A Proposed Injury Threshold for Mild Traumatic Brain Injury

2004 ◽  
Vol 126 (2) ◽  
pp. 226-236 ◽  
Author(s):  
Liying Zhang ◽  
King H. Yang ◽  
Albert I. King
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Human Head ◽  
Head Model ◽  
Tolerance Level ◽  
Social And Emotional ◽  
Injury Threshold ◽  
Accident Data

Traumatic brain injuries constitute a significant portion of injury resulting from automotive collisions, motorcycle crashes, and sports collisions. Brain injuries not only represent a serious trauma for those involved but also place an enormous burden on society, often exacting a heavy economical, social, and emotional price. Development of intervention strategies to prevent or minimize these injuries requires a complete understanding of injury mechanisms, response and tolerance level. In this study, an attempt is made to delineate actual injury causation and establish a meaningful injury criterion through the use of the actual field accident data. Twenty-four head-to-head field collisions that occurred in professional football games were duplicated using a validated finite element human head model. The injury predictors and injury levels were analyzed based on resulting brain tissue responses and were correlated with the site and occurrence of mild traumatic brain injury (MTBI). Predictions indicated that the shear stress around the brainstem region could be an injury predictor for concussion. Statistical analyses were performed to establish the new brain injury tolerance level.

A Proposed New Brain Injury Tolerance for Minor Traumatic Brain Injury

2001 ◽  
Author(s):  
Liying Zhang ◽  
King H. Yang ◽  
Albert I. King
Keyword(s):  
Brain Injury ◽  
Brain Injuries ◽  
Injury Severity ◽  
Human Head ◽  
Head Model ◽  
Tolerance Level ◽  
Social And Emotional ◽  
Accident Data ◽  
Actual Field ◽  
Injury Tolerance

Abstract Traumatic brain injuries constitute a significant portion of injury resulting from automotive collisions, motorcycle crashes, and sports collisions. Brain injuries not only represent a serious trauma for those involved but also place an enormous burden on society, often exacting a heavy economical, social, and emotional price. Development of intervention strategies to prevent or minimize these injuries requires a complete understanding of injury mechanism, response and tolerance level. In this study, an attempt is made to delineate actual injury causation and establish a meaningful injury criterion through the use of the actual field accident data. Twenty-four actual field head-to-head collisions that occurred in professional football games were duplicated using a validated finite element human head model. The injury predictors and injury levels were analyzed based on resulting brain tissue responses and were correlated with the site and occurrence of MTBI. Prediction indicated that the shear deformation around the brainstem region could be an injury predictor for concussion. Statistical analyses were performed to establish the new brain injury tolerance level and to further reduce brain injury severity.

Computational Study on the Bridging Vein Rupture of Blast-Induced Traumatic Brain Injury Using a Numerical Human Head Model

2011 ◽  
Author(s):  
Chenzhi Wang ◽  
Jae Bum Pahk ◽  
Carey D. Balaban ◽  
Jeffrey S. Vipperman
Keyword(s):  
Shock Wave ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subdural Hematoma ◽  
Human Head ◽  
Head Model ◽  
Cerebral Contusion ◽  
Injury Threshold ◽  
Bridging Vein ◽  
Human Head Model

The occurrence of blast-induced traumatic brain injury (bTBI) in people serving in battle environments is dramatically high. The blast front, or leading edge of the shock wave is a brief, acute overpressure wave that travels supersonically with a magnitude that is several times higher than that of ambient. The shock wave propagates through the human head and injures intracranial tissues. Classical neuropathologic signs of bTBI include cerebral contusion, diffuse axonal injury, subdural hematoma (SDH) and subarachnoid hematoma, of which subdural hematoma is the most dominating sign of bTBI. Here, computational finite element (FE) modeling is used to investigate the mechanical process of bTBI. The overall goal of the present study is to find the injury threshold of the SDH injury due to bTBI, by investigating the biomechanical response of the bridging veins in the human brain under shock wave loading that originates from detonation. This research mainly develops a basic FE human head model which consists of skull and parts of the brain. The geometric models of skull and brain are developed from segmentations of magnetic resonance imaging (MRI) files of a real human head. The boundary conditions on the neck and head are modeled as a displacement-fixed condition. The numerically simulated blast waves are applied on the human head model as external loading conditions. The internal response in the subarachnoid space is used as loadings on the bridging vein submodel. The maximum principal stress of the bridging vein is used to determine the whether there is failure of the bridging vein, thus estimating the “injury threshold” of SDH in bTBI. Results show that 150g TNT blast of 1 meter away from the head can result in a high possibility of SDH occurrence.

scholarly journals A Novel Closed-Head Model of Mild Traumatic Brain Injury Using Focal Primary Overpressure Blast to the Cranium in Mice

2016 ◽  
Vol 33 (4) ◽  
pp. 403-422 ◽  
Author(s):  
Natalie H. Guley ◽  
Joshua T. Rogers ◽  
Nobel A. Del Mar ◽  
Yunping Deng ◽  
Rafiqul M. Islam ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Head Model ◽  
Closed Head

scholarly journals Introduction of the Abbreviated Westmead Post-Traumatic Amnesia Scale and Impact on Length of Stay

2017 ◽  
Vol 106 (4) ◽  
pp. 356-360 ◽  
Author(s):  
C. E. Watson ◽  
E. A. Clous ◽  
M. Jaeger ◽  
S. K. D’Amours
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Hospital Admissions ◽  
Assessment Tool ◽  
Hospital Length Of Stay ◽  
Traumatic Amnesia ◽  
Post Traumatic

Background and Aims: Mild traumatic brain injury is a common presentation to Emergency Departments. Early identification of patients with cognitive deficits and provision of discharge advice are important. The Abbreviated Westmead Post-traumatic Amnesia Scale provides an early and efficient assessment of post-traumatic amnesia for patients with mild traumatic brain injuries, compared with the previously used assessment, the Modified Oxford Post-traumatic Scale. Material and Methods: This retrospective cohort study reviewed 270 patients with mild traumatic brain injury assessed for post-traumatic amnesia over a 2-year period between February 2011 and February 2013. It identified those assessed with Abbreviated Westmead Post-traumatic Amnesia Scale versus Modified Oxford Post-traumatic Scale, the outcomes of these post-traumatic amnesia assessments, the hospital length of stay for patients, and their readmission rates. Results: The Abbreviated Westmead Post-traumatic Amnesia Scale was used in 91% of patient cases (and the Modified Oxford Post-traumatic Scale in 7%), and of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 94% cleared post-traumatic amnesia testing within 4 h. Of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 56% had a shorter length of stay than had they been assessed with the Modified Oxford Post-traumatic Scale, resulting in 295 bed-days saved. Verbal and written discharge advice was provided to those assessed for post-traumatic amnesia to assist their recovery. In all, 1% of patients were readmitted for monitoring of mild post-concussion symptoms. Conclusion: The Abbreviated Westmead Post-traumatic Amnesia Scale provides an effective and timely assessment of post-traumatic amnesia for patients presenting to the Emergency Department with mild traumatic brain injury compared with the previously used assessment tool. It helps identify patients with cognitive impairment and the need for admission and further investigation, resulting in appropriate access to care. It also results in a decreased length of stay and decreased hospital admissions, with subsequent cost savings to the hospital.

scholarly journals A Biomechanical Evaluation of a Novel Airbag Bicycle Helmet Concept for Traumatic Brain Injury Mitigation

2021 ◽  
Vol 8 (11) ◽  
pp. 173
Author(s):  
Kwong Ming Tse ◽  
Daniel Holder
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Risk ◽  
Synergetic Effect ◽  
Human Head ◽  
Head Model ◽  
Bicycle Helmet ◽  
Impact Simulations ◽  
The Impact ◽  
Helmet Design

In this study, a novel expandable bicycle helmet, which integrates an airbag system into the conventional helmet design, was proposed to explore the potential synergetic effect of an expandable airbag and a standard commuter-type EPS helmet. The traumatic brain injury mitigation performance of the proposed expandable helmet was evaluated against that of a typical traditional bicycle helmet. A series of dynamic impact simulations on both a helmeted headform and a representative human head with different configurations were carried out in accordance with the widely recognised international bicycle helmet test standards. The impact simulations were initially performed on a ballast headform for validation and benchmarking purposes, while the subsequent ones on a biofidelic human head model were used for assessing any potential intracranial injury. It was found that the proposed expandable helmet performed admirably better when compared to a conventional helmet design—showing improvements in impact energy attenuation, as well as kinematic and biometric injury risk reduction. More importantly, this expandable helmet concept, integrating the airbag system in the conventional design, offers adequate protection to the cyclist in the unlikely case of airbag deployment failure.

scholarly journals A model of longitudinal hemodynamic alterations after mild traumatic brain injury in adolescents

2019 ◽  
Vol 3 ◽  
pp. 205970021983865
Author(s):  
Corey M Thibeault ◽  
Samuel Thorpe ◽  
Nicolas Canac ◽  
Michael J O’Brien ◽  
Mina Ranjbaran ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Diagnostic Tool ◽  
Brain Injuries ◽  
Transcranial Doppler Ultrasound ◽  
Traumatic Brain Injuries ◽  
Traumatic Injuries ◽  
Adolescent Population ◽  
Inverse Models

There is an unquestionable need for quantitative biomarkers of mild traumatic brain injuries. Something that is particularly true for adolescents – where the recovery from these injuries is still poorly understood. However, within this population, it is clear that the vasculature is distinctly affected by a mild traumatic brain injury. In addition, our group recently demonstrated how that effect appears to show a progression of alterations similar but in contrast to that found in severe traumatic injuries. Through measuring an adolescent population with transcranial Doppler ultrasound during a hypercapnia challenge, multiple phases of hemodynamic dysfunction were suggested. Here, we create a generalized model of the hemodynamic responses by fitting a set of inverse models to the dominant features from that work. The resulting model helps define the multiple phases of hemodynamic recovery after a mild traumatic brain injury. This can eventually be generalized, potentially providing a diagnostic tool for clinicians tracking patient’s recovery, and ultimately, resulting in more informed decisions and better outcomes.

scholarly journals Sensorimotor conflict tests in an immersive virtual environment reveal subclinical impairments in mild traumatic brain injury

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hrishikesh M. Rao ◽  
Tanya Talkar ◽  
Gregory Ciccarelli ◽  
Michael Nolan ◽  
Anne O’Brien ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Virtual Environment ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Clinical Tests ◽  
Immersive Virtual Environment ◽  
Average Accuracy ◽  
Patient Reported ◽  
Huge Impact

Abstract Current clinical tests lack the sensitivity needed for detecting subtle balance impairments associated with mild traumatic brain injury (mTBI). Patient-reported symptoms can be significant and have a huge impact on daily life, but impairments may remain undetected or poorly quantified using clinical measures. Our central hypothesis was that provocative sensorimotor perturbations, delivered in a highly instrumented, immersive virtual environment, would challenge sensory subsystems recruited for balance through conflicting multi-sensory evidence, and therefore reveal that not all subsystems are performing optimally. The results show that, as compared to standard clinical tests, the provocative perturbations illuminate balance impairments in subjects who have had mild traumatic brain injuries. Perturbations delivered while subjects were walking provided greater discriminability (average accuracy ≈ 0.90) than those delivered during standing (average accuracy ≈ 0.65) between mTBI subjects and healthy controls. Of the categories of features extracted to characterize balance, the lower limb accelerometry-based metrics proved to be most informative. Further, in response to perturbations, subjects with an mTBI utilized hip strategies more than ankle strategies to prevent loss of balance and also showed less variability in gait patterns. We have shown that sensorimotor conflicts illuminate otherwise-hidden balance impairments, which can be used to increase the sensitivity of current clinical procedures. This augmentation is vital in order to robustly detect the presence of balance impairments after mTBI and potentially define a phenotype of balance dysfunction that enhances risk of injury.

scholarly journals P048: Current practices of management for mild traumatic brain injuries with intracranial hemorrhage

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S80
Author(s):  
É. Fortier ◽  
V. Paquet ◽  
M. Émond ◽  
J. Chauny ◽  
S. Hegg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Intracranial Hemorrhage ◽  
Management Practices ◽  
Brain Injuries ◽  
Quebec City ◽  
Historical Cohort ◽  
Public Sector Health

Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.

Intracranial pressure–based validation and analysis of traumatic brain injury using a new three-dimensional finite element human head model

2019 ◽  
Vol 234 (1) ◽  
pp. 3-15 ◽  
Author(s):  
Tanu Khanuja ◽  
Harikrishnan Narayanan Unni
Keyword(s):  
Finite Element ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Brain Injuries ◽  
Three Dimensional ◽  
Human Head ◽  
Von Mises Stress ◽  
Head Model ◽  
Injury Mechanisms ◽  
Von Mises

Traumatic brain injuries are life-threatening injuries that can lead to long-term incapacitation and death. Over the years, numerous finite element human head models have been developed to understand the injury mechanisms of traumatic brain injuries. Many of these models are erroneous and used ellipsoidal or spherical geometries to represent brain. This work is focused on the development of high-quality, comprehensive three-dimensional finite element human head model with accurate representation of cerebral sulci and gyri structures in order to study traumatic brain injury mechanisms. Present geometry, predicated on magnetic resonance imaging data consist of three rudimentary components, that is, skull, cerebrospinal fluid with the ventricular system, and the soft tissues comprising the cerebrum, cerebellum, and brain stem. The brain is modeled as a hyperviscoelastic material. Meshed model with 10 nodes modified tetrahedral type element (C3D10M) is validated against two cadaver-based impact experiments by comparing the intracranial pressures at different locations of the head. Our results indicate a better agreement with cadaver results, specifically for the case of frontal and parietal intracranial pressure values. Existing literature focuses mostly on intracranial pressure validation, while the effects of von Mises stress on brain injury are not analyzed in detail. In this work, a detailed interpretation of neurological damage resulting from impact injury is performed by analyzing von Mises stress and intracranial pressure distribution across numerous segments of the brain. A reasonably good correlation with experimental data signifies the robustness of the model for predicting injury mechanisms based on clinical predictions of injury tolerance criteria.

scholarly journals Traumatic Brain Injury and Delayed Sequelae: A Review - Traumatic Brain Injury and Mild Traumatic Brain Injury (Concussion) are Precursors to Later-Onset Brain Disorders, Including Early-Onset Dementia

2007 ◽  
Vol 7 ◽  
pp. 1768-1776 ◽  
Author(s):  
Michael A. Kiraly ◽  
Stephen J. Kiraly
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Brain Disorders ◽  
Early Onset Dementia ◽  
Human Experiments ◽  
Delayed Consequences ◽  
Subsequent Onset

Brain injuries are too common. Most people are unaware of the incidence of and horrendous consequences of traumatic brain injury (TBI) and mild traumatic brain injury (MTBI). Research and the advent of sophisticated imaging have led to progression in the understanding of brain pathophysiology following TBI. Seminal evidence from animal and human experiments demonstrate links between TBI and the subsequent onset of premature, psychiatric syndromes and neurodegenerative diseases, including Alzheimer's disease (AD) and Parkinson's disease (PD). Objectives of this summary are, therefore, to instill appreciation regarding the importance of brain injury prevention, diagnosis, and treatment, and to increase awareness regarding the long-term delayed consequences following TBI.

Sign in / Sign up

Export Citation Format

Share Document