Influence of seat characteristics on occupant motion in low-speed rear impacts

Kinematic analysis of an unrestrained passenger in an autonomous vehicle during emergency braking

Analyzing human body movement is a critical aspect of biomechanical studies in road safety. While most studies have traditionally focused on assessing the head-neck system due to the restraint provided by seat belts, it is essential to examine the entire pelvis-thorax-head kinematic chain when these body regions are free to move. The absence of restraint systems is prevalent in public transport and is also being considered for future integration into autonomous vehicles operating at low speeds. This article presents an experimental study examining the movement of the pelvis, thorax and head of 18 passengers seated without seat belts during emergency braking in an autonomous bus. The movement was recorded using a video analysis system capturing 100 frames per second. Reflective markers were placed on the knee, pelvis, lumbar region, thorax, neck and head, enabling precise measurement of the movement of each body segment and the joints of the lumbar and cervical spine. Various kinematic variables, including angles, displacements, angular velocities and accelerations, were measured. The results delineate distinct phases of body movement during braking and elucidate the coordination and sequentiality of pelvis, thorax and head rotation. Additionally, the study reveals correlations between pelvic rotation, lumbar flexion, and vertical trunk movement, shedding light on their potential impact on neck compression. Notably, it is observed that the elevation of the C7 vertebra is more closely linked to pelvic tilt than lumbar flexion. Furthermore, the study identifies that the maximum angular acceleration of the head and the maximum tangential force occur during the trunk's rebound against the seatback once the vehicle comes to a complete stop. However, these forces are found to be insufficient to cause neck injury. While this study serves as a preliminary investigation, its findings underscore the need to incorporate complete trunk kinematics, particularly of the pelvis, into braking and impact studies, rather than solely focusing on the head-neck system, as is common in most research endeavors.

Predictors of high-cost patients with acute whiplash-associated disorder in Japan

INTRODUCTION

The proportion of neck injuries due to traffic accidents is increasing. Little is known about high-cost patients with acute whiplash-associated disorder (WAD). The present study aimed to investigate whether time to first visit for conventional medicine, multiple doctor visits, or alternative medicine could predict high-cost patients with acute WAD in Japan.

METHODS

Data from a compulsory, no-fault, government automobile liability insurance agency in Japan between 2014 and 2019 were used. The primary economic outcome was the total cost of healthcare per person. Treatment-related variables were assessed based on the time to first visit for conventional and alternative medicine, multiple doctor visits, and visits for alternative medicine. Patients were categorized according to total healthcare cost (low, medium, and high cost). The variables were subjected to univariate and multivariate analysis to compare high-cost and low-cost patients.

RESULTS

A total of 104,911 participants with a median age of 42 years were analyzed. The median total healthcare cost per person was 67,366 yen. The cost for consecutive medicine, for consecutive and alternative medicine, and total healthcare costs were significantly associated with all clinical outcomes. Female sex, being a homemaker, a history of WAD claim, residential area, patient responsibility in a traffic accident, multiple doctor visits, and visits for alternative medicine were identified as independent predictive factors for a high cost in multivariate analysis. Multiple doctor visits and visits for alternative medicine showed large differences between groups (odds ratios 2673 and 694, respectively). Patients with multiple doctor visits and visits for alternative medicine showed a significantly high total healthcare cost per person (292,346 yen) compared to those without (53,587 yen).

CONCLUSIONS

A high total healthcare cost is strongly associated with multiple doctor visits and visits for alternative medicine in patients with acute WAD in Japan.

Surface Electromyography Study Using a Low-Cost System: Are There Neck Muscles Differences When the Passenger Is Warned during an Emergency Braking Inside an Autonomous Vehicle?

Deaths and serious injuries caused by traffic accidents is a concerning public health problem. However, the problem can be mitigated by the Autonomous Emergency Braking (AEB) system, which can avoid the impact. The market penetration of AEB is exponentially growing, and non-impact situations are expected to become more frequent. Thus, new injury patterns must be analysed, and the neck is particularly sensitive to sudden acceleration changes. Abrupt braking would be enough to be a potential risk for cervical spine injury. There is controversy about whether or not there are differences in cervical behaviour depending on whether passengers are relaxed or contract their muscles before the imminent accident. In the present manuscript, 18 volunteers were subjected to two different levels of awareness during an emergency braking test. Cervical muscles (sternocleidomastoid and trapezius) were analysed by the sEMG signal captured by means of a low-cost system. The differences observed in the muscle response according to gender and age were notable when passengers are warned. Gender differences were more significant in the post-braking phase. When passengers were relaxed, subjects older than 35 registered higher sEMG values. Meanwhile, when passengers contract their muscles, subjects who were younger than or equal to 35 years old experienced an increment in the values of the sEMG signals.

Study of the Emergency Braking Test with an Autonomous Bus and the sEMG Neck Response by Means of a Low-Cost System

Nowadays, due to the advances and the increasing implementation of the autonomous braking systems in vehicles, the non-collision accident is expected to become more common than a crash when a sudden stop happens. The most common injury in this kind of accident is whiplash or cervical injury since the neck has high sensitivity to sharp deceleration. To date, biomechanical research has usually been developed inside laboratories and does not entirely represent real conditions (e.g., restraint systems or surroundings of the experiment). With the aim of knowing the possible neck effects and consequences of an automatic emergency braking inside an autonomous bus, a surface electromyography (sEMG) system built by low-cost elements and developed by us, in tandem with other devices, such as accelerometers or cameras, were used. Moreover, thanks to the collaboration of 18 participants, it was possible to study the non-collision effects in two different scenarios (braking test in which the passenger is seated and looking ahead while talking with somebody in front of him (BT1) and, a second braking test where the passenger used a smartphone (BT2) and nobody is seated in front of him talking to him). The aim was to assess the sEMG neck response in the most common situations when somebody uses some kind of transport in order to conclude which environments are riskier regarding a possible cervical injury.

Low-velocity motor vehicle collision characteristics associated with claimed low back pain

Objective: Up to 50% of individuals involved in low-velocity motor vehicle collisions report low back pain (LBP). A major limitation in such cases is the lack of knowledge of injury mechanisms linking the collision characteristics to the pain and pathology associated with LBP reporting. Thus, the objective of this investigation was to characterize the physical circumstances of low-velocity motor vehicle collisions that resulted in claims of LBP. Methods: Eighty-three forensically assessed cases were analyzed to identify specific collision and claimant characteristics. Results: Seventy-seven percent of reviewed cases involved a claim of LBP. Of these LBP claim cases, 70% of cases involved a rear-end collision configuration, and 40% of all cases were low-velocity collisions, with severities ranging between 10 and 12 km/h. The most common pre-existing medical condition was prior LBP or evidence of disc degeneration. Conclusions: The results of this investigation provide knowledge of collision characteristics that can be employed in future studies on the mechanisms of low back injury in low-speed motor vehicle collisions.

Real-world adjustments of driver seat and head restraint in Saab 9-3 vehicles

OBJECTIVE

Whiplash-associated disorder (WAD), commonly denoted whiplash injury, is a worldwide problem. These injuries occur at relatively low changes of velocity (typically <25 km/h) in impacts from all directions. Rear impacts, however, are the most common in the injury statistics. Females have a 1.5-3 times higher risk of whiplash injury than males.  Improved seat design is the prevailing means of increasing the protection of whiplash injury for occupants in rear impacts. Since 1997, more advanced whiplash protection systems have been introduced on the market, the Saab Active Head Restraint (SAHR) being one of the most prominent. The SAHR-which is height adjustable-is mounted to a pressure plate in the seatback by means of a spring-resisted link mechanism.  Nevertheless, studies have shown that seats equipped with reactive head restraints (such as the SAHR) have a very high injury-reducing effect for males (∼60-70%) but very low or no reduction effect for females. One influencing factor could be the position of the head restraint relative to the head, because a number of studies have reported that adjustable head restraints often are incorrectly positioned by drivers.  The aim was to investigate how female and male Saab drivers adjust the seat in the car they drive the most.

METHODS

The seated positions of drivers in stationary conditions have been investigated in a total of 76 volunteers (34 females, 42 males) who participated in the study. Inclusion criteria incorporated driving a Saab 9-3 on a regularly basis.

RESULTS

The majority of the volunteers (89%) adjusted the head restraint to any of the 3 uppermost positions and as many as 59% in the top position.  The average vertical distance between the top of the head and the top of the head restraint (offset) increase linearly with increasing statures, from an average of -26 mm (head below the head restraint) for small females to an average of 82 mm (head above the head restraint) for large males. On average, the offset was 23 mm for females, which is within a satisfactory range and in accordance with recommendations; the corresponding value for males was 72 mm.  The backset tended to be shorter among female volunteers (on average 27 mm) compared to the male volunteers (on average 44 mm). Moreover, the backset tended to increase with increasing statures.

CONCLUSIONS

Incorrect adjustment of the head restraint cannot explain the large differences found between the sexes in the effectiveness of the SAHR system.

Effects of whole spine alignment patterns on neck responses in rear end impact

OBJECTIVE

The aim of this study was to investigate the whole spine alignment in automotive seated postures for both genders and the effects of the spinal alignment patterns on cervical vertebral motion in rear impact using a human finite element (FE) model.

METHODS

Image data for 8 female and 7 male subjects in a seated posture acquired by an upright open magnetic resonance imaging (MRI) system were utilized. Spinal alignment was determined from the centers of the vertebrae and average spinal alignment patterns for both genders were estimated by multidimensional scaling (MDS). An occupant FE model of female average size (162 cm, 62 kg; the AF 50 size model) was developed by scaling THUMS AF 05. The average spinal alignment pattern for females was implemented in the model, and model validation was made with respect to female volunteer sled test data from rear end impacts. Thereafter, the average spinal alignment pattern for males and representative spinal alignments for all subjects were implemented in the validated female model, and additional FE simulations of the sled test were conducted to investigate effects of spinal alignment patterns on cervical vertebral motion.

RESULTS

The estimated average spinal alignment pattern was slight kyphotic, or almost straight cervical and less-kyphotic thoracic spine for the females and lordotic cervical and more pronounced kyphotic thoracic spine for the males. The AF 50 size model with the female average spinal alignment exhibited spine straightening from upper thoracic vertebra level and showed larger intervertebral angular displacements in the cervical spine than the one with the male average spinal alignment.

CONCLUSIONS

The cervical spine alignment is continuous with the thoracic spine, and a trend of the relationship between cervical spine and thoracic spinal alignment was shown in this study. Simulation results suggested that variations in thoracic spinal alignment had a potential impact on cervical spine motion as well as cervical spinal alignment in rear end impact condition.

A Female Ligamentous Cervical Spine Finite Element Model Validated for Physiological Loads

Mathematical cervical spine models allow for studying of impact loading that can cause whiplash associated disorders (WAD). However, existing models only cover the male anthropometry, despite the female population being at a higher risk of sustaining WAD in automotive rear-end impacts. The aim of this study is to develop and validate a ligamentous cervical spine intended for biomechanical research on the effect of automotive impacts. A female model has the potential to aid the design of better protection systems as well as improve understanding of injury mechanisms causing WAD. A finite element (FE) mesh was created from surface data of the cervical vertebrae of a 26-year old female (stature 167 cm, weight 59 kg). Soft tissues were generated from the skeletal geometry and anatomical literature descriptions. Ligaments were modeled with nonlinear elastic orthotropic membrane elements, intervertebral disks as composites of nonlinear elastic bulk elements, and orthotropic anulus fibrosus fiber layers, while cortical and trabecular bones were modeled as isotropic plastic-elastic. The model has geometrical features representative of the female cervical spine-the largest average difference compared with published anthropometric female data was the vertebral body depth being 3.4% shorter for the model. The majority the cervical segments compare well with respect to biomechanical data at physiological loads, with the best match for flexion-extension loads and less biofidelity for axial rotation. An average female FE ligamentous cervical spine model was developed and validated with respect to physiological loading. In flexion-extension simulations with the developed female model and an existing average male cervical spine model, a greater range of motion (ROM) was found in the female model.

IIHS head restraint ratings and insurance injury claim rates

OBJECTIVES

The Insurance Institute for Highway Safety (IIHS) rates front seat/head restraint designs using a combination of static and dynamic measurements following RCAR-IIWPG procedures. The purpose of this study was to determine whether vehicles with better IIHS-rated seats/head restraints had lower injury risk in rear-end collisions and how the effect of better rated seats interacted with driver gender and age.

METHODS

The presence of an associated insurance injury claim was determined for rear-impact crashes using 2001-2014 model year cars and SUVs. Logistic regression was used to compare injury risk for vehicles with good, acceptable, and marginal IIHS-rated seats/head restraints with poor-rated seats/head restraints. Analyses were run by gender and driver age and also by the rate of more severe injury claims.

RESULTS

Injury rates were 11.2% lower for vehicles with seats/head restraints rated good compared to vehicles with seats/head restraints rated poor. The percentage reduction for good- versus poor-rated seats was greater for females (12.7%) than males (8.9%). Comparing good- with poor-rated seats, driver ages 15-24 had the largest reduction at 19.8%, followed by 10.7% for driver ages 45-64 and 10.4% for driver ages 25-44.

CONCLUSIONS

Seats/head restraints with better IIHS ratings are associated with lower injury rates in rear-impact collisions than seats rated poor. The reductions in injury rates were strongest for females and for young-to-middle-age drivers. The strong reductions in injury rates for these groups are encouraging given their high initial injury rates.

Anthropometric specifications, development, and evaluation of EvaRID--a 50th percentile female rear impact finite element dummy model

OBJECTIVES

Whiplash-associated disorders (WADs), or whiplash injuries, due to low-severity vehicle crashes are of great concern in motorized countries and it is well established that the risk of such injuries is higher for females than for males, even in similar crash conditions. Recent protective systems have been shown to be more beneficial for males than for females. Hence, there is a need for improved tools to address female WAD prevention when developing and evaluating the performance of whiplash protection systems. The objective of this study is to develop and evaluate a finite element model of a 50th percentile female rear impact crash test dummy.

METHODS

The anthropometry of the 50th percentile female was specified based on literature data. The model, called EvaRID (female rear impact dummy), was based on the same design concept as the existing 50th percentile male rear impact dummy, the BioRID II. A scaling approach was developed and the first version, EvaRID V1.0, was implemented. Its dynamic response was compared to female volunteer data from rear impact sled tests.

RESULTS

The EvaRID V1.0 model and the volunteer tests compared well until ∼250 ms of the head and T1 forward accelerations and rearward linear displacements and of the head rearward angular displacement. Markedly less T1 rearward angular displacement was found for the EvaRID model compared to the female volunteers. Similar results were received for the BioRID II model when comparing simulated responses with experimental data under volunteer loading conditions. The results indicate that the biofidelity of the EvaRID V1.0 and BioRID II FE models have limitations, predominantly in the T1 rearward angular displacement, at low velocity changes (7 km/h). The BioRID II model was validated against dummy test results in a loading range close to consumer test conditions (EuroNCAP) and lower severity levels of volunteer testing were not considered.

CONCLUSIONS

The EvaRID dummy model demonstrated the potential of becoming a valuable tool when evaluating and developing seats and whiplash protection systems. However, updates of the joint stiffness will be required to provide better correlation at lower load levels. Moreover, the seated posture, curvature of the spine, and head position of 50th percentile female occupants needs to be established and implemented in future models.

ADSEAT--Adaptive Seat to Reduce Neck Injuries for Female and Male Occupants

Neck injuries sustained in low severity vehicle crashes are of worldwide concern and the risk is higher for females than for males. The objective of the study was to provide guidance on how to evaluate protective performance of vehicle seat designs aiming to reduce the incidence of neck injuries for female and male occupants. The objective was achieved by reviewing injury risk, establishing anthropometric data of an average female, performing dynamic volunteer tests comprising females and males, and developing a finite element model, EvaRID, of an average female. With respect to injury criteria, it was concluded based on the tests that using NIC (with a lower threshold value) and Nkm (with reduced intercept values) for females would be a suitable starting point. Virtual impact simulations with seats showed that differences were found in the response of the BioRID II and EvaRID models, for certain seats.

Analysis of the stability of PTW riders in autonomous braking scenarios

While fatalities of car occupants in the EU decreased remarkably over the last decade, Powered Two Wheelers (PTWs) fatalities still increase following the increase of PTW ownership. Autonomous braking systems have been implemented in several types of vehicles and are presently addressed by research in the field of PTWs. A major concern in this context is the rider stability. Experiments with volunteers were performed in order to find out whether autonomous braking for PTWs will produce a greater instability of the rider in comparison to manual braking. The PTW's braking conditions were simulated in a laboratory with a motorcycle mock-up mounted on a sled, which was accelerated with an average of 0.35 g. The motion of the rider was captured in autonomous braking scenarios with and without pre-warning as well as in manual braking scenarios. No significant differences between the scenarios were found with respect to maximum forward displacement of the volunteer's torso and head (p<0.05). By performing clustering analysis on two kinematic parameters, two different strategies of the volunteers were identified. They were not related to the braking scenarios. A relation of the clusters with the initial posture represented by the elbow angle was revealed (p<0.05). It is concluded that autonomous braking at low deceleration will not cause significant instabilities of the rider in comparison to manual braking in idealized laboratory conditions. Based on this, further research into the development and implementation of autonomous braking systems for PTWs, e.g. by extensive riding tests, seems valuable.

Motion of the head and neck of female and male volunteers in rear impact car-to-car impacts

OBJECTIVES

The objectives of this study were to quantify and compare dynamic motion responses between 50th percentile female and male volunteers in rear impact tests. These data are fundamental for developing future occupant models for crash safety development and assessment.

METHODS

High-speed video data from a rear impact test series with 21 male and 21 female volunteers at 4 and 8 km/h, originally presented in Siegmund et al. (1997), were used for further analysis. Data from a subset of female volunteers, 12 at 4 km/h and 9 at 8 km/h, were extracted from the original data set to represent the 50th percentile female. Their average height was 163 cm and their average weight was 62 kg. Among the male volunteers, 11 were selected, with an average height of 175 cm and an average weight of 73 kg, to represent the 50th percentile male. Response corridors were generated for the horizontal and angular displacements of the head, T1 (first thoracic vertebra), and the head relative to T1. T-tests were performed with the statistical significance level of .05 to quantify the significance of the differences in parameter values for the males and females.

RESULTS

Several differences were found in the average motion response of the male and female volunteers at 4 and 8 km/h. Generally, females had smaller rearward horizontal and angular motions of the head and T1 compared to the males. This was mainly due to shorter initial head-to-head restraint distance and earlier head-to-head restraint contact for the females. At 8 km/h, the female volunteers showed 12 percent lower horizontal peak rearward head displacement (P = .018); 22 percent lower horizontal peak rearward head relative to T1 displacement (P = .018); and 30 percent lower peak head extension angle (P = .001). The females also had more pronounced rebound motion.

CONCLUSIONS

This study indicates that there may be characteristic differences in the head-neck motion response between 50th percentile males and females in rear impacts. The exclusive use of 50th percentile male rear impact dummies may thus limit the assessment and development of whiplash prevention systems that adequately protect both male and female occupants. The results of this study could be used in the development and evaluation of a mechanical and/or computational average-sized female dummy model for rear impact safety assessment. These models are used in the development and evaluation of protective systems. It would be of interest to make further studies into seat configurations featuring a greater head-to-head restraint distance.

Dynamic kinematic responses of female volunteers in rear impacts and comparison to previous male volunteer tests

OBJECTIVES

The objective was to quantify dynamic responses of 50th percentile females in rear impacts and compare to those from similar tests with males. The results will serve as a basis for future work with models, criteria, and safety systems.

METHODS

A rear impact sled test series with 8 female volunteers was performed at velocity changes of 5 and 7 km/h. The following dynamic response corridors were generated for the head, T1 (first thoracic vertebra) and head relative to T1: (1) accelerations in posterior-anterior direction, (2) horizontal and vertical displacements, (3) angular displacements for 6 females close to the 50th percentile in size. Additionally, the head-to-head restraint distance and contact time and neck injury criterion (NIC) were extracted from the data set. These data were compared to results from previously performed male volunteer tests, representing the 50th percentile male, in equivalent test conditions. T-tests were performed with the statistical significance level of .05 to quantify the significance of the parameter value differences for the males and females.

RESULTS

At 7 km/h, the females showed 29 percent earlier head-to-head restraint contact time (p = .0072); 27 percent shorter horizontal rearward head displacement (p = .0017); 36 percent narrower head extension angle (p = .0281); and 52 percent lower NIC value (p = .0239) than the males in previous tests. This was mainly due to 35 percent shorter initial head-to-head restraint distance for the females (p = .0125). The peak head acceleration in the posterior-anterior direction was higher and occurred earlier for the females.

CONCLUSIONS

The overall result indicated differences in the dynamic response for the female and male volunteers. The results could be used in developing and evaluating a mechanical and/or mathematical average-sized female dummy model for rear impact safety assessment. These models can be used as a tool in the design of protective systems and for further development and evaluation of injury criteria.

Deceleration during 'real life' motor vehicle collisions - a sensitive predictor for the risk of sustaining a cervical spine injury?

Background

The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (ΔV) for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents.

Methods

ΔV was determined for every car and clinical findings related to the cervical spine were assessed and classified according to the Quebec Task Force (QTF).

Results

In our study, 32 (56%) subjects did not complain about symptoms and were therefore classified as QTF grade 0; 25 (44%) patients complained of neck pain: 8 (14%) were classified as QTF grade I, 6 (10%) as QTF grade II, and 11 (19%) as QTF grade IV. Only a slight correlation (r = 0.55) was found between the reported pain and ΔV. No relevant correlation was found between ΔV and the neck disability index (r = 0.46) and between ΔV and the QTF grade (r = 0.45) for any of the collision types. There was no ΔV threshold associated with acceptable sensitivity and specificity for the prognosis of a cervical spine injury.

Conclusion

The results of this study indicate that ΔV is not a conclusive predictor for cervical spine injury in real-life motor vehicle accidents. This is of importance for surgeons involved in medicolegal expertise jobs as well as patients who suffer from whiplash-associated disorders (WADs) after motor vehicle accidents.

Trial registration

The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.

Influence of anthropometry on the kinematics of the cervical spine and the risk of injury in sled tests in female volunteers

The objective of this study was to investigate the influence of anthropometric data on the kinematics of the cervical spine and the risk factors for sustaining a neck injury during rear-end collisions occurring in a sled test. A rear-end collision with a velocity change (DeltaV) of 6.3 km/h was simulated in a sled test with eight healthy female subjects. The study analysed the association of anthropometric data with the initial distance between the head and the head restraint, defined kinematic characteristics, the neck injury criterion (NIC) and the neck injury criterion minor (NICmin). The head circumference is negatively associated (r=-0.598) with the initial distance between the head and the head restraint, the maximal head extension (r=-0.687) and the maximal dorsal angular head acceleration (r=-0.633). The body weight (r=0.800), body height (r=0.949) and thorax circumference (r=0.632) are positively associated with the maximal ventral head translation. The neck length correlates positively with the NIC (r=0.826) and negatively with the NICmin (r=-0.797). Anthropometric factors influence the kinematics of the cervical spine and the risk of injury. A high risk of injury may be assumed for individuals with a small head circumference, long neck, tall body height and high body weight.

Influence of seat geometry and seating posture on NIC(max) long-term AIS 1 neck injury predictability

OBJECTIVE

Validated injury criteria are essential when developing restraints for AIS 1 neck injuries, which should protect occupants in a variety of crash situations. Such criteria have been proposed and attempts have been made to validate or disprove these. However, no criterion has yet been fully validated. The objective of this study is to evaluate the influence of seat geometry and seating posture on the NIC(max) long-term AIS 1 neck injury predictability by making parameter analyses on reconstructed real-life rear-end crashes with known injury outcomes.

METHODS

Mathematical models of the BioRID II and three car seats were used to reconstruct 79 rear-end crashes involving 110 occupants with known injury outcomes. Correlations between the NIC(max) values and the duration of AIS 1 neck injuries were evaluated for variations in seat geometry and seating posture. Sensitivities, specificities, positive predictive values, and negative predictive values were also calculated to evaluate the NIC(max) predictability.

RESULTS

Correlations between the NIC(max) values and the duration of AIS 1 neck injuries were found and these relations were used to establish injury risk curves for variations in seat geometry and seating posture. Sensitivities, specificities, positive predictive values, and negative predictive values showed that the NIC(max) predicts long-term AIS 1 neck injuries also for variations in seat geometry and seating postures.

CONCLUSION

The NIC(max) can be used to predict long-term AIS 1 neck injuries.

A new acceleration apparatus for the study of whiplash with human cadaveric cervical spine specimens

The biomechanics of whiplash is often studied using cadaveric cervical spine specimens. One of the most important points in this kind of study is to create realistic loading conditions. The aim of the present project therefore was to develop an acceleration apparatus, which allows the study of whiplash with human cadaveric cervical spine specimens under as realistic loading conditions as possible. The new acceleration apparatus mainly consisted of a sled, a pneumatic acceleration unit and a railtrack and offered several unique features to create more realistic loading conditions. Among these features, the possibility to simulate the passive movements of the trunk is of capital importance. In this new apparatus, first, the general feasibility of whiplash experiments was studied, second, the reproducibility of the impacts was quantified and third, the effect of simulated movements of the trunk on accelerations and loads was examined. In the new acceleration apparatus various types of collisions could reproducibly be simulated. Simulated passive movements of the trunk strongly influenced the loading pattern of the neck. Without pivoting a steep increase of all loading parameters could be observed. This increase was less pronounced if pivoting was allowed. In conclusion, biomechanical aspects of whiplash could reproducibly be examined in the new acceleration apparatus. Due to its significant effects on the loading of the neck, pivoting of the trunk should always be taken into account in future experiments on the biomechanics of whiplash in which isolated cervical spine specimens are used.

[Whiplash injury of the neck from concepts to facts]

OBJECTIVES

To focus on a topic of traumatology and rehabilitation becoming recently a much debated public health problem.

METHOD

A references search from Medline database with whiplash as keyword was carried out. Were selected articles with abstracts in french or english and focusing on accidentology, biomechanics, demonstrated lesions, epidemiology and treatments.

RESULTS

From 1664 references found, 232 were reviewed. The usual mechanism of crash is a rear-end collision inducing in the occupants of the bumped vehicle a sudden lower cervical spine extension with upper flexion followed by a global flexion. In nearly 50% of the cases, the stress occurring in the collision is comparable to that observed in bumper cars. The velocity changes are seldom up to 15 km/h. A headrest at the level of the center of gravity of the head restrict significantly the extension of the neck. Every structure of the cervical spine could be damaged and mainly the facet joints but the lesions were only demonstrated in severes traumatisms. The discrepancies in incidence among the different countries could be related to their medicolegal system. Although subjectives, the early symptoms are rather similar among patients suggesting true anatomical or functional disorders but the chronicity seems to be mainly related to social and psychological factors. The association of: no posterior midline cervical tenderness, no intoxication, normal alertness, no focal neurological deficit and no painful distracting injuries has a good predictive value of the lack of osteo-articular lesion on X-rays. Except the grade IV of the Quebec task Force (0, no symptom; 1, pain and stiffness; 2, neck complaint and physical signs; 3, neck complaint and neurological signs; 4, fracture or dislocation) the use of a collar should be avoided and the cervical spine should be mobilized.

CONCLUSION

In most whiplash injuries, the mildness should be early stated, mobilization encouraged, and procedures of compensation shortened.

Lumbar spinal strains associated with whiplash injury: a cadaveric study

OBJECTIVES

To study and quantify the effects of rear-end collision on the lumbar spine.

DESIGN

The lumbar spine of a cadaver was instrumented with rosette strain gauges applied on the lateral and anterior surfaces of T12, L2, and L4. Biaxial accelerometers were mounted on L1, L3, and L5. The cadaver was seated, restrained, and subjected to rear impacts of 5g and 8g.

RESULTS

The anterior shear strains had a biphasic shape. Spinal strains peaked at the T12 at approximately 120 and 370 msec, whereas in the L4 vertebra, it peaked at 200 and 380 msec. The anterior strain pattern of the L4 and T12 vertebrae were in diametrically opposite directions. In the second set of tests (8g experiment), the acceleration forces and strains pattern were similar to the 5g test but of higher magnitude. The principal anterior strain was 480 microm/m for 5g and 530 microm/m for 8g; the lateral shear strain was 680 microm/m and 1500 microm/m in the 5g and 8g experiments, respectively.

CONCLUSIONS

Forces generated during simulated whiplash collision induce biphasic lumbar spinal motions (increased-decreased lordosis) of insufficient magnitude to cause bony injuries, but they may be sufficient to cause soft-tissue injuries.

The effectiveness of active head restraint in preventing whiplash

BACKGROUND

Whiplash injury claims have increased for two decades and manual head restraints are often incorrectly adjusted. A Self-Aligning Head Restraint (SAHR) was designed to move upward and forward by occupant motion in a rear crash providing earlier neck support, even when the head restraint is positioned low. This study determines its field effectiveness.

METHODS

Insurance records were analyzed for consecutive Saab rear crashes in Sweden over 18 months. The Saab 9000/900 had standard head restraints and Saab 9-5/9-3 had SAHR. A questionnaire was mailed to the occupants, insurance and medical records were reviewed, and phone interviews were conducted.

RESULTS

SAHR reduced whiplash injury risks by 75 +/- 11% from an 18 +/- 5% incidence in 85 occupants with standard head restraints to 4 +/- 3% in 92 occupants with SAHR. No SAHR seat required repair or replacement after the crashes.

CONCLUSION

SAHR is effective in reducing whiplash injury in rear crashes and is a passive public-health approach that works irrespective of manual head-restraint adjustment.

Whiplash: a review of a commonly misunderstood injury

Whiplash injury is a relatively common occurrence, but its mechanism and optimal treatment remain poorly understood. It is estimated that the incidence of whiplash injury is approximately 4 per 1,000 persons. The most common radiographic findings include either preexisting degenerative changes or a slight flattening of the normal lordotic curvature of the cervical spine. Computed tomography and magnetic resonance imaging are generally reserved for cases of neurologic deficit, suspected disc or spinal cord damage, fracture, or ligamentous damage. Biomechanics studies have determined that after rear impact C6 is rotated back into extension before movement of the upper cervical vertebrae. Thus, the lower cervical vertebrae were in extension while the upper vertebrae were in a position of relative flexion, producing an S shape in the cervical spine. It is believed that this abnormal motion pattern might play a role in the development of whiplash injuries. Historically, a soft cervical collar has been used early after the injury in an attempt to restrict cervical range of motion and limit the chances of further injury. More recent studies report rest and restriction of motion to be detrimental and to slow the healing process.