots' back health. LBP is commonly associated with high weekly flying hours, worsening neck pain, transversus abdominis insufficient activation, and reduced hip extensor/rotator strength. Risk factors vary among pilots of different aircraft. Thus, specific core muscle training would be especially important for military pilots.
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Affiliation(s)
- Yizhuo Yang
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Shuai Liu
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Mengyu Ling
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China.,Department of Rehabilitation Medicine and Physiotherapy, Anhui Medical University, Hefei, China
| | - Chaoqun Ye
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China
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Abstract
Canine sports medicine and rehabilitation recently have evolved to embody the optimization of performance, injury prevention, and mitigation of musculoskeletal degeneration. This article discusses the diverse factors and considerations of working dog wellness and injury prevention and the importance of recognizing normal and abnormal posture and anatomic structure for performance evaluation and early indication of musculoskeletal injury. The importance of a canine physical fitness program is highlighted and the need for a 4-phase recovery plan to determine if a working dog can safely return to work after injury discussed.
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7
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Patterson F, Miralami R, Tansey KE, Prabhu RK, Priddy LB. Deleterious effects of whole-body vibration on the spine: A review of in vivo, ex vivo, and in vitro models. Animal Model Exp Med 2021; 4:77-86. [PMID: 34179716 PMCID: PMC8212824 DOI: 10.1002/ame2.12163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/19/2021] [Indexed: 12/19/2022] Open
Abstract
Occupational exposure to whole-body vibration is associated with the development of musculoskeletal, neurological, and other ailments. Low back pain and other spine disorders are prevalent among those exposed to whole-body vibration in occupational and military settings. Although standards for limiting exposure to whole-body vibration have been in place for decades, there is a lack of understanding of whole-body vibration-associated risks among safety and healthcare professionals. Consequently, disorders associated with whole-body vibration exposure remain prevalent in the workforce and military. The relationship between whole-body vibration and low back pain in humans has been established largely through cohort studies, for which vibration inputs that lead to symptoms are rarely, if ever, quantified. This gap in knowledge highlights the need for the development of relevant in vivo, ex vivo, and in vitro models to study such pathologies. The parameters of vibrational stimuli (eg, frequency and direction) play critical roles in such pathologies, but the specific cause-and-effect relationships between whole-body vibration and spinal pathologies remain mostly unknown. This paper provides a summary of whole-body vibration parameters; reviews in vivo, ex vivo, and in vitro models for spinal pathologies resulting from whole-body vibration; and offers suggestions to address the gaps in translating injury biomechanics data to inform clinical practice.
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Affiliation(s)
- Folly Patterson
- Department of Agricultural and Biological EngineeringMississippi State UniversityMississippi StateMSUSA
- Center for Advanced Vehicular SystemsMississippi State UniversityStarkvilleMSUSA
| | - Raheleh Miralami
- Center for Advanced Vehicular SystemsMississippi State UniversityStarkvilleMSUSA
| | - Keith E. Tansey
- Department of Neurosurgery and NeurobiologyUniversity of Mississippi Medical CenterJacksonMSUSA
- Center for Neuroscience and Neurological RecoveryMethodist Rehabilitation CenterJacksonMSUSA
- Spinal Cord Injury Medicine and Research ServicesG.V. (Sonny) Montgomery VA Medical CenterJacksonMSUSA
| | - Raj K. Prabhu
- Department of Agricultural and Biological EngineeringMississippi State UniversityMississippi StateMSUSA
- Center for Advanced Vehicular SystemsMississippi State UniversityStarkvilleMSUSA
| | - Lauren B. Priddy
- Department of Agricultural and Biological EngineeringMississippi State UniversityMississippi StateMSUSA
- Center for Advanced Vehicular SystemsMississippi State UniversityStarkvilleMSUSA
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Estep PN, Bonts EG, Shivers BL, Wurzbach JM, Novotny BL, Rybarczyk K, Chancey VC. Mass Properties Comparison of Dismounted and Ground-Mounted Head-Supported Mass Configurations to Existing Performance and Acute Injury Risk Guidelines. Mil Med 2019; 184:245-250. [PMID: 30901469 DOI: 10.1093/milmed/usy342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/26/2018] [Indexed: 11/12/2022] Open
Abstract
In order to limit the aviator's exposure to potentially unsafe helmet configurations, the U.S. Army Aeromedical Research Laboratory (USAARL) developed the USAARL Head-supported mass (HSM) Performance Curve and Acute Injury Risk Curve as guidelines for Army aviation HSM. These Curves remain the only established guidelines for Army HSM, but have limited applicability outside of the aviation environment. Helmet developers and program managers have requested guidelines be developed for the dismounted, ground-mounted, and airborne operating environments that consider currently fielded and proposed HSM configurations. The aim of this project was to measure mass properties (mass and center of mass offset) of currently fielded and proposed HSM configurations and compare them against the existing USAARL HSM Curve guidelines. Mass properties were collected for 71 unique dismounted and ground-mounted HSM configurations. None of the 71 HSM configurations met the Acute Injury Risk Curve recommendations, and only 11 of the 71 configurations met Performance Curve recommendations. While some helmets fell within acceptable limits, the addition of night vision goggles and protective masks pushed all configurations outside of the recommended guidelines. Future guidelines will need to be expanded to consider the operating environment, movement techniques, and primary mechanism of injury.
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Affiliation(s)
- Patrick N Estep
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,Laulima Government Solutions, LLC, 12565 Research Pkwy, Suite 300, Orlando, FL
| | - Emily G Bonts
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,OakRidge Institute for Science and Education, 100 ORAU Way, Oak Ridge, TN
| | - Bethany L Shivers
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL
| | - John M Wurzbach
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,Laulima Government Solutions, LLC, 12565 Research Pkwy, Suite 300, Orlando, FL
| | - Brian L Novotny
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,Laulima Government Solutions, LLC, 12565 Research Pkwy, Suite 300, Orlando, FL
| | - Kyle Rybarczyk
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL
| | - Valeta Carol Chancey
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL
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