Head protection for horse riders: a cause for concern

We report the frequency with which horse riders with a significant head injury present to a large accident and emergency department. We have also recorded details about the use of headwear and conclude that horse-riding is associated with a serious risk of head injury and 'protective' headwear may not always protect.

Behavior analysis, program development, and transfer of control in the treatment of self-injury

This case study illustrates an empirical approach to the diagnosis, treatment, and controlled follow-up of self-injurious clients. Following an assessment period, during which environmental factors associated with a severely retarded adolescent's self-injury were identified, the contingent application of protective equipment was combined with a differential reinforcement procedure (DRO) and implemented in a multiple baseline design across two hospital settings. Results showed a marked decrease in the rate of self-injury. Upon discharge from the hospital, the program was successfully replicated at the adolescent's residential center, again using a multiple baseline design across settings.

Prevention of nervous system trauma from travel in motor vehicles

Brain and spinal cord injuries are a frequent cause of death and long-term disability in motor vehicle accidents. Helmet use reduces death and head injury severity in motorcycle accidents. Proper use of child restraints can prevent death from falls and vehicle crashes. Auto lap and shoulder restraints, when in use, reduce death from accidents and falls from cars. Passive protections, such as air bags, vehicle design for crashworthiness, and automatic seatbelt systems are less available for economic reasons. Voluntary use of available devices is the remaining viable option. One-to-one education may help promote use of protective devices. The greatest impact lies in legislative requirements for self-protection. It is ethically justifiable to require use of devices such as child restraints, seatbelts, and motorcycle helmets to prevent death and disability.

The biomechanics of helmets and helmet removal

To better understand motion in the cervical spine related to helmet wearing and removal, normal volunteers underwent videotaped fluoroscopy during helmet removal and lateral spine X-rays in various positions. There was a tendency towards increased flexion in the supine position in the helmeted volunteers which disappeared with minimal traction. In forced hyperextension, the posterior lip of the helmet did not guillotine the cervical spine. There was no significant difference in cervical spine motion between a one-person and two-person technique of helmet removal, and in both techniques, a minimum amount of flexion occurred in clearing the occiput.

Head injury in road traffic accidents. A prospective Study in Trøndelag, Norway, 1979-80

The purpose of the present prospective investigation was to study the epidemiology of head injuries sustained in road traffic accidents. The characteristics of all 503 head-injured patients admitted to hospitals in the two counties of Trøndelag province, Norway, in 1979 and 1980 are described. The annual incidence was 89 per 100 000 inhabitants. There was a male preponderance in all categories of victims. The highest male to female ratio was found in motorcyclists and mopedists (6.3:1). Pedal cycle accidents accounted for 33% of all accidents, constituting the most common cause of head injury on the roads in the period from May to the end of September. There were more pedal cycle accidents in the present series than in previous studies on road traffic accidents.

Eye injuries in Canadian amateur hockey

The incidence of eye injury in Canadian amateur hockey has declined sharply, from 257 cases in the 1974-75 season to 124 in the 1983-84 season, since face protectors certified by the Canadian Standards Association (CSA) and attached to CSA-certified helmets became mandatory for minor hockey players in this country. None of the reported cases in 1983-84 were in players wearing such equipment. The average age of the injured players was 14 years in 1974-75 but 24 years in 1983-84; that is, younger players are now protected, but older players are not. Hockey sticks and pucks were the top two causes of eye injury in both seasons, but hyphema became the commonest type of injury in 1983-84, surpassing soft tissue damage. The frequency of legal blindness as the visual outcome fell from 19% in 1974-75 to 11% in 1983-84. A suitable face protector must now be developed for older players.

The epidemiology of injuries to bicycle riders

Over half a million injuries related to bicycle crashes were seen in U.S. hospital emergency rooms in 1982. The data reviewed show a strong link between bicycle/motor vehicle collisions, head injury, and serious morbidity and mortality.

A comparison of iron oxide fume inside and outside of welding helmets

A study was conducted to compare the iron oxide fume concentrations inside and outside the helmets of welders. Airborne iron oxide fume concentrations were determined simultaneously at four body locations--the left front shoulder, right front shoulder, front chest, and inside the helmet--during welders' normal activity. Results indicate that the fume concentrations at the actual breathing zone inside helmets are reduced to 36%-71% of concentrations outside the helmets, depending on the type of welding and employees' postures.

[Pneumatic cold cap for the prevention of doxorubicin-induced alopecia]

Since 1973 several methods were described in the literature to prevent Doxorubicin induced alopecia. Besides the application of pressure scalp hypothermia gained increasing importance. Various modifications of scalp hypothermia were developed which are expensive and not easy in the handling so far. We are introducing a method in which a pneumatic cap is used for the application of ice on the scalp. With this method which is comperatively cheap and easy to be handled we got a protective effect against doxorubicin-induced hair loss which was at least as efficient as the current results with other methods referred in the literature.

"The grave yawns for the horseman." Equestrian deaths in South Australia 1973-1983

The fatalities associated with the riding and handling of horses in South Australia over the 11-year period 1973-1983 are reviewed. There were 18 deaths, including two sudden natural deaths in the saddle and one drowning. The 15 cases of horse-related trauma represent a death rate of approximately one per million population per annum. Thirteen of the deaths were the result of a head injury after a fall. Nine persons were not wearing protective headgear. The two principal groups at risk were male professional riders with a mean age of 32 years and female amateurs with a mean age of 19 years.

The impact of head trauma on society

In this address I shall discuss head trauma from an angle which may be unusual for neuroscientists. Our preoccupations are diagnostic challenges and management problems, but that which we experience at the bedside is only a narrow segment of a continuum which started with trauma somewhere in a war, on the road, at home, on the football field, in the boxing ring, and in many other distinct locations. When our role is over, there are only three places where head trauma victims can be found; in cemeteries, where every year, 5,000 new graves are made to accommodate fatal head injuries in Canada; in chronic hospitals, which are already overloaded with victims of various insults to the brain, and, of course, within society, which accepts the fully recovered or tolerates the subtle and not so subtle consequences of so-called ‘minor’ head injuries.

Clinical and pathological studies of brain injuries in horse-riding accidents: a description of cases and review with a warning to the unhelmeted

We present a clinical and pathological study of brain injuries in horse-riding accidents. Among six fatal cases, all experienced riders varying in age and sex, two were not wearing helmets and four had inadequate protective headgear. Among five non-fatal cases, four wore adequate helmets and only one of these suffered permanent neurological damage. The fifth was not wearing a helmet and although he eventually returned to work, a CT scan following the fall showed a deep-seated perithalamic hematoma. These findings are consistent with those of virtually all other studies in that they suggest that the present type of riding helmet is inadequate and largely unable to absorb the shock of a normal fall. We hope these findings will serve as a warning to those who choose to ride unhelmeted.

The inertial and geometrical properties of helmets

The center of gravity (CG) and the principal mass moments of inertia about the CG of Army aviator, American football, and bicycle helmets were experimentally determined by a variation of the classic differential weighing and torsional pendulum techniques. In the course of these experiments, an innovative method for three-dimensional (3D) digitization was found. An electronic caliper, which measured length, was used with a computer algorithm to achieve 3D digitization. The results of the above measurements show that the weight of the helmet and the distances from the CG to the orthogonal coordinate axes intercepts with the outer shell surface were highly correlated with its principal mass moments of inertia. A set of regression equations was derived on theoretical considerations and served to unify the experimentally obtained data. Our results indicate that the principal mass moments of inertia of helmets vary linearly with its mass but nonlinearly with size and shape. For a helmet, given its weight and certain geometrical distances, the regression equations estimate the principal mass moments of inertia to within 5% of its experimentally-determined values. For the helmets studied in this series, a modified linear-regression relationship between the principal mass moments of inertia and its mass was found. This result is reasonable because the mass distribution of the current generation of helmets are set primarily by the head size and secondarily by helmet size, shape, and materials.

Cervical injury from skiing

A retrospective study of 18 patients with cervical spine injuries from skiing accidents is presented. Four patients were treated surgically because of instabilities. Twelve patients had associated head injuries, two of whom were operated on. One patient died from severe craniocervical injury caused by collision with another skier. The causes of the cervical spine injuries are analyzed and the possibilities for preventing them are presented.

Recommended helmet removal techniques in a cervical spine injured patient

Helmet removal techniques in the absence of C-spine injuries have been developed and promulgated. Utilizing a cadaver model, these techniques were demonstrated to adversely affect pre-existing C-spine injury. Removal of helmets with cast cutters is recommended.

Cardiovascular responses to isometric neck muscle contractions: results after dynamic exercise with various headgear loading configurations

Experiments were conducted to quantify the cardiovascular response (blood pressure and heart rate) elicited by sustained isometric contractions of the neck muscles. The response was secondary to dynamic exercise with various headgear loading combinations. The neck muscles were loaded by the head itself (CON), the standard U.S. Army SPH-4 helmet (HEL), and a combination of the SPH-4 helmet with Night Vision Goggles (H/NVG). During two exercise periods of 5 min and 35 min, each of the five subjects would rotate the head from side-to-side in the CON, HEL, or H/NVG configuration. Immediately thereafter, the subject would position his head in an isometric head dynamometer and exert a sustained right lateral (LAT) neck contraction or forward (FOR) neck contraction at 70% of a maximal voluntary contraction (MVC). During this isometric neck muscle contraction, the subject's endurance time to fatigue was recorded, the blood pressure was manually recorded, and the heart rate was continuously recorded. Characteristic increases in the systolic and diastolic blood pressure and heart rate occurred with sustained isometric neck muscle contractions. There was an average 40% increase in the systolic blood pressure, an average 50% increase in the diastolic blood pressure, and an average 45% increase in the heart rate from resting to the end of a fatiguing 70% MVC (p less than 0.05). These responses appear to be relatively independent of the duration of the exercise period, the loading during the exercise period, and the specific muscle mass involved. The mechanisms for the pressor response and the heart rate response are reviewed.

Helmets and haematomas

This report discusses two cases referred on the same day to the Mersey Regional Neurosurgical Unit. Both patients bore positions of responsibility and each developed an extradural haematoma as a result of neglecting to wear the appropriate safety helmet for their respective sports. The two survived, without detectable morbidity, to learn the relevant lesson.

Effect of rebreathing on psychomotor skills when wearing integral crash helmets

Nine volunteer subjects underwent psychomotor testing when wearing an integral crash helmet in a variety of conditions which lead to rebreathing. There was a wide individual variation in the extent of rebreathing. In the worst conditions the minimum inspired carbon dioxide tension (PICO2) increased to 2.6 kPa. The psychomotor test was a tracking test based on a microcomputer. There was a significant deterioration in the ability to perform the test when the helmet was worn with the visor down and restricted airflow into the helmet (P = less than 0.05). In those tests when the minimum PICO2 exceeded 0.5 kPa the decrease in performance was more highly statistically significant (p = less than 0.005). Rebreathing wearing integral crash helmets results in a variable impairment in the subjects' ability to perform a tracking test. We recommend that the maximum level of CO2 retention inside integral crash helmets should not exceed 0.5 kPa minimum PICO2.

Why pedal cyclists should wear safety helmets

The safety of motor vehicle occupants has been improved dramatically by legislation compelling the wearing of seat belts; protection of motor cyclists against head injury has followed the mandatory wearing of a safety helmet. Bicyclists have been relatively ignored, which is especially regrettable when two thirds of bicycle casualties are school children. Helmets are worn by approximately 25 per cent of adult bicyclists using arterial roads but by less than five per cent of school children.

Head and neck injuries in Canadian Forces ejections

This paper reviews the head and neck injuries experienced by Canadian Forces Aircrew who ejected while wearing the DH 41-2 helmet during the period from 1 Jan. 1972 through 31 July 1982. Pre and post-ejection factors, including a review of helmet performance, are presented.

Contingent application of a protective device to treat the severe self-biting behavior of a disturbed autistic child

This study introduces the Bubble Helmet, a protective device, as an effective means of treating severe cases of self-biting behavior with disturbed developmentally disabled persons. The apparatus is a clear plastic sphere which fastens over the client's head, shielding the mouth from contact with hands and forearms. Use of the bubble in a response-contingent manner effectively eliminated the intense self-biting behavior of a 9-year-old autistic child in a community-based group home. This made it possible for her to be placed in a less restrictive community facility.

Othematoma associated with ill-fitting helmet and high G load: a case report

One case of othematoma caused by high +Gz load and an improperly fitted helmet is described. Many recommended modalities of treatment are followed by the reaccumulation of the fluid. Compression sutures should, therefore, be the treatment of choice. A properly-fitted, light-weight helmet can help prevent this injury.

Benefits of helmet-mounted display image stabilisation under whole-body vibration

The effects of whole-body vertical vibration in the range 2.5-25 Hz on visual performance with two types of raster scan helmet-mounted display have been determined. The benefit of an image stabilisation system on numeral reading performance during vibration was also assessed with both display systems. Increases in mean reading time of over 130%/m . s-2 R.M.S. and increases in percentage reading error of more than 30%/m . s-2 R.M.S. were recorded with unstabilised displays. With vertical and horizontal image stabilisation, these decrements in performance were reduced to less than 40%/m . s-2 R.M.S. increase in reading time and less than 10%/m . s-2 R.M.S. increase in reading error. Data on the transmission of vibration from the seat to the head and from the head to the helmet were also obtained. These indicate a relation between biodynamic behaviour and visual performance during vibration.

Reducing self-injury and corresponding self-restraint through the strategic use of protective clothing

We examined the use of protective clothing to reduce a retarded male's face-punching and leg-kicking and two corresponding forms of self-restraint--arm and leg self-restraint. The resident was observed each day in three sessions of randomly ordered conditions (one condition per session): without any protective clothing, with a padded helmet, and with a padded helmet and padded slippers. Use of the padded helmet substantially reduced face-punching and arm self-restraint. The addition of padded slippers reduced leg-kicking and leg self-restraint. These results suggest a practical and effective means of controlling self-injury and self-restraint. They are also consistent with the possibility that the resident's arm restraint was maintained in part by escape or avoidance of face-punching and that his leg restraint was maintained in part by escape or avoidance of leg-kicking.

Reduction of neonatal heat loss by an insulated head cover

When exposed to a cool environment, the newborn infant responds by nonshivering thermogenesis. The increased heat production is at the expense of body fuel and energy stores. A significant quantity of heat is lost from the head because of its large surface area and the high metabolic activity of the neonatal brain. The purpose of this study was to determine whether dry cranial heat loss could be significantly reduced by covering the head with highly insulated material, and to determine whether plastic lined hats decreased evaporative heat loss. A total of 46 fullterm and premature infants were studied. Hats insulated with material made of olefin and polyester reduced cranial dry heat loss by 73% and 63%. Plastic lined hats reduced evaporative heat loss by 68%. The insulated and lined hats proved to be a simple and safe method of effectively reducing dry and evaporative heat loss.

Neck muscle loading and fatigue: systematic variation of headgear weight and center-of-gravity

An extensive series of experiments has been conducted to quantify the fatigue of neck muscles as measured by isometric endurance time. The neck muscles were dynamically and statically loaded by systematic variation of 15 headgear configurations consisting of 5 different centers-of-gravity (forward-low, center-low, center-high, right-lateral-low and afterward-low) and 3 different weights (3.2 lb, 5.0 lb, 9.0 lb, 1.45, 2.27, 4.09 kg). Each of six subjects would rotate his head laterally (from side-to-side) for 30 min in each of the 15 headgear loading combinations. Immediately thereafter, the subject would position his head in an isometric head dynamometer and exert a sustained right lateral neck contraction at 70% of his maximum strength (MVC), during which endurance time (to fatigue) was recorded. The results indicate that there were no significant differences (p greater than 0.05) in endurance time between the 3.2 lb/forward-low, 3.2 lb/lateral-right-low, and 9.0 lb/afterward-low compared to controls (endurance time for at 70% MVC isometric neck contraction in which there was no prior head loading). All other head loading configurations (weight and center-of-gravity combinations) did result in a significant reduction (p less than or equal to 0.05) in endurance times (compared to controls). These results are significant since they provide useful insights into the optimal trade-off between various centers-of-gravity and helmet weight combinations which result in the optimization of neck muscle endurance.

[Modeling cranio-cerebral injury for evaluation and elaboration of the methods of protection of pilots from an impact]

This paper reviews the results of developing a model of craniocerebral trauma. The study led to the manufacture of a man's head model and to the development of a criterion of impact safety. The model and the criterion can be used for experimental assessment of pilot's protective helmets.

Fatal injuries to bicyclists: the experience of Dade County, Florida

Among 173 fatally injured bicyclists, the head or neck was the region most seriously injured in 86%. The frequency of injury to the head and neck region and the frequency of nonsurvivable (AIS 6) injury were highest among the cases aged 16 years or less. Vertebral fractures occurred most often in the highest cervical vertebra (C1) and progressively less often in lower vertebrae. The relationship between vertebral position and fracture likelihood is approximately log linear. Bicyclists with a relatively long time from injury to death tended to be older persons with survivable injuries. They often died from complications (pneumonia, pulmonary embolus) rather than directly from their injuries.

Motorcycling morbidity and mortality--an unstudied epidemic

South Africa has the highest motorcycle accident and associated casualty rate in the world. In dealing with the problem South Africa lags far behind other countries where rider training programmes have had astonishing success. Accident statistics, problems relating to motorcycling and protective clothing are discussed. Recommendations are made which if implemented should reduce the accident and casualty rate by at least 50%; this indicates the size of the problem in this neglected field of automotive preventive medicine.

Basilar skull fracture in U.S. Army aircraft accidents

Of the 222 flight helmets retrieved from Army aircraft accidents during 1971-79 under the Aviation Life Support Equipment Retrieval Programs, 175 were SPH-4 helmets that were analyzed for physical damage and for the relationship of damage to injury sustained by the wearer. This analysis showed that lateral impacts resulted in a significantly higher rate of serious injury (AIS greater than or equal to 4) than impacts to other regions (68% versus 46%, p less than 0.001) Lateral impacts yielded a higher rate of basilar skull fracture than impacts to other areas of the helmet (46% versus 18%, p less than 0.001). It is concluded that lack of energy-absorbing material in the lateral portions of the helmet causes the high rate of basilar skull fracture and the increased prevalence of severe injury associated with lateral impacts. The incorporation of an energy-absorbing earcup design is recommended to reduce the high rate of severe injuries associated with lateral impacts.

Head and/or torso cooling during simulated cockpit heat stress

Liquid-conditioned garments (LCG's) may be useful in alleviating heat stress on aircrew members. This study evaluated the effects of a liquid-cooled vest and/or cap on subjects exposed to a thermal environment which simulated the stress of low-level flight in hot weather. The chamber was set at dry bulb temperature 35 degrees C, wet bulb temperature 26 degrees C, and black globe temperature 43 degrees C. Subjects were eight men, aged 23-45 yr. Each subject was studied in four 100-min exposures: uncooled control (XX); head cooling only (HX); torso cooling only (XT); and combined head and torso cooling (HT). Cooling effects were evaluated by using rectal temperature (Tre); heart rate (HR); sweat rate (SRF and SRT for forehead and total body, respectively); and subjective comfort. Uncooled runs (XX) produced final values: Tre = 37.8 degrees C, HR = 94 beats/min, SRT = 25 g/m2 X h and SRF = 45 g/m2 X h. Combined head and torso cooling maintained the subjects at nearly their initial (baseline) state. Cap effects per se were assessed by comparing HX to XX, and HT to XT. Head cooling proved 2-3 times as efficient as torso cooling, although limited by the small surface area involved. We conclude that the specific effects of head cooling in improving comfort and diminishing forehead sweating, as well as the efficient systemic cooling observed, justify further work on cockpit applications.