1
|
Patton DA, Huber CM, Jain D, Kleiven S, Zhou Z, Master CL, Arbogast KB. Head Impact Kinematics and Brain Tissue Strains in High School Lacrosse. Ann Biomed Eng 2024:10.1007/s10439-024-03513-0. [PMID: 38649514 DOI: 10.1007/s10439-024-03513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Male lacrosse and female lacrosse have differences in history, rules, and equipment. There is current debate regarding the need for enhanced protective headwear in female lacrosse like that worn by male lacrosse players. To inform this discussion, 17 high school lacrosse players (6 female and 11 male) wore the Stanford Instrumented Mouthguard during 26 competitive games over the 2021 season. Time-windowing and video review were used to remove false-positive recordings and verify head acceleration events (HAEs). The HAE rate in high school female lacrosse (0.21 per athlete exposure and 0.24 per player hour) was approximately 35% lower than the HAE rate in high school male lacrosse (0.33 per athlete exposure and 0.36 per player hour). Previously collected kinematics data from the 2019 high school male and female lacrosse season were combined with the newly collected 2021 kinematics data, which were used to drive a finite element head model and simulate 42 HAEs. Peak linear acceleration (PLA), peak angular velocity (PAV), and 95th percentile maximum principal strain (MPS95) of brain tissue were compared between HAEs in high school female and male lacrosse. Median values for peak kinematics and MPS95 of HAEs in high school female lacrosse (PLA, 22.3 g; PAV, 10.4 rad/s; MPS95, 0.05) were lower than for high school male lacrosse (PLA, 24.2 g; PAV, 15.4 rad/s; MPS95, 0.07), but the differences were not statistically significant. Quantifying a lower HAE rate in high school female lacrosse compared to high school male lacrosse, but similar HAE magnitudes, provides insight into the debate regarding helmets in female lacrosse. However, due to the small sample size, additional video-verified data from instrumented mouthguards are required.
Collapse
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Roberts Pediatric Research Building, 2716 South Street, 13th Floor, Philadelphia, PA, 19146, USA.
| | - Colin M Huber
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Roberts Pediatric Research Building, 2716 South Street, 13th Floor, Philadelphia, PA, 19146, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Divya Jain
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Roberts Pediatric Research Building, 2716 South Street, 13th Floor, Philadelphia, PA, 19146, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Zhou Zhou
- Division of Neuronic Engineering, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Roberts Pediatric Research Building, 2716 South Street, 13th Floor, Philadelphia, PA, 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Roberts Pediatric Research Building, 2716 South Street, 13th Floor, Philadelphia, PA, 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Mayer AR, Dodd AB, Dodd RJ, Stephenson DD, Ling JM, Mehos CJ, Patton DA, Robertson-Benta CR, Gigliotti AP, Vermillion MS, Noghero A. Head Kinematics, Blood Biomarkers, and Histology in Large Animal Models of Traumatic Brain Injury and Hemorrhagic Shock. J Neurotrauma 2023; 40:2205-2216. [PMID: 37341029 PMCID: PMC10701512 DOI: 10.1089/neu.2022.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Traumatic brain injury (TBI) and severe blood loss resulting in hemorrhagic shock (HS) are each leading causes of mortality and morbidity worldwide, and present additional treatment considerations when they are comorbid (TBI+HS) as a result of competing pathophysiological responses. The current study rigorously quantified injury biomechanics with high precision sensors and examined whether blood-based surrogate markers were altered in general trauma as well as post-neurotrauma. Eighty-nine sexually mature male and female Yucatan swine were subjected to a closed-head TBI+HS (40% of circulating blood volume; n = 68), HS only (n = 9), or sham trauma (n = 12). Markers of systemic (e.g., glucose, lactate) and neural functioning were obtained at baseline, and at 35 and 295 min post-trauma. Opposite and approximately twofold differences existed for both magnitude (device > head) and duration (head > device) of quantified injury biomechanics. Circulating levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and ubiquitin C-terminal hydrolase L1 (UCH-L1) demonstrated differential sensitivity for both general trauma (HS) and neurotrauma (TBI+HS) relative to shams in a temporally dynamic fashion. GFAP and NfL were both strongly associated with changes in systemic markers during general trauma and exhibited consistent time-dependent changes in individual sham animals. Finally, circulating GFAP was associated with histopathological markers of diffuse axonal injury and blood-brain barrier breach, as well as variations in device kinematics following TBI+HS. Current findings therefore highlight the need to directly quantify injury biomechanics with head mounted sensors and suggest that GFAP, NfL, and UCH-L1 are sensitive to multiple forms of trauma rather than having a single pathological indication (e.g., GFAP = astrogliosis).
Collapse
Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychology, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew B. Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Rebecca J. Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - David D. Stephenson
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Josef M. Ling
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Carissa J. Mehos
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cidney R. Robertson-Benta
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Andrew P. Gigliotti
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Meghan S. Vermillion
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Alessio Noghero
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| |
Collapse
|
3
|
Huber CM, Patton DA, Rownd KR, Patterson Gentile C, Master CL, Arbogast KB. Neurophysiological Effects of Repeated Soccer Heading in Youth. J Biomech Eng 2023; 145:091005. [PMID: 37216312 PMCID: PMC10259471 DOI: 10.1115/1.4062423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/12/2023] [Indexed: 05/24/2023]
Abstract
Repeated head loading in sports is associated with negative long-term brain health, and there is growing evidence of short-term neurophysiological changes after repeated soccer heading. The objective of this study was to quantify the head kinematics and effects of repetitive soccer headers in adolescents using an instrumented mouthguard. Adolescent soccer players aged 13-18 years were randomly assigned to a kicking control, frontal heading, or oblique heading group. Participants completed neurophysiological assessments at three-time points: immediately prior to, immediately after, and approximately 24 h after completing 10 headers or kicks. The suite of assessments included the Post-Concussion Symptom Inventory, visio-vestibular exam, King-Devick test, modified Clinical Test of Sensory Interaction and Balance with force plate sway measurement, pupillary light reflex, and visual evoked potential. Data were collected for 19 participants (17 male). Frontal headers resulted in significantly higher peak resultant linear acceleration (17.4 ± 0.5 g) compared to oblique headers (12.1 ± 0.4 g, p < 0.001), and oblique headers resulted in significantly higher peak resultant angular acceleration (frontal: 1147 ± 45 rad/s2, oblique: 1410 ± 65 rad/s2, p < 0.001). There were no neurophysiological deficits for either heading group or significant differences from controls at either post-heading timepoint, and therefore, a bout of repeated headers did not result in changes in the neurophysiological measures evaluated in this study. The current study provided data regarding the direction of headers with the goal to reduce the risk of repetitive head loading for adolescent athletes.
Collapse
Affiliation(s)
- Colin M. Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146
| | - Declan A. Patton
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146
| | - Kathryn R. Rownd
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146
| | - Carlyn Patterson Gentile
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Christina L. Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146; Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19146; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| |
Collapse
|
4
|
Huber CM, Patton DA, Maheshwari J, Zhou Z, Kleiven S, Arbogast KB. Finite element brain deformation in adolescent soccer heading. Comput Methods Biomech Biomed Engin 2023:1-11. [PMID: 37477178 PMCID: PMC10799973 DOI: 10.1080/10255842.2023.2236746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/27/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
Finite element (FE) modeling provides a means to examine how global kinematics of repetitive head loading in sports influences tissue level injury metrics. FE simulations of controlled soccer headers in two directions were completed using a human head FE model to estimate biomechanical loading on the brain by direction. Overall, headers were associated with 95th percentile peak maximum principal strains up to 0.07 and von Mises stresses up to 1450 Pa, and oblique headers trended toward higher values than frontal headers but below typical injury levels. These quantitative data provide insight into repetitive loading effects on the brain.
Collapse
Affiliation(s)
- Colin M. Huber
- Department of Bioengineeing, University of Pennsylvania, Philadelphia, United States of America
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
| | - Jalaj Maheshwari
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
| | - Zhou Zhou
- Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Svein Kleiven
- Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
| |
Collapse
|
5
|
Jain D, Huber CM, Patton DA, McDonald CC, Wang L, Ayaz H, Master CL, Arbogast KB. Use of functional near-infrared spectroscopy to quantify neurophysiological deficits after repetitive head impacts in adolescent athletes. Sports Biomech 2023:1-15. [PMID: 37430440 PMCID: PMC10776807 DOI: 10.1080/14763141.2023.2229790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
There is concern that repetitive head impact exposure (RHIE) may lead to neurophysiological deficits in adolescents. Twelve high school varsity soccer players (5 female) completed the King-Devick (K-D) and complex tandem gait (CTG) assessments pre- and post-season while wearing a functional near-infrared spectroscopy (fNIRS) sensor. The average head impact load (AHIL) for each athlete-season was determined via a standardised protocol of video-verification of headband-based head impact sensor data. Linear mixed effect models were used to determine the effects of AHIL and task condition (3 K-D cards or 4 CTG conditions) on the change in mean prefrontal cortical activation measured by fNIRS, and performance on K-D and CTG, from pre- to post-season. Although there was no difference in the pre- to post-season change in K-D or CTG performance, greater AHIL was associated with greater cortical activation at post-season in comparison to pre-season during the most challenging conditions of K-D (p = 0.003) and CTG (p = 0.02), suggesting that greater RHIE necessitates increased cortical activation to complete the more challenging aspects of these assessments at the same level of performance. These results describe the effect of RHIE on neurofunction and suggest the need for further study of the time course of these effects.
Collapse
Affiliation(s)
- Divya Jain
- Department of Bioengineering, University of Pennsylvania, PA, USA
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M. Huber
- Department of Bioengineering, University of Pennsylvania, PA, USA
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lei Wang
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
- Data Science and Biostatistics Unit, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hasan Ayaz
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Data Science and Biostatistics Unit, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
- Department of Psychology, College of Arts and Sciences, Drexel University, Philadelphia, PA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Drexel Solutions Institute, Drexel University, Philadelphia, PA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
6
|
Patton DA, Huber CM, Fedonni D, Margulies SS, Master CL, Arbogast KB. Quantifying head impact exposure, mechanisms and kinematics using instrumented mouthguards in female high school lacrosse. Res Sports Med 2023; 31:772-786. [PMID: 35195503 PMCID: PMC9921769 DOI: 10.1080/15438627.2022.2042294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Current debate exists regarding the need for protective headwear in female lacrosse. To inform this issue, the current study quantified head impact exposure, mechanisms and kinematics in female lacrosse using instrumented mouthguards. A female high school varsity lacrosse team of 17 players wore the Stanford Instrumented Mouthguard (MiG) during 14 competitive games. Video footage was reviewed to remove false-positive recordings and verify head impacts, which resulted in a rate of 0.32 head impacts per athlete-exposure. Of the 31 video-confirmed head impacts, 54.8% were identified as stick contacts, 38.7% were player contacts and 6.5% were falls. Stick contacts had the greatest peak head kinematics. The most common impact site was the side of the head (35.5%), followed by the face/jaw (25.8%), forehead (6.5%), and crown (6.5%). Impacts to the face/jaw region of the head had significantly (p < 0.05) greater peak kinematics compared to other regions of the head, which may have resulted from the interaction of the impacting surface, or the lower jaw, and the sensor. The current study provides initial data regarding the frequency, magnitude and site of impacts sustained in female high school lacrosse. A larger sample size of high quality head impact data in female lacrosse is required to confirm these findings.
Collapse
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M Huber
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniele Fedonni
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
7
|
Patton DA, Maheshwari J, Arbogast KB. Frontal-oblique impact sled tests of a rearward-facing child restraint system with and without a support leg. Accid Anal Prev 2023; 190:107137. [PMID: 37295359 DOI: 10.1016/j.aap.2023.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To quantify the head and neck injury metrics of an anthropometric test device (ATD) in a rearward-facing child restraint system (CRS), with and without a support leg, in frontal-oblique impacts. METHODS Sled tests using the Federal Motor Vehicle Safety Standards (FMVSS) 213 frontal crash pulse (48 km/h, 23 g) were performed with a simulated Consumer Reports test buck, which comprised a test bench that mimics the rear outboard vehicle seat of a sport utility vehicle (SUV). The test bench was rigidised to increase durability for repeated testing and the seat springs and cushion were replaced every five tests. A force plate was mounted to the floor of the test buck directly in front of the test bench to measure support leg peak reaction force. The test buck was rotated 30° and 60° relative to the longitudinal axis of the sled deck to represent frontal-oblique impacts. The door surrogate from the FMVSS 213a side impact test was rigidly attached to the sled deck adjacent to the test bench. The 18-month-old Q-Series (Q1.5) ATD was seated in a rearward-facing infant CRS, which was attached to the test bench with either rigid lower anchors or a three-point seatbelt. The rearward-facing infant CRS was tested with and without a support leg. Conductive foil was attached to the upper edge of the door panel and a strip of conductive foil was attached to the top of the ATD head so that a voltage signal quantified contact with the door panel. A new CRS was used for each test. A repeat test was performed for each condition for a total of 16 tests. DATA SOURCES Resultant linear head acceleration 3 ms clip; head injury criterion 15 ms (HIC15); peak neck tensile force; peak neck flexion moment; potential difference between the ATD head and the door panel; support leg peak reaction force. RESULTS The presence of a support leg significantly reduced head injury metrics (p < 0.001) and peak neck tensile force (p = 0.004) compared to tests without a support leg. Rigid lower anchors were associated with significant reductions in head injury metrics and peak neck flexion moment (p < 0.001) compared to tests that attached the CRS with the seatbelt. The 60° frontal-oblique tests had significantly elevated head injury metrics (p < 0.01) compared to the 30° frontal-oblique tests. No ATD head contact with the door was observed for 30° frontal-oblique tests. The ATD head contacted the door panel in the 60° frontal-oblique tests when the CRS was tested without the support leg. Average support leg peak reaction forces ranged from 2167 to 4160 N. The 30° frontal-oblique sled tests had significantly higher support leg peak reaction forces (p < 0.001) compared to the 60° frontal-oblique sled tests. CONCLUSIONS The findings of the current study add to the growing body of evidence regarding the protective benefits of CRS models with a support leg and rigid lower anchors.
Collapse
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, United States.
| | - Jalaj Maheshwari
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
8
|
Patton DA, Mansfield JA, Maheshwari J, Arbogast KB. Head excursions of rearward-facing child restraint systems in rear impacts. Traffic Inj Prev 2023; 24:213-217. [PMID: 36657143 DOI: 10.1080/15389588.2022.2160631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/31/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim of the current study was to quantify the head excursions of pediatric anthropomorphic test devices (ATDs) seated in rearward-facing child restraint system (CRS) models during rear impact sled tests and compare to roof heights of vehicles in the current fleet to assess the possibility of head contact against the vehicle roof. METHODS Head excursions of ATDs seated in rearward-facing CRS models were analyzed from high-speed video data from 14 rear impact sled tests across two different series. Tests were conducted in rigidized vehicle seats from recent model year vehicles. Rearward-facing infant and convertible CRS models were tested with a variety of pediatric ATDs aged 12 months to 6 years in a variety of installation conditions (e.g., lower anchors or seat belt, anti-rotation features, etc). Maximum ATD head excursions in plane of the seatback were compared to previously measured roof heights of 87 different vehicles. RESULTS The roof heights in all sedan seating positions (n = 58) and SUV/CUV/minivan seating positions (n = 60) were greater than the largest maximum ATD head excursions in plane of the seatback (792 mm). Head contact was possible in two of the pickup trucks which had roof heights of 730 and 775 mm. In all, 98% of vehicle seating positions measured in this study would accommodate all of the maximum ATD head excursions in plane of the seatback without contact. CONCLUSIONS The risk of head contact against the vehicle interior roof appears low as maximum ATD head excursions in plane of the seatback were typically not great enough to reach the rooflines of the vehicles in the sample. Head contact appears possible in pickup trucks, where the window/roofline is directly behind the head restraint.
Collapse
Affiliation(s)
- D A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J A Mansfield
- Injury Biomechanics Research Center, Ohio State University, Columbus, Ohio
| | - J Maheshwari
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - K B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
9
|
Roby PR, Metzger KB, McDonald CC, Corwin DJ, Huber CM, Patton DA, Margulies SS, Grady MF, Master CL, Arbogast KB. Pre- and post-season visio-vestibular function in healthy adolescent athletes. PHYSICIAN SPORTSMED 2022; 50:522-530. [PMID: 34521303 PMCID: PMC8934744 DOI: 10.1080/00913847.2021.1980744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes. METHODS This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season). RESULTS Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25). CONCLUSIONS Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.
Collapse
Affiliation(s)
- Patricia R Roby
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Corwin
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M Huber
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Declan A Patton
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan S Margulies
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Matthew F Grady
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
10
|
Patton DA, Maheshwari J, Arbogast KB. Interactions between rearward-facing child restraint systems and the front row seatback in frontal impact sled tests. Traffic Inj Prev 2022; 23:S99-S104. [PMID: 35713941 DOI: 10.1080/15389588.2022.2078812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Some child restraint system (CRS) manufacturers specify a minimum distance between the CRS and the seatback, whereas others require that the CRS may contact the seatback but cannot be "braced"; however, few studies have investigated these interactions. Therefore, the aim was to investigate the interactions between the front row seat and rearward-facing CRS models with and without a support leg during frontal crashes. METHODS Sled tests using the FMVSS 213 frontal crash pulse were performed with the Q1.5 and Q3 anthropomorphic test devices (ATDs) seated in rearward-facing infant and convertible CRS models, respectively. A front row vehicle seat was in front of the test bench in three track positions: brace, touch and gap. For the touch condition, the front row seat was translated aftward until the seatback contacted the CRS. For the brace condition, the front row seat was translated 20 mm aftward. For the gap condition, the front row seat was translated 50 mm forward. Each condition was tested with and without the support leg of the CRS. RESULTS The tests with a support leg were associated with significantly (p = 0.007) lower resultant linear head acceleration 3 ms clip compared to the tests without a support leg, but the reduction of head injury criterion 15 ms (HIC15) was not significant (p = 0.057). The Q1.5 ATD in the rearward-facing infant CRS with a support leg had the lowest injury metrics for the touch and gap conditions, whereas the Q3 in the rearward-facing convertible CRS had the lowest head injury metrics for the brace condition. CONCLUSIONS The use of a support leg provided a clear benefit in terms of reducing head injury metrics for the Q1.5 in the rearward-facing infant CRS, especially for the touch and gap conditions. The rearward-facing convertible CRS in the current study appears to benefit from being braced against the front row seat. However, further tests are required to allow further statistical comparisons and determine if these preliminary findings extend to other rearward-facing CRS models.
Collapse
Affiliation(s)
- D A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J Maheshwari
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - K B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
11
|
Patton DA, Maheshwari J, Arbogast KB, Graci V. Head contacts in second-row pediatric occupants when the front-seat is reclined during automated emergency braking. Comput Methods Biomech Biomed Engin 2022; 25:1637-1648. [PMID: 35107393 DOI: 10.1080/10255842.2022.2032003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Seating configurations for autonomous driving will include reclined front seated occupants, which may expose child occupants seated directly behind to head impacts even in pre-crash scenarios. This study used mathematical modelling to investigate head contact for second-row child occupants seated behind a reclined front-seat during an automatic emergency braking (AEB) scenario. Although characterized by low speed (<1 m/s), head contacts were observed for a seatbelt-restrained 10-year-old and a 6-year-old in a low-back booster when the front-seat was reclined and in an aftward track position. Future seating configurations should consider the potential for head contact by second-row child occupants during crash-avoidance scenarios.
Collapse
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jalaj Maheshwari
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Valentina Graci
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,School of Biomedical Engineering, Science and Health System, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
12
|
Huber CM, Patton DA, Margulies S, Master C, Arbogast K. Head Impact Exposure and Mechanisms in Female High School Lacrosse via an Instrumented Mouthguard. Neurology 2022. [PMID: 34969904 DOI: 10.1212/01.wnl.0000801856.45976.d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To quantify the head impact biomechanics, by impact mechanism, of female high school lacrosse players during games using an instrumented mouthguard. BACKGROUND There is growing concern for the neurologic effects of repetitive head impacts in sports, which have been linked with several short-term neurophysiologic deficits. Girls' lacrosse represents a popular but understudied sport with regard to head impact exposure and current debate exists as to the need for enhanced protective equipment. DESIGN/METHODS A female high school varsity lacrosse team wore the Stanford Instrumented Mouthguard during competitive games for the 2019 season. Video footage was reviewed to confirm head impact events and remove false-positive recordings. For each impact event, the mechanism was coded as stick contact, player contact, fall, or ball contact. Head impact rates were calculated per athlete exposure (AE, defined as a single player participating in a single game). RESULTS Sensor data were recorded for 15 female varsity lacrosse players for 14 games and 97 AEs. During games, 31 sensor-recorded head impacts were video-confirmed resulting in a pooled average head impact rate of 0.32 impacts/AE. The video-confirmed impacts were distributed between stick contact (17, 54.8%), player contact (12, 38.7%), and falls (2, 6.5%). There were no ball impacts. Overall peak kinematics were 34.0 ± 26.6 g, 12.0 ± 9.1 rad/s, and 3,666.5 ± 2,987.6 rad/s2. Stick contacts had the highest peak linear acceleration (42.7 ± 32.2 g), angular velocity (14.5 ± 11.1 rad/s), and angular acceleration (4,242.4 ± 3,634.9 rad/s2). CONCLUSIONS Stick impacts were the most common impact mechanism and resulted in the highest peak linear and angular kinematics, which may help explain why they are the most common cause of head injury in female lacrosse. By quantifying the head impact exposure, kinematics and mechanisms in female high school lacrosse, targeted injury preventions can be developed, such as rule changes and protective equipment.
Collapse
|
13
|
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, PA 19146, USA
| |
Collapse
|
14
|
Gamble ASD, Bigg JL, Sick S, Krolikowski M, Patton DA, Hagel BE, Emery CA. Helmet Fit Assessment and Concussion Risk in Youth Ice Hockey Players: A Nested Case-Control Study. J Athl Train 2021; 56:845-850. [PMID: 33238008 DOI: 10.4085/1062-6050-0294.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Injury surveillance has shown that concussions are the most common injury in youth ice hockey. Research examining the criteria for ensuring the correct fit of protective equipment and its potential relationship with concussion risk is very limited. OBJECTIVE To evaluate the association between helmet fit and the odds of experiencing a concussion among youth ice hockey players. DESIGN Nested case-control within a cohort study. SETTING Calgary, Alberta, Canada. PATIENTS OR OTHER PARTICIPANTS Data were collected for 72 concussed, 41 nonconcussion-injured, and 62 uninjured ice hockey players aged 11 to 18 years. MAIN OUTCOME MEASURE(S) Helmet-fit assessments were conducted across players and encompassed helmet specifications, condition, certification, and criteria measuring helmet fit. Using a validated injury-surveillance system, we identified participants as players with suspected concussions or physician-diagnosed concussions or both. One control group comprised players who sustained nonconcussion injuries, and a second control group comprised uninjured players. Helmet-fit criteria (maximum score = 16) were assessed for the concussed players and compared with each of the 2 control groups. The primary outcome was dichotomous (>1 helmet-fit criteria missing versus 0 or 1 criterion missing). Logistic and conditional logistic regression were used to investigate the effect of helmet fit on the odds of concussion. RESULTS The primary analysis (54 pairs matched for age, sex, and level of play) suggested that inadequate helmet fit (>1 criterion missing) resulted in greater odds of sustaining a concussion when comparing concussed and uninjured players (odds ratio [OR] = 2.67 [95% CI = 1.04, 6.81], P = .040). However, a secondary unmatched analysis involving all participants indicated no significant association between helmet fit and the odds of sustaining a concussion when we compared concussed players with nonconcussion-injured players (OR = 0.98 [0.43, 2.24], P = .961) or uninjured players (OR = 1.66 [0.90, 3.05], P = .103). CONCLUSIONS Inadequate helmet fit may affect the odds of sustaining a concussion in youth ice hockey players. Future investigators should continue to evaluate this relationship in larger samples to inform helmet-fit recommendations.
Collapse
Affiliation(s)
- Alexander S D Gamble
- Department of Human Health and Nutritional Sciences, University of Guelph, ON, Canada
| | - Jessica L Bigg
- Department of Human Health and Nutritional Sciences, University of Guelph, ON, Canada
| | - Stacy Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB, Canada
| | - Maciek Krolikowski
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB, Canada
| | - Declan A Patton
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB, Canada
| |
Collapse
|
15
|
Roby PR, Metzger KB, McDonald CC, Corwin DJ, Huber CM, Patton DA, Grady MF, Master CL, Arbogast KB. Pre- And Post-season Visio-vestibular Function In Healthy Adolescent Athletes. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763588.43774.2f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
16
|
Mayer AR, Ling JM, Dodd AB, Rannou-Latella JG, Stephenson DD, Dodd RJ, Mehos CJ, Patton DA, Cullen DK, Johnson VE, Pabbathi Reddy S, Robertson-Benta CR, Gigliotti AP, Meier TB, Vermillion MS, Smith DH, Kinsler R. Reproducibility and Characterization of Head Kinematics During a Large Animal Acceleration Model of Traumatic Brain Injury. Front Neurol 2021; 12:658461. [PMID: 34177763 PMCID: PMC8219951 DOI: 10.3389/fneur.2021.658461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Acceleration parameters have been utilized for the last six decades to investigate pathology in both human and animal models of traumatic brain injury (TBI), design safety equipment, and develop injury thresholds. Previous large animal models have quantified acceleration from impulsive loading forces (i.e., machine/object kinematics) rather than directly measuring head kinematics. No study has evaluated the reproducibility of head kinematics in large animal models. Nine (five males) sexually mature Yucatan swine were exposed to head rotation at a targeted peak angular velocity of 250 rad/s in the coronal plane. The results indicated that the measured peak angular velocity of the skull was 51% of the impulsive load, was experienced over 91% longer duration, and was multi- rather than uni-planar. These findings were replicated in a second experiment with a smaller cohort (N = 4). The reproducibility of skull kinematics data was mostly within acceptable ranges based on published industry standards, although the coefficients of variation (8.9% for peak angular velocity or 12.3% for duration) were higher than the impulsive loading parameters produced by the machine (1.1 vs. 2.5%, respectively). Immunohistochemical markers of diffuse axonal injury and blood-brain barrier breach were not associated with variation in either skull or machine kinematics, suggesting that the observed levels of variance in skull kinematics may not be biologically meaningful with the current sample sizes. The findings highlight the reproducibility of a large animal acceleration model of TBI and the importance of direct measurements of skull kinematics to determine the magnitude of angular velocity, refine injury criteria, and determine critical thresholds.
Collapse
Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States.,Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, United States.,Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, United States.,Psychology Department, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Julie G Rannou-Latella
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - David D Stephenson
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Rebecca J Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Carissa J Mehos
- Neurosciences Department, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - D Kacy Cullen
- Department of Neurosurgery and Penn Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Victoria E Johnson
- Department of Neurosurgery and Penn Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sharvani Pabbathi Reddy
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Cidney R Robertson-Benta
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Andrew P Gigliotti
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Meghan S Vermillion
- The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Douglas H Smith
- Department of Neurosurgery and Penn Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel Kinsler
- Enroute Care Group, U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL, United States
| |
Collapse
|
17
|
Huber CM, Patton DA, Jain D, Master CL, Margulies SS, McDonald CC, Arbogast KB. Variations in Head Impact Rates in Male and Female High School Soccer. Med Sci Sports Exerc 2021; 53:1245-1251. [PMID: 33986230 PMCID: PMC8122001 DOI: 10.1249/mss.0000000000002567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Repetitive head impacts in soccer have been linked to short-term neurophysiological deficits, and female soccer players have higher concussion rates than males. These findings have inspired investigation into gender differences in head impact exposure and how head impact rate contributes to the cumulative effect of head impact exposure on neurological outcomes. Various periods of exposure have been used to calculate head impact rates, including head impacts per season, game, and player-hour. PURPOSE The aim of this study was to apply different methodological approaches to quantify and compare head impact rates by gender for two seasons of high school varsity soccer. METHODS Video review was used to confirm all events recorded by a headband-mounted impact sensor and calculate playing time for all players. Impact rates were calculated per athlete exposure (presence and participation) and per player-hour (scheduled game time, individual play time, and absolute time). RESULTS Impact rates per athlete exposure ranged from 2.5 to 3.2 for males and from 1.4 to 1.6 for females, and impact rates per player-hour ranged from 2.7 to 3.8 for males and from 1.0 to 1.6 for females. The exposure calculation method significantly affected head impact rates; however, regardless of approach, the head impact rate for males was higher, up to threefold, than for females. Individual head impact exposure varied substantially within a team with one in five players experiencing no impacts. CONCLUSIONS Overall, the gender differences found in this study indicate that males experience higher head impact exposure compared with females. Future studies are needed to understand potential clinical implications of variability in head impact exposure and reconcile higher female concussion rates with the reduced head impact rates presented herein.
Collapse
Affiliation(s)
- Colin M Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA,Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Divya Jain
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA,Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
18
|
Patton DA, Huber CM, Margulies SS, Master CL, Arbogast KB. NON-HEADER IMPACT EXPOSURE AND KINEMATICS OF MALE YOUTH SOCCER PLAYERS. Biomed Sci Instrum 2021; 57:106-113. [PMID: 36238448 PMCID: PMC9555802 DOI: 10.34107/yhpn9422.04106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Previous studies have investigated the head impact kinematics of purposeful heading in youth soccer; however, less than a third of all head injuries in youth soccer have been found to involve ball contact. The aim of the current study was to identity the head impact kinematics and exposure not associated with purposeful heading of the ball in male youth soccer. Headband-mounted sensors were used to monitor the head kinematics of male junior varsity and middle school teams during games. Video analysis of sensor-recorded events was used to code impact mechanism, surface and site. Junior varsity players had non-header impact rates of 0.28 per athlete-exposure (AE) and 0.37 per player-hour (PH), whereas middle school players had relatively lower non-header impact rates of 0.16 per AE and 0.25 per PH. Such impact rates fell within the large range of values reported by previous studies, which is likely affected by sensor type and recording trigger threshold. The most common non-header impact mechanism in junior varsity soccer was player contact, whereas ball-to-head was the most common non-header impact mechanism in middle school soccer. Non-header impacts for junior varsity players had median peak kinematics of 31.0 g and 17.4 rad/s. Non-header impacts for middle school players had median peak kinematics of 40.6 g and 16.2 rad/s. For non-header impacts, ball impacts to the rear of the head the highest peak kinematics recorded by the sensor. Such data provide targets for future efforts in injury prevention, such as officiating efforts to control player-to-player contact.
Collapse
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Colin M Huber
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
19
|
Huber CM, Patton DA, McDonald CC, Jain D, Simms K, Lallo VA, Margulies SS, Master CL, Arbogast KB. Sport- and Gender-Based Differences in Head Impact Exposure and Mechanism in High School Sports. Orthop J Sports Med 2021; 9:2325967120984423. [PMID: 33738313 PMCID: PMC7933779 DOI: 10.1177/2325967120984423] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only). Results: Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 [95% CI, 1.8-2.6]), basketball (0.90 vs 0.25; 3.6 [2.6-4.6]), and lacrosse (0.83 vs 0.06; 12.9 [10.1-15.8]). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact. Conclusion: Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.
Collapse
Affiliation(s)
- Colin M Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Divya Jain
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine Simms
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Valerie A Lallo
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Biomedical Engineering Department, Widener University, Chester, Pennsylvania, USA
| | - Susan S Margulies
- Walter H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
20
|
Huber CM, Patton DA, Wofford KL, Margulies SS, Cullen DK, Arbogast KB. Laboratory Assessment of a Headband-Mounted Sensor for Measurement of Head Impact Rotational Kinematics. J Biomech Eng 2021; 143:024502. [PMID: 32975553 PMCID: PMC10782863 DOI: 10.1115/1.4048574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/31/2020] [Indexed: 11/08/2022]
Abstract
Head impact sensors measure head kinematics in sports, and sensor accuracy is crucial for investigating the potential link between repetitive head loading and clinical outcomes. Many validation studies mount sensors to human head surrogates and compare kinematic measures during loading from a linear impactor. These studies are often unable to distinguish intrinsic instrumentation limitations from variability caused by sensor coupling. The aim of the current study was to evaluate intrinsic sensor error in angular velocity in the absence of coupling error for a common head impact sensor. Two Triax SIM-G sensors were rigidly attached to a preclinical rotational injury device and subjected to rotational events to assess sensor reproducibility and accuracy. Peak angular velocities between the SIM-G sensors paired for each test were correlated (R2 > 0.99, y = 1.00x, p < 0.001). SIM-G peak angular velocity correlated with the reference (R2 = 0.96, y = 0.82x, p < 0.001); however, SIM-G underestimated the magnitude by 15.0% ± 1.7% (p < 0.001). SIM-G angular velocity rise time (5% to 100% of peak) correlated with the reference (R2 = 0.97, y = 1.06x, p < 0.001) but exhibited a slower fall time (100% to 5% of peak) by 9.0 ± 3.7 ms (p < 0.001). Assessing sensor performance when rigidly coupled is a crucial first step to interpret on-field SIM-G rotational kinematic data. Further testing in increasing biofidelic conditions is needed to fully characterize error from other sources, such as coupling.
Collapse
Affiliation(s)
- Colin M. Huber
- Department of Bioengineering, University of Pennsylvania, 2716 South Street, Philadelphia, PA 19146; Children's Hospital of Philadelphia, Center for Injury Research and Prevention (CIRP), 2716 South Street, Philadelphia, PA 19146
| | - Declan A. Patton
- Children's Hospital of Philadelphia, Center for Injury Research and Prevention (CIRP), 2716 South Street, Philadelphia, PA 19146
| | - Kathryn L. Wofford
- Department of Neurosurgery, University of Pennsylvania, 3320 Smith Walk, 105 Hayden Hall, Philadelphia, PA 19104
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, U.A. Whitaker Building, 313 Ferst Drive, Suite 2116, Atlanta, GA 30332-0535
| | - D. Kacy Cullen
- Department of Neurosurgery, Center for Brain Injury & Repair, University of Pennsylvania, 3320 Smith Walk, 105E Hayden Hall, Philadelphia, PA 19104; Department of Bioengineering, University of Pennsylvania, 3320 Smith Walk, 105E Hayden Hall, Philadelphia, PA 19104
| | - Kristy B. Arbogast
- Children's Hospital of Philadelphia, Center for Injury Research and Prevention (CIRP), 2716 South Street, Philadelphia, PA 19146; Department of Pediatrics, University of Pennsylvania, 2716 South Street, Philadelphia, PA 19146
| |
Collapse
|
21
|
Patton DA, Belwadi AN, Maheshwari J, Arbogast KB. Evaluation of Rotation Reduction Features in Infant and Extended-Use Convertible Child Restraint Systems during Frontal and Rear Impacts. Stapp Car Crash J 2020; 64:61-81. [PMID: 33636003 DOI: 10.4271/2020-22-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A correctly used child restraint system (CRS) is associated with a substantial reduction of injury and mortality risks in motor vehicle crashes and epidemiologic data suggests that toddlers are provided greater protection when restrained in a rearward-facing CRS compared to a forward-facing CRS. Some 'extended-use' European CRS models can accommodate children up to six years rearward-facing and have a support (load) leg and/or a pair of lower (Swedish) tethers to reduce rotation during frontal and rear impacts, respectively. Laboratory studies have found that a support leg reduces head and neck injury metrics of anthropomorphic test devices (ATDs) younger than three years in rearward-facing CRS models during frontal impacts. The objectives of the current study were to perform sled tests to: (1) evaluate the effects of using a support leg in rearward-facing infant and extended-use convertible CRS models during frontal impacts, (2) evaluate the effects of using a pair of lower tethers in a rearward-facing extended-use convertible CRS model during rear impacts and (3) compare responses of ATDs in an extendeduse convertible CRS with a support leg and a pair of lower tethers in rearward- and forward-facing configurations during frontal and rear impacts. The presence of a support leg in rearward-facing infant and extended-use convertible CRS models in frontal impacts was associated with reductions in head injury metrics across a range of pediatric ATDs and neck injury metrics were below injury tolerance values. Other strategies in the design of rearward-facing CRS and front row vehicle seatbacks may be available to further reduce head injury metrics. Lower tethers reduced the rearward rotation of an extended-use convertible CRS toward the vehicle seatback in rear impacts and were typically associated with reductions in head and neck injury metrics for the Q6 ATD, but not the Q3 ATD. For frontal impacts, neck injury metrics were typically greater for ATDs in the forward-facing extended-use convertible CRS, whereas head injury metrics were typically greater for the rearward-facing condition (with a support leg and a pair of lower tethers). Interactions of the ATD head and/or the rearward-facing extended-use convertible CRS with the blocker plate in rearward-facing frontal impacts need to be further investigated.
Collapse
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, USA
| | - Aditya N Belwadi
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, USA
| | - Jalaj Maheshwari
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
22
|
Corwin DJ, McDonald CC, Arbogast KB, Mohammed FN, Metzger KB, Pfeiffer MR, Patton DA, Huber CM, Margulies SS, Grady MF, Master CL. Clinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion. Med Sci Sports Exerc 2020; 52:542-548. [PMID: 31524833 DOI: 10.1249/mss.0000000000002163] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Evaluate the discriminatory ability of two clinical measures and one device-based measure of gait and balance for concussed youth. METHODS We enrolled 81 cases and 90 controls age 14-18 yr old from August 2017 to June 2018. Controls were recruited from a suburban high school, and cases were recruited from the concussion program of an academic pediatric tertiary care center. Tests included two clinical measures: 1) complex tandem gait, scored as sway/errors walking forward and backward eyes open and closed; 2) Modified Balance Error Scoring System (mBESS), scored as total number of errors on three standing tasks; and one device-based measure; 3) Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) using the Biodex Biosway Balance System, scored as a sway index. Sensitivity, specificity, ideal cutpoint, and area under the receiver operating characteristic curve (AUC) were calculated for all test components. RESULTS Ideal cutpoint for total number of sway/errors for tandem gait = 5, sensitivity 41%, specificity 90%. Ideal cutpoint for total mBESS errors = 4, sensitivity 55%, specificity 75%. Ideal cutpoint for mCTSIB = 1.37, sensitivity 37%, specificity 88%. Among each test, some individual components outperformed overall composites, in particular tandem gait (specificity forward eyes open = 99%, sensitivity backward eyes closed = 81%). Among the 40 cases and 65 controls with all three assessments, AUC (95% CI) for tandem gait = 0.63 (0.52,0.75), mBESS = 0.70 (0.60,0.81), and mCTSIB = 0.54 (0.42,0.66). CONCLUSIONS A device-based measure of balance did not produce better discriminatory ability than two clinical assessments. Complex tandem gait has the additional benefit of being an easy-to-perform and graded test with highly sensitive and specific individual components.
Collapse
Affiliation(s)
| | | | | | - Fairuz N Mohammed
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Declan A Patton
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Colin M Huber
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | |
Collapse
|
23
|
Abstract
BACKGROUND Recent advances in technology have enabled the development of head impact sensors, which provide a unique opportunity for sports medicine researchers to study head kinematics in contact sports. Studies have suggested that video or observer confirmation of head impact sensor data is required to remove false positives. In addition, manufacturer filtering algorithms may be ineffective in identifying true positives and removing true negatives. PURPOSE To (1) identify the percentage of video-confirmed events recorded by headband-mounted sensors in high school soccer through video analysis, overall and by sex; (2) compare video-confirmed events with the classification by the manufacturer filtering algorithms; and (3) quantify and compare the kinematics of true- and false-positive events. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Adolescent female and male soccer teams were instrumented with headband-mounted impact sensors (SIM-G; Triax Technologies) during games over 2 seasons of suburban high school competition. Sensor data were sequentially reduced to remove events recorded outside of game times, associated with players not on the pitch (ie, field) and players outside the field of view of the camera. With video analysis, the remaining sensor-recorded events were identified as an impact event, trivial event, or nonevent. The mechanisms of impact events were identified. The classifications of sensor-recorded events by the SIM-G algorithm were analyzed. RESULTS A total of 6796 sensor events were recorded during scheduled varsity game times, of which 1893 (20%) were sensor-recorded events associated with players on the pitch in the field of view of the camera during verified game times. Most video-confirmed events were impact events (n = 1316, 70%), followed by trivial events (n = 396, 21%) and nonevents (n = 181, 10%). Female athletes had a significantly higher percentage of trivial events and nonevents with a significantly lower percentage of impact events. Most impact events were head-to-ball impacts (n = 1032, 78%), followed by player contact (n = 144, 11%) and falls (n = 129, 10%) with no significant differences between male and female teams. The SIM-G algorithm correctly identified 70%, 52%, and 66% of video-confirmed impact events, trivial events, and nonevents, respectively. CONCLUSION Video confirmation is critical to the processing of head impact sensor data. Percentages of video-confirmed impact events, trivial events, and nonevents vary by sex in high school soccer. Current manufacturer filtering algorithms and magnitude thresholds are ineffective at correctly classifying sensor-recorded events and should be used with caution.
Collapse
Affiliation(s)
- Declan A. Patton
- Address correspondence to Declan A. Patton, PhD, Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, 734 Schuylkill Avenue, Philadelphia, PA 19104, USA ()
| | | | | | | | | | | |
Collapse
|
24
|
Patton DA, Huber CM, Arbogast KB. Head Impact Sensor Attachment and Data Transformation in a Youth Female Soccer Heading Drill. Conf Proc Int Res Counc Biomech Inj 2020; 2020:870-871. [PMID: 36161206 PMCID: PMC9495276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia in Philadelphia, PA
| | | | - Kristy B Arbogast
- Co-Scientific Director of the Center for Injury Research and Prevention, Children's Hospital of Philadelphia and a Professor at the University of Pennsylvania in Philadelphia, PA
| |
Collapse
|
25
|
McIntosh AS, Willmott C, Patton DA, Mitra B, Brennan JH, Dimech-Betancourt B, Howard TS, Rosenfeld JV. An assessment of the utility and functionality of wearable head impact sensors in Australian Football. J Sci Med Sport 2019; 22:784-789. [PMID: 31000457 DOI: 10.1016/j.jsams.2019.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/05/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To assess the utility and functionality of the X-Patch® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined. DESIGNS Laboratory tests and prospective observational study. METHODS Laboratory tests on X-Patch® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch® and reference data were analysed. Australian Football players wore the X-Patch® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch® head acceleration events. Wearability of the X-Patch® was assessed using the Comfort Rating Scale for Wearable Computers. RESULTS Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p<0.05 for all). On average, the X-Patch®-recorded peak linear acceleration (PLA) was 17% greater than the reference PLA, 28% less for peak rotational acceleration (PRA) and 101% greater for the Head Injury Criterion (HIC). For video analysis, 118 head acceleration events (HAE) were included with PLA ≥30g across 53 players. Video recordings of X-Patch®-measured HAEs (PLA ≥30g) determined that 31.4% were direct head impacts, 9.3% were indirect impacts, 44.1% were unknown or unclear and 15.3% were neither direct nor indirect head impacts. The X-Patch® system was deemed wearable by 95-100% of respondents. CONCLUSIONS This study reinforces evidence that use of the current X-Patch® devices should be limited to research only and in conjunction with video analysis.
Collapse
Affiliation(s)
- Andrew S McIntosh
- MUARC, Monash University, Melbourne, Australia; Federation University Australia, Ballarat, Australia.
| | - Catherine Willmott
- Monash Institute of Cognitive & Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | | | - Biswadev Mitra
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - James H Brennan
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Bleydy Dimech-Betancourt
- Monash Institute of Cognitive & Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
| | - Teresa S Howard
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| |
Collapse
|
26
|
Hatfield J, Dozza M, Patton DA, Maharaj P, Boufous S, Eveston T. On the use of naturalistic methods to examine safety-relevant behaviours amongst children and evaluate a cycling education program. Accid Anal Prev 2017; 108:91-99. [PMID: 28865315 DOI: 10.1016/j.aap.2017.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/18/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
School-based cycling education programs aim to improve cycling safety and participation amongst children. Available research suggests that typical programs, which focus on bicycle manoeuvring skills, have limited effects on behaviour observed on a track or planned route. The current study uses theoretically more valid, naturalistic cycling data, to evaluate Safe Cycle, a program that incorporates hazard and self-awareness training. Soon after Safe Cycle was delivered at treatment schools, research bicycles instrumented with a rearward- and a forward-facing camera were loaned to six children from treatment schools and six children from (waitlist) control schools. In each group half the children were in Year 6, and half were in Year 7/8. Each child was instructed to ride the research bicycle instead of their own bicycle for the 1-2 weeks that they had a research bicycle. Video data were reduced using a purpose-designed coding scheme that identified whether participants performed specific safety-relevant behaviours in appropriate circumstances. While the participants controlled their bicycles well, gave way appropriately to traffic at intersections, and stopped at red lights, participants frequently removed one or both hands from the handlebars, and seldom signalled turns, conducted over-shoulder-checks when changing lanes, or looked in multiple directions at intersections (except when crossing a road). While aspects of design and small sample sizes limited evaluation findings, this research demonstrated the feasibility and potential of naturalistic data to support cycling education program evaluation. Further, the study substantially extended available naturalistic study of children's cycling behaviour to highlight behaviours which might be targeted by cycling safety initiatives.
Collapse
Affiliation(s)
- J Hatfield
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia.
| | - M Dozza
- Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden
| | - D A Patton
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia
| | - P Maharaj
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia
| | - S Boufous
- Transport and Road Safety [TARS] Research, The University of NSW, Sydney, Australia
| | - T Eveston
- ACT Education and Training Directorate, Canberra, Australia
| |
Collapse
|
27
|
McIntosh AS, Patton DA. Q. why doesn’t headgear prevent concussion? a. no one bothered to ask. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097270.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
28
|
Patton DA, McIntosh AS, Kleiven S. A review of misnomers and misconceptions in concussion biomechanics. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097270.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
29
|
Abstract
OBJECTIVES The ability to determine risk management controls for quad bike use is confounded by limitations in crash and injury information. The aim of this article is to identify the injury mechanisms, crash characteristics, and contributing factors in fatal quad bike incidents in Australia by activity (recreation and work). METHODS An in-depth case series study was undertaken of 106 Australian quad bike fatalities that had occurred between 2000 and 2013. All case material held by Australian coroners was obtained and reviewed. RESULTS One hundred and six cases were categorized as occurring during recreation (53) and work (53). Fifty-two of the work cases occurred during farmwork. The mean age for those killed during a work activity was 56 years compared to 27 years for recreational riders. Two children under 16 years died while performing farmwork and 13 children under 16 years during recreational activities. The analyses show a very clear pattern for farmwork-related deaths: quad bike rolls or pitches over (farmworker, 85%; recreational rider, 55%), rider becomes pinned under quad bike (farmworker, 68%; recreational rider, 30%), and death by asphyxia (farmworker, 42%; recreational rider, 11%). In contrast, recreational riders suffered complex impact injuries to the head and chest that occurred when the rider was traveling at speed, lost control, was ejected, and collided with an object in the environment and/or interacted with the moving quad bike. CONCLUSIONS The analyses support the need to improve safe quad bike operation through consideration of the age of the rider, training, helmet use, reducing the propensity of quad bikes to roll, and improving handling so that loss of control events are reduced and to prevent crushing and pinning by the vehicle during and after a rollover crash.
Collapse
Affiliation(s)
- A S Mcintosh
- a McIntosh Consultancy and Research , Sydney , Australia
- b Monash Injury Research Institute, Monash University , Melbourne , Australia
| | - D A Patton
- c Transport and Road Safety (TARS) Research, University of New South Wales , Sydney , Australia
| | - G Rechnitzer
- c Transport and Road Safety (TARS) Research, University of New South Wales , Sydney , Australia
| | - R Grzebieta
- c Transport and Road Safety (TARS) Research, University of New South Wales , Sydney , Australia
| |
Collapse
|
30
|
|
31
|
|
32
|
Abstract
OBJECTIVE Concussion is a prevalent brain injury in sport and the wider community. Despite this, little research has been conducted investigating the dynamics of impacts to the unprotected human head and injury causation in vivo, in particular the roles of linear and angular head acceleration. SETTING Professional contact football in Australia. PARTICIPANTS Adult male professional Australian rules football players participating in 30 games randomly selected from 103 games. Cases selected based on an observable head impact, no observable symptoms (eg, loss-of-consciousness and convulsions), no on-field medical management and no injury recorded at the time. PRIMARY AND SECONDARY OUTCOME MEASURES A data set for no-injury head impact cases comprising head impact locations and head impact dynamic parameters estimated through rigid body simulations using the MAthematical DYnamic MOdels (MADYMO) human facet model. This data set was compared to previously reported concussion case data. RESULTS Qualitative analysis showed that the head was more vulnerable to lateral impacts. Logistic regression analyses of head acceleration and velocity components revealed that angular acceleration of the head in the coronal plane had the strongest association with concussion; tentative tolerance levels of 1747 rad/s(2) and 2296 rad/s(2) were reported for a 50% and 75% likelihood of concussion, respectively. The mean maximum resultant angular accelerations for the concussion and no-injury cases were 7951 rad/s(2) (SD 3562 rad/s(2)) and 4300 rad/s(2) (SD 3657 rad/s(2)), respectively. Linear acceleration is currently used in the assessment of helmets and padded headgear. The 50% and 75% likelihood of concussion values for resultant linear head acceleration in this study were 65.1 and 88.5 g, respectively. CONCLUSIONS As hypothesised by Holbourn over 70 years ago, angular acceleration plays an important role in the pathomechanics of concussion, which has major ramifications in terms of helmet design and other efforts to prevent and manage concussion.
Collapse
Affiliation(s)
- Andrew S McIntosh
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia
- Monash Injury Research Institute, Monash University, Melbourne Australia
| | - Declan A Patton
- Faculty of Science, University of New South Wales, Sydney, Australia
| | - Bertrand Fréchède
- Université de Lyon, F-69622, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne
- IFSTTAR, UMR_T9406, LBMC, F-69675, Bron
| | | | - Edouard Ferry
- Centre d'Expertise en Dynamique Rapide, Explosions et Multiphysique (CEDREM), Ecoparc d'Affaires de Sologne, Domaine de Villemorant, Neung-sur-Beuvron, France
| | | |
Collapse
|
33
|
Budziszewski GJ, Lewis SP, Glover LW, Reineke J, Jones G, Ziemnik LS, Lonowski J, Nyfeler B, Aux G, Zhou Q, McElver J, Patton DA, Martienssen R, Grossniklaus U, Ma H, Law M, Levin JZ. Arabidopsis genes essential for seedling viability: isolation of insertional mutants and molecular cloning. Genetics 2001; 159:1765-78. [PMID: 11779813 PMCID: PMC1461917 DOI: 10.1093/genetics/159.4.1765] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have undertaken a large-scale genetic screen to identify genes with a seedling-lethal mutant phenotype. From screening approximately 38,000 insertional mutant lines, we identified >500 seedling-lethal mutants, completed cosegregation analysis of the insertion and the lethal phenotype for >200 mutants, molecularly characterized 54 mutants, and provided a detailed description for 22 of them. Most of the seedling-lethal mutants seem to affect chloroplast function because they display altered pigmentation and affect genes encoding proteins predicted to have chloroplast localization. Although a high level of functional redundancy in Arabidopsis might be expected because 65% of genes are members of gene families, we found that 41% of the essential genes found in this study are members of Arabidopsis gene families. In addition, we isolated several interesting classes of mutants and genes. We found three mutants in the recently discovered nonmevalonate isoprenoid biosynthetic pathway and mutants disrupting genes similar to Tic40 and tatC, which are likely to be involved in chloroplast protein translocation. Finally, we directly compared T-DNA and Ac/Ds transposon mutagenesis methods in Arabidopsis on a genome scale. In each population, we found only about one-third of the insertion mutations cosegregated with a mutant phenotype.
Collapse
Affiliation(s)
- G J Budziszewski
- Syngenta Biotechnology, Inc., Research Triangle Park, North Carolina 27709, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Schomburg FM, Patton DA, Meinke DW, Amasino RM. FPA, a gene involved in floral induction in Arabidopsis, encodes a protein containing RNA-recognition motifs. Plant Cell 2001; 13:1427-36. [PMID: 11402170 PMCID: PMC135578 DOI: 10.1105/tpc.13.6.1427] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2001] [Accepted: 04/19/2001] [Indexed: 05/19/2023]
Abstract
FPA is a gene that regulates flowering time in Arabidopsis via a pathway that is independent of daylength (the autonomous pathway). Mutations in FPA result in extremely delayed flowering. FPA was identified by means of positional cloning. The predicted FPA protein contains three RNA recognition motifs in the N-terminal region. FPA is expressed most strongly in developing tissues, similar to the expression of FCA and LUMINIDEPENDENS, two components of the autonomous pathway previously identified. Overexpression of FPA in Arabidopsis causes early flowering in noninductive short days and creates plants that exhibit a more day-neutral flowering behavior.
Collapse
Affiliation(s)
- F M Schomburg
- Department of Biochemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | | | | | | |
Collapse
|
35
|
Schomburg FM, Patton DA, Meinke DW, Amasino RM. FPA, a gene involved in floral induction in Arabidopsis, encodes a protein containing RNA-recognition motifs. Plant Cell 2001; 13:1427-1436. [PMID: 11402170 DOI: 10.1105/tpc.010017] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
FPA is a gene that regulates flowering time in Arabidopsis via a pathway that is independent of daylength (the autonomous pathway). Mutations in FPA result in extremely delayed flowering. FPA was identified by means of positional cloning. The predicted FPA protein contains three RNA recognition motifs in the N-terminal region. FPA is expressed most strongly in developing tissues, similar to the expression of FCA and LUMINIDEPENDENS, two components of the autonomous pathway previously identified. Overexpression of FPA in Arabidopsis causes early flowering in noninductive short days and creates plants that exhibit a more day-neutral flowering behavior.
Collapse
Affiliation(s)
- F M Schomburg
- Department of Biochemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | | | | | | |
Collapse
|
36
|
Patton DA, Mullen JD. An Analysis of the Private Returns From Three Land Development Options in the Southern Mallee of Nsw. Rangel J 1999. [DOI: 10.1071/rj9990244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In early 1993, the DLWC initiated a project to develop regional planning strategies for clearing and cultivation activities in the Southern Mallee and Northern Floodplain areas of the Western Division of NSW. Concentrating on the Southern Mallee region, a benefit-cost analysis of current clearing and cultivation proposals and their impact on the financial viability of the individual landholder has been conducted. While the development proposals all had the potential to return much higher levels of expected net income to farmers than the existing extensive grazing strategy, market and climatic uncertainty meant that the probability of the extensive grazing activity returning more than cropping was as high as 50% for some proposals. This means that farmers have to weigh up higher incomes on average from cropping against the more certain income from grazing. Clearly, this is a personal choice with the more risk averse decision makers favouring the extensive grazing option. However, we found that for levels of risk aversion that research suggests typifies Australian farmers, the development proposals were dominant over the extensive grazing option except where there was a higher proportion of land devoted to conservation at a discount rate of 12%. No attempt has been made in the present study to evaluate the public benefits and costs, in the form of changes in environmental resources, associated with such development proposals Key words: Western Division, conservation, clearing and cultivation, stochastic dominance, economics.
Collapse
|
37
|
Patton DA, Johnson M, Ward ER. Biotin synthase from Arabidopsis thaliana. cDNA isolation and characterization of gene expression. Plant Physiol 1996; 112:371-8. [PMID: 8819333 PMCID: PMC157958 DOI: 10.1104/pp.112.1.371] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The full-length BIO2 cDNA from Arabidopsis thaliana was isolated using an expressed sequence tag that was homologous to the Escherichia coli biotin synthase gene (BioB). Comparisons of the deduced amino acid sequence from BIO2 with bacterial and yeast biotin synthase homologs revealed a high degree of sequence similarity. The amino terminus of the predicted BIO2 protein contains a stretch of hydrophobic residues similar in composition to transit peptide sequences. BIO2 is a single-copy nuclear gene in Arabidopsis that is expressed at high levels in the tissues of immature plants. Expression of BIO2 was higher in the light relative to dark and was induced 5-fold during biotin-limited conditions. These results demonstrate that expression of at least one gene in this pathway is regulated in response to developmental, environmental, and bio-chemical stimuli.
Collapse
Affiliation(s)
- D A Patton
- Ciba Agricultural Biotechnology, Research Triangle Park, North Carolina 27709, USA.
| | | | | |
Collapse
|
38
|
Patton DA, Volrath S, Ward ER. Complementation of an Arabidopsis thaliana biotin auxotroph with an Escherichia coli biotin biosynthetic gene. Mol Gen Genet 1996; 251:261-6. [PMID: 8676868 DOI: 10.1007/bf02172516] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Arabidopsis thaliana biotin auxotroph biol was rendered prototrophic by transformation with a chimeric transgene containing the Escherichia coli bio A gene driven by a constitutive promoter. The bio A gene encodes the biotin biosynthetic enzyme 7, 8-diaminopelargonic acid aminotransferase. Unlike the untransformed control plants, transgenic plants expressing the bacterial transgene synthesized biotin and grew to maturity without biotin-deficiency symptoms. These findings demonstrate that bio1/bio1 mutant plants are defective in the gene encoding 7,8-diaminopelargonic acid aminotransferase.
Collapse
Affiliation(s)
- D A Patton
- Ciba Agricultural Biotechnology, Research Triangle Park, NC 27709, USA
| | | | | |
Collapse
|
39
|
Abstract
We have previously isolated and characterized over 90 recessive mutants of Arabidopsis thaliana defective in embryo development. These emb mutants have been shown to differ in lethal phase, extent of abnormal development, and response in culture. We demonstrate in this report the value and efficiency of mapping emb genes relative to visible and molecular markers. Sixteen genes essential for embryo development were mapped relative to visible markers by analyzing progeny of selfed F1 plants. Embryonic lethals are now the most common type of visible marker included on the linkage map of Arabidopsis. Backcrosses were used in several cases to orient genes relative to adjacent markers. Three genes were located to chromosome arms with telotrisomics by screening for a reduction in the percentage of aborted seeds produced by F1 plants. A restriction fragment length polymorphism (RFLP) mapping strategy that utilizes pooled EMB/EMB F2 plants was devised to increase the efficiency of mapping embryonic lethals relative to molecular markers. This strategy was tested by demonstrating that the bio1 locus of Arabidopsis is within 0.5 cM of an existing RFLP marker. Mapping embryonic lethals with both visible and molecular markers may therefore help to identify large numbers of genes with essential functions in Arabidopsis.
Collapse
Affiliation(s)
- D A Patton
- Department of Botany, Oklahoma State University, Stillwater 74078
| | | | | |
Collapse
|
40
|
Franzmann L, Patton DA, Meinke DW. In vitro morphogenesis of arrested embryos from lethal mutants of Arabidopsis thaliana. Theor Appl Genet 1989; 77:609-616. [PMID: 24232790 DOI: 10.1007/bf00261231] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/1988] [Accepted: 11/15/1988] [Indexed: 06/02/2023]
Abstract
Arrested embryos from lethal (emb) mutants of Arabidopsis thaliana were rescued on a nutrient medium designed to promote plant regeneration from immature wild-type cotyledons. The best response was observed with mutant embryos arrested at the heart to cotyledon stages of development. Embryos arrested at a globular stage produced callus but failed to turn green or form normal shoots in culture. Many of the mutant plants produced in culture were unusually pale with abnormal leaves, rosettes, and patterns of reproductive development. Other plants were phenotypically normal except for the presence of siliques containing 100% aborted seeds following self-pollination. These results demonstrate that genes with essential functions during plant embryo development differ in their pattern of expression at later stages of the life cycle. Most of the 15 genes examined in this study were essential for embryogenesis but were required again for subsequent stages of development. Only EMB24 appeared to be limited in function to embryo development. These differences in the response of mutant embryos in culture may facilitate the classification of embryonic lethals and the identification of genes with developmental rather than housekeeping functions.
Collapse
Affiliation(s)
- L Franzmann
- Department of Botany and Microbiology, Oklahoma State University, 74078, Stillwater, OK, USA
| | | | | |
Collapse
|
41
|
Patton DA, Meinke DW. High-frequency plant regeneration from cultured cotyledons of Arabidopsis thaliana. Plant Cell Rep 1988; 7:233-237. [PMID: 24241755 DOI: 10.1007/bf00272531] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/1988] [Revised: 04/28/1988] [Indexed: 06/02/2023]
Abstract
Wild-type plants of Arabidopsis thaliana strain "Columbia" regenerated at a high frequency from immature cotyledons cultured on a shoot-inducing medium containing 1.0 mg/l 6-benzylaminopurine and 0.1 mg/l 1-naphthaleneacetic acid. Cotyledon segments expanded rapidly and produced numerous shoots after 2-3 weeks in culture. Regeneration occurred in the absence of the original shoot apex. Hypocotyl segments from immature embryos produced root hairs and callus in culture but only rarely developed shoots. Hygromycin, kanamycin and G-418 inhibited cotyledon expansion and shoot formation in culture. Vancomycin was much less toxic to cotyledon segments than either carbenicillin or cefotaxime. Immature cotyledons therefore yield numerous regenerated plants that may be useful in future transformation studies.
Collapse
Affiliation(s)
- D A Patton
- Department of Botany and Microbiology, Oklahoma State University, 74078, Stillwater, OK, USA
| | | |
Collapse
|