Pediatric thoracoabdominal biomechanics

Biofidelic Evaluation of the Large Omni-Directional Child Anthropomorphic Test Device in Low Speed Loading Conditions

Motor vehicle crashes remain the leading cause of death for children. Traditionally, restraint design has focused on the crash phase of the impact with an optimally seated occupant. In order to optimize restrain design for real-world scenarios, research has recently expanded its focus to non-traditional loading conditions including pre-crash positioning and lower speed impacts. The goal of this study was to evaluate the biofidelity of the large omni-directional child (LODC) ATD in non-traditional loading conditions by comparing its response to pediatric volunteer data in low-speed sled tests. Low-speed (2-4 g, 1.9-3.0 m/s) frontal (0°), far-side oblique (60°), and far-side lateral (90º) sled tests, as well as lateral swerving (0.72 g, 0.5 Hz) tests, were conducted using the LODC. The LODC was restrained using a 3-point-belt with an electromechanical motorized seat belt retractor, or pre-pretensioner. Motion capture markers were placed on the head, torso, and belt. The LODC was compared to previously collected pediatric volunteer data as well as the HIII 10 and Q10. Significant difference between the pediatric volunteers and ATDs were identified by comparing the mean ATD response to the pediatric volunteer 95% CI. The LODC exhibited lower forward head excursion (262 mm) compared to pediatric volunteers (263 - 333 mm) in low-speed frontal sled tests (p<0.05), but was closer to the pediatric volunteers than the HIII 10 (179 mm) and Q10 (171 mm). In lateral swerving, the LODC (429 mm) exhibited greater lateral head excursion (p<0.05) compared to pediatric volunteers (115 - 171 mm). The LODC exhibited a greater reduction in kinematics compared to the pediatric volunteers in all loading conditions with a pre-pretensioner. These data provide valuable insight into the biofidelity of the LODC in non-traditional loading conditions, such as evaluating pre-crash maneuvers on occupant response.

A Novel Approach to Scaling Age-, Sex-, and Body Size-Dependent Thoracic Responses using Structural Properties of Human Ribs

Thoracic injuries are frequently observed in motor vehicle crashes, and rib fractures are the most common of those injuries. Thoracic response targets have previously been developed from data obtained from post-mortem human subject (PMHS) tests in frontal loading conditions, most commonly of mid-size males. Traditional scaling methods are employed to identify differences in thoracic response for various demographic groups, but it is often unknown if these applications are appropriate, especially considering the limited number of tested PMHS from which those scaling factors originate. Therefore, the objective of this study was to establish a new scaling approach for generating age-, sex-, and body size- dependent thoracic responses utilizing structural properties of human ribs from direct testing of various demographics. One-hundred forty-seven human ribs (140 adult; 7 pediatric) from 132 individuals (76 male; 52 female; 4 pediatric) ranging in age from 6 to 99 years were included in this study. Ribs were tested at 2 m/s to failure in a frontal impact scenario. Force and displacement for individual ribs were used to develop new scaling factors, with a traditional mid-size biomechanical target as a baseline response. This novel use of a large, varied dataset of dynamic whole rib responses offers vast possibilities to utilize existing biomechanical data in creative ways to reduce thoracic injuries in diverse vehicle occupants.

The Effects of Inboard Shoulder Belt and Lap Belt Loadings on Chest Deflection

Chest injuries occur frequently in frontal collisions. During impact, tension in the lap belt is transferred to the inboard shoulder belt, which compresses the lower ribs of the occupant. In this research, inboard shoulder belt and lap belt geometries and forces were investigated to reduce chest deflection. First, the inboard shoulder belt geometry was changed by the lap/shoulder belt (L/S) junction for the rear seat occupant in sled tests using Hybrid III finite element simulation, sled tests and THOR simulation. As the L/S junction was closer to the ASIS (anterior superior iliac spine), chest deflection of the Hybrid III was smaller. The L/S junction around the ilium has the potential to reduce chest deflection without significant increase of head excursion. For THOR, although the chest deflection reduction effect due to closer L/S junction to the ASIS was observed, chest deflection was still substantially large since the lap belt overrode the ASIS. Second, measures to hook the ASIS of the THOR by the lap belt were examined. Sled tests at 30 and 50 km/h were conducted with THOR in the rear seat, and it was demonstrated that the outboard lap belt and buckle pretensioners improved the lap belt and ASIS interaction, and were also useful in reducing the deflection at the inboard-side of the lower chest. Finally, the lap belt overlap with the ASIS was compared among 10 volunteers, Hybrid III, and THOR. Some volunteers had the ASIS located at the torso-thigh junction, and the lap belt did not overlap the ASIS sufficiently. However, although the ASIS location of THOR is also at the torso-thigh junction, the lap belt overlapped the ASIS because of the abdomen's and femur's shape. In the future, it will be necessary to consider that the outboard lap belt and buckle pretensioners are also effective for the ASIS restraint of all human car occupants.

Side Impact Assessment and Comparison of Appropriate Size and Age Equivalent Porcine Surrogates to Scaled Human Side Impact Response Biofidelity Corridors

Analysis and validation of current scaling relationships and existing response corridors using animal surrogate test data is valuable, and may lead to the development of new or improved scaling relationships. For this reason, lateral pendulum impact testing of appropriate size cadaveric porcine surrogates of human 3-year-old, 6-year-old, 10-year-old, and 50^th percentile male age equivalence, were performed at the thorax and abdomen body regions to compare swine test data to already established human lateral impact response corridors scaled from the 50^th percentile human adult male to the pediatric level to establish viability of current scaling laws. Appropriate Porcine Surrogate Equivalents PSE for the human 3-year-old, 6-year-old, 10-year-old, and 50^th percentile male, based on whole body mass, were established. A series of lateral impact thorax and abdomen pendulum testing was performed based on previously established scaled lateral impact assessment test protocols. The PSE thorax and abdominal impact response data were assessed against previously established scaled human thorax lateral impact response corridors and scaled abdominal oblique impact response corridors for the 3-year-old, 6-year-old, 10-year-old, and 50^th percentile human male based on lateral pendulum impact testing. The overall findings of the current study confirm that lateral impact force response of the thorax and abdomen of appropriate weight porcine surrogates established for human-equivalent-age 3-year-old, 6-year-old, 10-year-old, and 50^th adult male are consistent with the previously established human scaled lateral impact response corridors). Porcine surrogate biomechanics testing can prove to be a powerful research means to further characterize and understand injury and response in lateral impact.

The Large Omnidirectional Child (LODC) ATD: Biofidelity Comparison with the Hybrid III 10 Year Old

When the Hybrid III 10-year old (HIII-10C) anthropomorphic test device (ATD) was adopted into Code of Federal Regulations (CFR) 49 Part 572 as the best available tool for evaluating large belt-positioning booster seats in Federal Motor Vehicle Safety Standard (FMVSS) No. 213, NHTSA stated that research activities would continue to improve the performance of the HIII-10C to address biofidelity concerns. A significant part of this effort has been NHTSA's in-house development of the Large Omnidirectional Child (LODC) ATD. This prototype ATD is comprised of (1) a head with pediatric mass properties, (2) a neck that produces head lag with Zaxis rotation at the atlanto-occipital joint, (3) a flexible thoracic spine, (4) multi-point thoracic deflection measurement capability, (5) skeletal anthropometry representative of a seated child, and (6) an abdomen that can directly measure belt loading. The objective of this study was to evaluate the LODC by comparing its body region and full-body responses to both standard HIII-10C responses and pediatric biomechanical data. In body region tests, the LODC (BioRank = 1.21) showed improved biofidelity over the HIII-10C (BioRank = 2.70). The LODC also exhibited kinematics more similar to pediatric PMHS kinematics in a reconstruction test. In FMVSS No. 213 tests, the LODC was observed to have lower HIC values with the absence of hard chin-to-chest contacts, indicating that chin-to-chest contact severity is mitigated in the LODC design. LODC abdomen pressures and belt penetrations discriminated between restraint conditions. These results suggest the LODC has biofidelic characteristics that make it a candidate for improved assessment of injury risk in restraint system development.

Abdominal Twin Pressure Sensors for the assessment of abdominal injuries in Q dummies: in-dummy evaluation and performance in accident reconstructions

The Abdominal Pressure Twin Sensors (APTS) for Q3 and Q6 dummies are composed of soft polyurethane bladders filled with fluid and equipped with pressure sensors. Implanted within the abdominal insert of child dummies, they can be used to detect abdominal loading due to the belt during frontal collisions. In the present study - which is part of the EC funded CASPER project - two versions of APTS (V1 and V2) were evaluated in abdominal belt compression tests, torso flexion test (V1 only) and two series of sled tests with degraded restraint conditions. The results suggest that the two versions have similar responses, and that the pressure sensitivity to torso flexion is limited. The APTS ability to detect abdominal loading in sled tests was also confirmed, with peak pressures typically below 1 bar when the belt loaded only the pelvis and the thorax (appropriate restraint) and values above that level when the abdomen was loaded directly (inappropriate restraint). Then, accident reconstructions performed as part of CASPER and previous EC funded projects were reanalyzed. Selected data from 19 dummies (12 Q6 and 7 Q3) were used to plot injury risk curves. Maximum pressure, maximum pressure rate and their product were all found to be injury predictors. Maximum pressure levels for a 50% risk of AIS3+ were consistent with the levels separating appropriate and inappropriate restraint in the sled tests (e.g. 50% risk of AIS3+ at 1.09 bar for pressure filtered CFC180). Further work is needed to refine the scaling techniques between ages and confirm the risk curves.

Evaluation of injury criteria for the prediction of commotio cordis from lacrosse ball impacts

Commotio Cordis (CC) is the second leading cause of mortality in youth sports. Impacts occurring directly over the left ventricle (LV) during a vulnerable period of the cardiac cycle can cause ventricular fibrillation (VF), which results in CC. In order to better understand the pathophysiology of CC, and develop a mechanical model for CC, appropriate injury criteria need to be developed. This effort consisted of impacts to seventeen juvenile porcine specimens (mass 21-45 kg). Impacts were delivered over the cardiac silhouette during the venerable period of the cardiac cycle. Four impact speeds were used: 13.4, 17.9, 22.4, and 26.8 m/s. The impactor was a lacrosse ball on an aluminum shaft instrumented with an accelerometer (mass 188 g-215 g). The impacts were recorded using high-speed video. LV pressure was measured with a catheter. Univariate binary logistic regression analyses were performed to evaluate the predictive ability of ten injury criteria. A total of 187 impacts were used in the analysis. The criteria were evaluated on their predictive ability based on Somers' D (D) and Goodman-Kruskal gamma (γ). Injury risk functions were created for all criteria using a 2-parameter Weibull distribution using survival analysis. The best criteria for predicting CC were impact force (D=0.52, and γ=0.52) force*compression (D=0.49, and γ=0.49), and impact power (D=0.49, and γ=0.49). All of these criteria proved significant in predicting the probability of CC from projectile impacts in youth sports (p<0.01). Force proved to be the most predictive of the ten criteria evaluated.

The mechanics of the in vivo infant and toddler trunk during respiratory physiotherapy

BACKGROUND

The purpose of this study is to quantify the in vivo mechanical response of the child trunk under loading during physiotherapy treatments.

METHODS

Twenty-six children aged 45 days to 7 years (14 girls and 12 boys) took part in this study. The forces applied by the physiotherapist were recorded using a force-plate embedded in the manipulation table supporting the child. Two synchronized cameras filmed the scene in a calibrated environment. The displacement of reflective targets glued on the physiotherapist's hands was calculated using an automatic tracking procedure and the 3D reconstruction "Direct Linear Transformation" algorithm. The progression of physical parameters was evaluated according to the age of the child. They included force, displacement, normalized displacement, loading speed, displacement and normalized displacement at the maximum force, force at the maximum displacement, viscous criterion and effective stiffness.

FINDINGS

For all patients, the mean maximum displacement and load were 22 mm (SD 9 mm) and 240 N (SD 46 N) respectively. The force-displacement curves had shown the complexity of the in vivo behavior: four phases have been distinguished with cycles in respect with the respiratory phases. The increase in force always occurred before the increase in displacement.

INTERPRETATION

This study helps to understand the in vivo behavior of the child trunk subjected to repetitive non-injurious mechanical loading. Further analysis in other populations and with different therapeutic maneuvers would refine the results.