Tissue-level thresholds for axonal damage in an experimental model of central nervous system white matter injury

Peaks and Distributions of White Matter Tract-related Strains in Bicycle Helmeted Impacts: Implication for Helmet Ranking and Optimization

Traumatic brain injury (TBI) in cyclists is a growing public health problem, with helmets being the major protection gear. Finite element head models have been increasingly used to engineer safer helmets often by mitigating brain strain peaks. However, how different helmets alter the spatial distribution of brain strain remains largely unknown. Besides, existing research primarily used maximum principal strain (MPS) as the injury parameter, while white matter fiber tract-related strains, increasingly recognized as effective predictors for TBI, have rarely been used for helmet evaluation. To address these research gaps, we used an anatomically detailed head model with embedded fiber tracts to simulate fifty-one helmeted impacts, encompassing seventeen bicycle helmets under three impact locations. We assessed the helmet performance based on four tract-related strains characterizing the normal and shear strain oriented along and perpendicular to the fiber tract, as well as the prevalently used MPS. Our results showed that both the helmet model and impact location affected the strain peaks. Interestingly, we noted that different helmets did not alter strain distribution, except for one helmet under one specific impact location. Moreover, our analyses revealed that helmet ranking outcome based on strain peaks was affected by the choice of injury metrics (Kendall's Tau coefficient: 0.58-0.93). Significant correlations were noted between tract-related strains and angular motion-based injury metrics. This study provided new insights into computational brain biomechanics and highlighted the helmet ranking outcome was dependent on the choice of injury metrics. Our results also hinted that the performance of helmets could be augmented by mitigating the strain peak and optimizing the strain distribution with accounting the selective vulnerability of brain subregions and more research was needed to develop region-specific injury criteria.

A comparison of head impact characteristics during elite men's Rugby Union fifteens and sevens match play

Different forms of rugby may pose distinct risks to head injury. Video of rugby match footage was analyzed using head impact magnitude, frequency, and time interval for 15s and 7s athletes. Impacts were reconstructed in laboratory, and finite element modeling was used to estimate maximum principal strain. No difference was found in impact frequency or time interval between the two forms. Significantly more head impacts of higher severity levels were documented during 7s. These findings provide objective comparisons between 7s and 15s which may guide risk mitigation strategies in managing brain trauma for specific forms of rugby.

Comparing frequency and maximum principal strain of head impacts for U15 ice hockey leagues with standard and modified body contact rules

Brain trauma in bodychecking ice hockey is of concern for youth participants, as it presents unique risks compared to the non-bodychecking version of the sport. This study compared head impact frequency and magnitude between two ice hockey leagues with different body contact rules in the U15 age division: AAA (standard bodychecking) and M15 Minor (modified body contact rules). Video analysis of 16 games per league revealed no significant overall diference in impact frequency. M15 Minor players sustained significantly more head-to-head (14 to 2) impacts and AAA players sustained significantly more head-to-glass (18 to 7) and punch impacts (4 to 0). Laboratory reconstructions and finite element modeling were used to determine impact magnitude as maximum principal strain (MPS) and categorized from very low to very high. Higher impact frequency of very low MPS head impact events were observed for M15 Minor (61 to 51). The findings from this study highlight that this method of modifying body contact rules in U15 hockey did not result in lower levels of brain trauma, rather it presented unique brain trauma mechanisms compared to bodychecking.

Helmets with lattice liners can mitigate traumatic brain injury from impacts

This study explores the effectiveness of architected lattice structures, specifically made of polyamide 12 (PA12) material, as potential helmet liners to mitigate traumatic brain injuries (TBI), with a focus on rotational acceleration. Evaluating three lattice unit cell topologies (simple cubic, dode-medium, and rhombic dodecahedron), the research builds upon prior investigations indicating that PA12 lattice liners may outperform conventional EPS liners. Employing a high-fidelity finite element male head model and utilizing direct and oblique impact scenarios, mechanical quantities, such as maximum principal strain (MPS) and shear strain, cumulative strain damage measure and intracranial pressure were measured at the tissue level in different brain regions. Results indicate that lattice liners, especially with dode-medium topology, exhibit promising reductions in brain tissue strains. On average, during oblique impacts, less than 1 % of the brain volume experienced an MPS level of 0.4 when the lattice liners were adopted, whereas that percentage was above 70 % with the expandable polystyrene (EPS) foam liners. Pressure-based assessments suggest that lattice liners may outperform EPS liners in oblique impacts, showcasing the limitations of EPS for effective TBI mitigation. Despite certain model limitations, this study emphasizes the need for advancements in helmet technology, particularly in the development of commercial lattice liners using additive manufacturing, to address the limitations of existing EPS liners in preventing rotational consequences of impacts and reducing TBI.

Simulating Cerebral Edema and Ischemia After Traumatic Acute Subdural Hematoma Using Triphasic Swelling Biomechanics

Poor outcome following traumatic acute subdural hematoma (ASDH) is associated with the severity of the primary injury and secondary injury including cerebral edema and ischemia. However, the underlying secondary injury mechanism contributing to elevated intracranial pressure (ICP) and high mortality rate remains unclear. Cerebral edema occurs in response to the exposure of the intracellular fixed charge density (FCD) after cell death, causing ICP to increase. The increased ICP from swollen tissue compresses blood vessels in adjacent tissue, restricting blood flow and leading to ischemic damage. We hypothesize that the mass occupying effect of ASDH exacerbates the ischemic injury, leading to ICP elevation, which is an indicator of high mortality rate in the clinic. Using FEBio (febio.org) and triphasic swelling biomechanics, this study modeled clinically relevant ASDHs and simulated post-traumatic brain swelling and ischemia to predict ICP. Results showed that common convexity ASDH significantly increased ICP by exacerbating ischemic injury, and surgical removal of the convexity ASDH may control ICP by preventing ischemia progression. However, in cases where the primary injury is very severe, surgical intervention alone may not effectively decrease ICP, as the contribution of the hematoma to the elevated ICP is insignificant. In addition, interhemispheric ASDH, located between the cerebral hemispheres, does not significantly exacerbate ischemia, supporting the conservative surgical management generally recommended for interhemispheric ASDH. The joint effect of the mass occupying effect of the blood clot and resulting ischemia contributes to elevated ICP which may increase mortality. Our novel approach may improve the fidelity of predicting patient outcome after motor vehicle crashes and traumatic brain injuries due to other causes.

An Objective Injury Threshold for the Maximum Principal Strain Criterion for Brain Tissue in the Finite Element Head Model and Its Application

Although the finite element head model (FEHM) has been widely utilized to analyze injury locations and patterns in traumatic brain injury, significant controversy persists regarding the selection of a mechanical injury variable and its corresponding threshold. This paper aims to determine an objective injury threshold for maximum principal strain (MPS) through a novel data-driven method, and to validate and apply it. We extract the peak responses from all elements across 100 head impact simulations to form a dataset, and then determine the objective injury threshold by analyzing the relationship between the combined injury degree and the threshold according to the stationary value principle. Using an occipital impact case from a clinical report as an example, we evaluate the accuracy of the injury prediction based on the new threshold. The results show that the injury area predicted by finite element analysis closely matches the main injury area observed in CT images, without the issue of over- or underestimating the injury due to an unreasonable threshold. Furthermore, by applying this threshold to the finite element analysis of designed occipital impacts, we observe, for the first time, supra-tentorium cerebelli injury, which is related to visual memory impairment. This discovery may indicate the biomechanical mechanism of visual memory impairment after occipital impacts reported in clinical cases.

Imaging of dysthyroid optic neuropathy

Dysthyroid optic neuropathy (DON) is a sight-threatening complication of thyroid eye disease and can lead to permanent vision loss if not treated early. Imaging with computed tomography (CT) or magnetic resonance imaging (MRI) can aid in the diagnosis and early recognition of DON. A number of quantitative and qualitative imaging features have been associated with DON. This article summarises the definition, prevalence, and utility of these radiological findings in the diagnosis of DON.

A proof of concept model to calculate white and grey matter AIS injuries in pedestrian collisions

In the real world, the severity of traumatic injuries is measured using the Abbreviated Injury Scale (AIS) and is often estimated, in finite element human computer models, with the maximum principal strains (MPS) tensor. MPS can predict when a serious injury is reached, but cannot provide any AIS measures lower and higher from this. To overcome these limitations, a new organ trauma model (OTM2), capable of calculating the threat to life of any organ injured, is proposed. The OTM2 model uses a power method, namely peak virtual power, and defines brain white and grey matters trauma responses. It includes human age effect (volume and stiffness), localised impact contact stiffness and provides injury severity adjustments for haemorrhaging. The focus, in this case, is on real-world pedestrian brain injuries. OTM2 model was tested against three real-life pedestrian accidents and has proven to reasonably predict the post mortem (PM) outcome. Its AIS predictions are closer to the real-world injury severity than the standard maximum principal strain (MPS) methods currently used. This proof of concept suggests that OTM2 has the potential to improve forensic predictions as well as contribute to the improvement in vehicle safety design through the ability to measure injury severity. This study concludes that future advances in trauma computing would require the development of a brain model that could predict haemorrhaging.

Brain trauma characteristics for lightweight and heavyweight fighters in professional mixed martial arts

Mixed martial arts (MMA) is a sport where the fighters are at high risk of brain trauma, with characteristics, such as the frequency, magnitude, and interval of head impacts influencing the risk of developing short- and long-term negative brain health outcomes. These characteristics may be influenced by weight class as they may have unique fighting styles. The purpose of this research was to compare frequency, magnitude, and interval of head impacts between lightweight and heavyweight fighters in professional MMA. Frequency, interval, event type, velocity, and location of head impacts were documented for 60 fighters from 15 Lightweight and 15 Heavyweight professional MMA fights. Head impact reconstructions of these events were performed using physical and finite element modelling methods to determine the strain in the brain tissues. The results found that LW and HW fighters sustained similar head impact frequencies and intervals. The LW fighters sustained a significantly higher frequency of very low and high magnitude impacts to the head from punches; HW a larger frequency of high category strains from elbow strikes. These brain trauma profiles reflect different fight strategies and may inform methods to manage and mitigate the long-term effects of repetitive impacts to the head.

Quantitative assessment of brain injury and concussion induced by an unintentional soccer ball impact

BACKGROUND

Accidental impact on a player's head by a powerful soccer ball may lead to brain injuries and concussions during games. It is crucial to assess these injuries promptly and accurately on the field. However, it is challenging for referees, coaches, and even players themselves to accurately recognize potential injuries and concussions following such impacts. Therefore, it is necessary to establish a list of minimum ball velocity thresholds that can result in concussions at different impact locations on the head. Additionally, it is important to identify the affected brain regions responsible for impairments in brain function and potential clinical symptoms.

METHODS

By using a full human finite element model, dynamic responses and brain injuries caused by unintentional soccer ball impacts on six distinct head locations (forehead, tempus, crown, occiput, face, and jaw) at varying ball velocities (10, 15, 20, 25, 30, 35, 40, and 60 m/s) were simulated and investigated. Intracranial pressure, Von-Mises stress, and first principal strain were analyzed, the ball velocity thresholds resulting in concussions at different impact locations were evaluated, and the damage evolution patterns in the brain tissue were analyzed.

RESULTS

The impact on the occiput is most susceptible to induce brain injuries compared to all other impact locations. For a conservative assessment, the risk of concussion is present once the soccer ball reaches 17.2 m/s in a frontal impact, 16.6 m/s in a parietal impact, 14.0 m/s in an occipital impact, 17.8 m/s in a temporal impact, 18.5 m/s in a facial impact or 19.2 m/s in a mandibular impact. The brain exhibits the most significant dynamic responses during the initial 10-20 ms, and the damaged regions are primarily concentrated in the medial temporal lobe and the corpus callosum, potentially causing impairments in brain functions.

CONCLUSIONS

This work offers a framework for quantitatively assessing brain injuries and concussions induced by an unintentional soccer ball impact. Determining the ball velocity thresholds at various impact locations provides a benchmark for evaluating the risks of concussion. The examination of brain tissue damage evolution introduces a novel approach to linking biomechanical responses with possible clinical symptoms.

Finite element brain deformation in adolescent soccer heading

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.

Computational modeling and uncertainty prediction of hyperelastic constitutive responses of damaged brain tissue under different temperature and strain rates

The effect of strain rate and temperature on the hyperelastic material stress-strain characteristics of the damaged porcine brain tissue is evaluated in this present work. The desired constitutive responses are obtained using the commercially available finite element (FE) tool ABAQUS, utilizing 8-noded brick elements. The model's accuracy has been verified by comparing the results from the previously published literature. Further, the stress-strain behavior of the brain tissue is evaluated by varying the damages at various strain rates and temperatures (13, 20, 27, and 37°C) under compression test. Additionally, the sensitivity analysis of the model is computed to check the effect of input parameters, that is, the temperature, strain rate, and damages on the material properties (shear modulus). The modeling and discussion sections enumerate the inclusive features and model capabilities.

Impact of prior axonal injury on subsequent injury during brain tissue stretching - A mesoscale computational approach

Epidemiology studies of traumatic brain injury (TBI) show individuals with a prior history of TBI experience an increased risk of future TBI with a significantly more detrimental outcome. But the mechanisms through which prior head injuries may affect risks of injury during future head insults have not been identified. In this work, we show that prior brain tissue injury in the form of mechanically induced axonal injury and glial scar formation can facilitate future mechanically induced tissue injury. To achieve this, we use finite element computational models of brain tissue and a history-dependent pathophysiology-based mechanically-induced axonal injury threshold to determine the evolution of axonal injury and scar tissue formation and their effects on future brain tissue stretching. We find that due to the reduced stiffness of injured tissue and glial scars, the existence of prior injury can increase the risk of future injury in the vicinity of prior injury during future brain tissue stretching. The softer brain scar tissue is shown to increase the strain and strain rate in its vicinity by as much as 40% in its vicinity during dynamic stretching that reduces the global strain required to induce injury by 20% when deformed at 15 s-1 strain rate. The results of this work highlight the need to account for patient history when determining the risk of brain injury.

Finite element modeling and analysis of effect of preexisting cervical degenerative disease on the spinal cord during flexion and extension

Recent studies have emphasized the importance of dynamic activity in the development of myelopathy. However, current knowledge of how degenerative factors affect the spinal cord during motion is still limited. This study aimed to investigate the effect of various types of preexisting herniated cervical disc and the ligamentum flavum ossification on the spinal cord during cervical flexion and extension. A detailed dynamic fluid-structure interaction finite element model of the cervical spine with the spinal cord was developed and validated. The changes of von Mises stress and maximum principal strain within the spinal cord in the period of normal, hyperflexion, and hyperextension were investigated, considering various types and grades of disc herniation and ossification of the ligamentum flavum. The flexion and extension of the cervical spine with spinal canal encroachment induced high stress and strain inside the spinal cord, and this effect was also amplified by increased canal encroachments and cervical hypermobility. The spinal cord might evade lateral encroachment, leading to a reduction in the maximum stress and principal strain within the spinal cord in local-type herniation. Although the impact was limited in the case of diffuse type, the maximum stress tended to appear in the white matter near the encroachment site while compression from both ventral and dorsal was essential to make maximum stress appear in the grey matter. The existence of canal encroachment can reduce the safe range for spinal cord activities, and hypermobility activities may induce spinal cord injury. Besides, the ligamentum flavum plays an important role in the development of central canal syndrome.Significance. This model will enable researchers to have a better understanding of the influence of cervical degenerative diseases on the spinal cord during extension and flexion.

Dynamic strain fields of the mouse brain during rotation

Mouse models are used to better understand brain injury mechanisms in humans, yet there is a limited understanding of biomechanical relevance, beginning with how the murine brain deforms when the head undergoes rapid rotation from blunt impact. This problem makes it difficult to translate some aspects of diffuse axonal injury from mouse to human. To address this gap, we present the two-dimensional strain field of the mouse brain undergoing dynamic rotation in the sagittal plane. Using a high-speed camera with digital image correlation measurements of the exposed mid-sagittal brain surface, we found that pure rotations (no direct impact to the skull) of 100-200 rad/s are capable of producing complex strain fields that evolve over time with respect to rotational acceleration and deceleration. At the highest rotational velocity tested, the largest tensile strains (≥ 21% elongation) in selected regions of the mouse brain approach strain thresholds previously associated with axonal injury in prior work. These findings provide a benchmark to validate the mechanical response in biomechanical computational models predicting diffuse axonal injury, but much work remains in correlating tissue deformation patterns from computational models with underlying neuropathology.

Development of a head-weighted injury criterion for evaluation of multiple types of AIS 4+ injuries for vulnerable road users

Vulnerable Road users (VRUs) often suffer multiple fatal head injury types simultaneously in road accidents. In this study, a head-weighted injury criterion (HWIC4) was proposed for assessing the risk of head AIS 4+ injuries considering multiple injury types. Firstly, the kinematic characteristics of VRUs in the 50 in-depth accidents were reconstructed by using multi-body system models, and head injuries were reconstructed using eight head kinematic-based injury criteria and eight brain tissue injury criteria via the THUMS (Ver. 4.0.2) head finite element model. The predictive capability of each injury criterion to predict head AIS 4+ injuries was assessed and four better predictors (HIC15, angular acceleration, coup pressure, and maximum principal strain) were selected. The different head injury types and the weighting parameters for each injury type were taken into account in the development of HWIC4. Finally, the effectiveness and evaluation of HWIC4 for head AIS 4+ injury was validated based on the area under of receiver operating characteristic (AUROC) curve and reconstruction results from 10 additional selected accident cases. The results showed that HWIC4 has a good predictive capability for head AIS 4+ injuries with an AUROC of 0.983, which means that HWIC4 is superior and more reliable than a single head injury criterion. This knowledge further improves the capability of head injury criteria to predict head AIS 4+ injuries.

Translational medical bioengineering research of traumatic brain injury among Chinese and American pedestrians caused by vehicle collision based on human body finite element modeling

Based on the average human body size in China and the THUMS AM50 finite element model of the human body, the Kriging interpolation algorithm was used to model the Chinese 50th percentile human body, and the biological fidelity of the model was verified. We built three different types of passenger vehicle models, namely, sedan, sports utility vehicle (SUV), and multi-purpose vehicle (MPV), and used mechanical response analysis and finite element simulation to compare and analyze the dynamic differences and head injury differences between the Chinese 50th percentile human body and the THUMS AM50 model during passenger vehicle collisions. The results showed that there are obvious differences between the Chinese mannequin and THUMS in terms of collision time, collision position, invasion speed, and angle. When a sedan collided with the mannequins, the skull damage to the Chinese human body model was more severe, and when a sedan or SUV collided, the brain damage to the Chinese human body was more severe. The abovementioned results suggest that the existing C-NCAP pedestrian protection testing regulations may not provide the best protection for Chinese human bodies, and that the regulations need to be improved by combining collision damage mechanisms and the physical characteristics of Chinese pedestrians. This thorough investigation is positioned to shed light on the fundamental biomechanics and injury mechanisms at play. Furthermore, the amalgamation of clinically rooted translational and engineering research in the realm of traumatic brain injury has the potential to establish a solid foundation for discerning preventive methodologies. Ultimately, this endeavor holds the potential to introduce effective strategies aimed at preventing and safeguarding against traumatic brain injuries.

Dysthyroid Optic Neuropathy

PURPOSE

Dysthyroid optic neuropathy (DON) is a sight-threatening complication of thyroid eye disease (TED). This review provides an overview of the epidemiology, pathogenesis, diagnosis, and current therapeutic options for DON.

METHODS

A literature review.

RESULTS

DON occurs in about 5% to 8% of TED patients. Compression of the optic nerve at the apex is the most widely accepted pathogenic mechanism. Excessive stretching of the nerve might play a role in a minority of cases. Increasing age, male gender, smoking, and diabetes mellitus have been identified as risk factors. Diagnosis of DON is based on a combination of ≥2 clinical findings, including decreased visual acuity, decreased color vision, relative afferent pupillary defect, visual field defects, or optic disc edema. Orbital imaging supports the diagnosis by confirming apical crowding or optic nerve stretching. DON should be promptly treated with high-dose intravenous glucocorticoids. Decompression surgery should be performed, but the response is incomplete. Radiotherapy might play a role in the prevention of DON development and may delay or avoid the need for surgery. The advent of new biologic-targeted agents provides an exciting new array of therapeutic options, though more research is needed to clarify the role of these medications in the management of DON.

CONCLUSIONS

Even with appropriate management, DON can result in irreversible loss of visual function. Prompt diagnosis and management are pivotal and require a multidisciplinary approach. Methylprednisolone infusions still represent first-line therapy, and surgical decompression is performed in cases of treatment failure. Biologics may play a role in the future.

Regional Strain Response of an Anatomically Accurate Human Finite Element Head Model Under Frontal Versus Lateral Loading

INTRODUCTION

Because brain regions are responsible for specific functions, regional damage may cause specific, predictable symptoms. However, the existing brain injury criteria focus on whole brain response. This study developed and validated a detailed human brain computational model with sufficient fidelity to include regional components and demonstrate its feasibility to obtain region-specific brain strains under selected loading.

METHODS

Model development used the Simulated Injury Monitor (SIMon) model as a baseline. Each SIMon solid element was split into 8, with each shell element split into 4. Anatomical regions were identified from FreeSurfer fsaverage neuroimaging template. Material properties were obtained from literature. The model was validated against experimental intracranial pressure, brain-skull displacement, and brain strain data. Model simulations used data from laboratory experiments with a rigid arm pendulum striking a helmeted head-neck system. Data from impact tests (6 m/s) at 2 helmet sites (front and left) were used.

RESULTS

Model validation showed good agreement with intracranial pressure response, fair to good agreement with brain-skull displacement, and good agreement for brain strain. CORrelation Analysis scores were between 0.72 and 0.93 for both maximum principal strain (MPS) and shear strain. For frontal impacts, regional MPS was between 0.14 and 0.36 (average of left and right hemispheres). For lateral impacts, MPS was between 0.20 and 0.48 (left hemisphere) and between 0.22 and 0.51 (right hemisphere). For frontal impacts, regional cumulative strain damage measure (CSDM20) was between 0.01 and 0.87. For lateral impacts, CSDM20 was between 0.36 and 0.99 (left hemisphere) and between 0.09 and 0.93 (right hemisphere).

CONCLUSIONS

Recognizing that neural functions are related to anatomical structures and most model-based injury metrics focus on whole brain response, this study developed an anatomically accurate human brain model to capture regional responses. Model validation was comparable with current models. The model provided sufficient anatomical detail to describe brain regional responses under different impact conditions.

Head trauma analysis of laboratory reconstructed headers using 1966 Slazenger Challenge and 2018 Telstar 18 soccer balls

Retired soccer players are presenting with early onset neurodegenerative diseases, potentially from heading the ball. It has been proposed that the older composition of soccer balls places higher strains on brain tissues. The purpose of this research was to compare the dynamic head response and brain tissue strain of laboratory reconstructed headers using replicas of the 1966 Slazenger Challenge and 2018 Telstar 18 World Cup soccer balls. Head-to-ball impacts were physically conducted in the laboratory by impacting a Hybrid III head form at three locations and four velocities using dry and wet soccer ball conditions, and computational simulation was used to measure the resulting brain tissue strain. This research showed that few significant differences were found in head dynamic response and maximum principal strain between the dry 1966 and 2018 balls during reconstructed soccer headers. Headers using the wet 1966 soccer ball resulted in higher head form responses at low-velocity headers and lower head responses as velocities increased. This study demonstrates that under dry conditions, soccer ball construction does not have a significant effect on head and brain response during headers reconstructed in the laboratory. Although ball construction didn't show a notable effect, this study revealed that heading the ball, comparable to goalkeeper kicks and punts at 22 m/s, led to maximum principal strains exceeding the 50% likelihood of injury risk threshold. This has implications for the potential risks associated with repetitive heading in soccer for current athletes.

Sex Differences in Axonal Dynamic Responses Under Realistic Tension Using Finite Element Models

Existing axonal finite element models do not consider sex morphological differences or the fidelity in dynamic input. To facilitate a systematic investigation into the micromechanics of diffuse axonal injury, we develop a parameterized modeling approach for automatic and efficient generation of sex-specific axonal models according to specified geometrical parameters. Baseline female and male axonal models in the corpus callosum with random microtubule (MT) gap configurations are generated for model calibration and evaluation. They are then used to simulate a realistic tensile loading consisting of both a loading and a recovery phase (to return to an initial undeformed state) generated from dynamic corpus callosum fiber strain in a real-world head impact simulation. We find that MT gaps and the dynamic recovery phase are both critical to successfully reproduce MT undulation as observed experimentally, which has not been reported before. This strengthens confidence in model dynamic responses. A statistical approach is further employed to aggregate axonal responses from a large sample of random MT gap configurations for both female and male axonal models (n = 10,000 each). We find that peak strains in MTs and the Ranvier node and associated neurofilament failures in female axons are substantially higher than those in male axons because there are fewer MTs in the former and also because of the random nature of MT gap locations. Despite limitations in various model assumptions as a result of limited experimental data currently available, these findings highlight the need to systematically characterize MT gap configurations and to ensure a realistic model input for axonal dynamic simulations. Finally, this study may offer fresh and improved insight into the biomechanical basis of sex differences in brain injury, and sets the stage for more systematic investigations at the microscale in the future, both numerically and experimentally.

A diagnostic model based on color vision examination for dysthyroid optic neuropathy using Hardy-Rand-Rittler color plates

PURPOSE

To investigate color vision deficiency and the value of Hardy-Rand-Rittler (HRR) color plates in monitoring dysthyroid optic neuropathy (DON) to improve the diagnosis of DON.

METHODS

The participants were divided into DON and non-DON (mild and moderate-to-severe) groups. All the subjects underwent HRR color examination and comprehensive ophthalmic examinations. The random forest and decision tree models based on the HRR score were constructed by R software. The ROC curve and accuracy of different models in diagnosing DON were calculated and compared.

RESULTS

Thirty DON patients (57 eyes) and sixty non-DON patients (120 eyes) were enrolled. The HRR score was lower in DON patients than in non-DON patients (12.1 ± 6.2 versus 18.7 ± 1.8, p < 0.001). The major color deficiency was red-green deficiency in DON using HRR test. The HRR score, CAS, RNFL, and AP100 were found to be important factors in predicting DON from random forest and selected by decision tree to construct the multifactor model. The sensitivity, specificity, and the area under the curve (AUC) of the HRR score were 86%, 72%, and 0.87, respectively. The HRR score decision tree had a sensitivity, specificity, and AUC of 93%, 57%, and 0.75, respectively, with an accuracy of 82%. The data of the multifactor decision tree were 90%, 89%, and 0.93 for sensitivity, specificity, and AUC, respectively, with an accuracy of 91%.

CONCLUSION

The HRR test was valid as screening method for DON. The multifactor decision tree based on the HRR test improved the diagnostic efficacy for DON. An HRR score of less than 12 and red-green deficiency may be characteristic of DON.

Effect of Cervical Stenosis and Rate of Impact on Risk of Spinal Cord Injury During Whiplash Injury

STUDY DESIGN

Finite Element Study.

OBJECTIVE

To determine the risk of spinal cord injury with pre-existing cervical stenosis during a whiplash injury.

SUMMARY OF BACKGROUND DATA

Patients with cervical spinal stenosis are often cautioned on the potential increased risk of spinal cord injury (SCI) from minor trauma such as rear impact whiplash injuries. However, there is no consensus on the degree of canal stenosis or the rate of impact that predisposes cervical SCI from minor trauma.

METHODS

A previously validated three-dimensional finite element model of the human head-neck complex with the spinal cord and activated cervical musculature was used. Rear impact acceleration was applied at 1.8 m/s and 2.6 m/s. Progressive spinal stenosis was simulated at the C5 to C6 segment, from 14 mm to 6 mm, at 2 mm intervals of ventral disk protrusion. Spinal cord von Mises stress and maximum principal strain were extracted and normalized with respect to the 14 mm spine at each cervical spine level from C2 to C7.

RESULTS

The mean segmental range of motion was 7.3 degrees at 1.8 m/s and 9.3 degrees at 2.6 m/s. Spinal cord stress above the threshold for SCI was noted at C5 to C6 for 6 mm stenosis at 1.8 m/s and 2.6 m/s. The segment (C6-C7) inferior to the level of maximum stenosis also showed increasing stress and strain with a higher rate of impact. For 8 mm stenosis, spinal cord stress exceeded SCI thresholds only at 2.6 m/s. Spinal cord strain above SCI thresholds were only noted in the 6 mm stenosis model at 2.6 m/s.

CONCLUSION

Increased spinal stenosis and rate of impact are associated with greater magnitude and spatial distribution of spinal cord stress and strain during a whiplash injury. Spinal canal stenosis of 6 mm was associated with consistent elevation of spinal cord stress and strain above SCI thresholds at 2.6 m/s.

An Instrumented Mouthguard for Real-Time Measurement of Head Kinematics under a Large Range of Sport Specific Accelerations

BACKGROUND

Head impacts in sports can produce brain injuries. The accurate quantification of head kinematics through instrumented mouthguards (iMG) can help identify underlying brain motion during injurious impacts. The aim of the current study is to assess the validity of an iMG across a large range of linear and rotational accelerations to allow for on-field head impact monitoring.

METHODS

Drop tests of an instrumented helmeted anthropometric testing device (ATD) were performed across a range of impact magnitudes and locations, with iMG measures collected concurrently. ATD and iMG kinematics were also fed forward to high-fidelity brain models to predict maximal principal strain.

RESULTS

The impacts produced a wide range of head kinematics (16-171 g, 1330-10,164 rad/s2 and 11.3-41.5 rad/s) and durations (6-18 ms), representing impacts in rugby and boxing. Comparison of the peak values across ATD and iMG indicated high levels of agreement, with a total concordance correlation coefficient of 0.97 for peak impact kinematics and 0.97 for predicted brain strain. We also found good agreement between iMG and ATD measured time-series kinematic data, with the highest normalized root mean squared error for rotational velocity (5.47 ± 2.61%) and the lowest for rotational acceleration (1.24 ± 0.86%). Our results confirm that the iMG can reliably measure laboratory-based head kinematics under a large range of accelerations and is suitable for future on-field validity assessments.

Mechanical mechanism and indicator of diffuse axonal injury under blast-type acceleration

Diffuse axonal injury (DAI) caused by acceleration is one of the most prominent forms of blast-induced Traumatic Brain Injury. However, the mechanical mechanism and indicator of axonal deformation-induced injury under blast-type acceleration with high peak and short duration are unclear. This study constructed a multilayer head model that can reflect the response characteristics of translational and rotational acceleration (the peak time of which is within 0.5 ms). Based on von Mises stress, axonal strain and axonal strain rate indicators, the physical process of axonal injury is studied, and the vulnerable area under blast-type acceleration load is given. In the short term (within 1.75 ms), dominated by sagittal rotational acceleration peaks, the constraint of falx and tentorium rapidly imposes the inertial load on the brain tissue, resulting in a high-rate deformation of axons (axonal strain rate of which exceed 100 s-1). For a long term (after 1.75 ms), fixed-point rotation of the brain following the head causes excessive distortion of brain tissue (von Mises stress of which exceeds 15 kPa), resulting in a large axonal stretch strain where the main axonal orientation coincides with the principal strain direction. It is found that the axonal strain rate can better indicate the pathological axonal injury area and coincides with external inertial loading in the risk areas, which suggests that DAI under blast-type acceleration overload is mainly caused by the rapid axonal deformation instead of by the excessive axonal strain. The research in this paper helps understand and diagnose blast-induced DAI.

Dynamic biophysical responses of neuronal cell nuclei and cytoskeletal structure following high impulse loading

Cells are continuously exposed to dynamic environmental cues that influence their behavior. Mechanical cues can influence cellular and genomic architecture, gene expression, and intranuclear mechanics, providing evidence of mechanosensing by the nucleus, and a mechanoreciprocity between the nucleus and environment. Force disruption at the tissue level through aging, disease, or trauma, propagates to the nucleus and can have lasting consequences on proper functioning of the cell and nucleus. While the influence of mechanical cues leading to axonal damage has been well studied in neuronal cells, the mechanics of the nucleus following high impulse loading is still largely unexplored. Using an in vitro model of traumatic neural injury, we show a dynamic nuclear behavioral response to impulse stretch (up to 170% strain per second) through quantitative measures of nuclear movement, including tracking of rotation and internal motion. Differences in nuclear movement were observed between low and high strain magnitudes. Increased exposure to impulse stretch exaggerated the decrease in internal motion, assessed by particle tracking microrheology, and intranuclear displacements, assessed through high-resolution deformable image registration. An increase in F-actin puncta surrounding nuclei exposed to impulse stretch additionally demonstrated a corresponding disruption of the cytoskeletal network. Our results show direct biophysical nuclear responsiveness in neuronal cells through force propagation from the substrate to the nucleus. Understanding how mechanical forces perturb the morphological and behavioral response can lead to a greater understanding of how mechanical strain drives changes within the cell and nucleus, and may inform fundamental nuclear behavior after traumatic axonal injury. STATEMENT OF SIGNIFICANCE: The nucleus of the cell has been implicated as a mechano-sensitive organelle, courting molecular sensors and transmitting physical cues in order to maintain cellular and tissue homeostasis. Disruption of this network due to disease or high velocity forces (e.g., trauma) can not only result in orchestrated biochemical cascades, but also biophysical perturbations. Using an in vitro model of traumatic neural injury, we aimed to provide insight into the neuronal nuclear mechanics and biophysical responses at a continuum of strain magnitudes and after repetitive loads. Our image-based methods demonstrate mechanically-induced changes in cellular and nuclear behavior after high intensity loading and have the potential to further define mechanical thresholds of neuronal cell injury.

Head Impact Modeling to Support a Rotational Combat Helmet Drop Test

INTRODUCTION

The Advanced Combat Helmet (ACH) military specification (mil-spec) provides blunt impact acceleration criteria that must be met before use by the U.S. warfighter. The specification, which requires a helmeted magnesium Department of Transportation (DOT) headform to be dropped onto a steel hemispherical target, results in a translational headform impact response. Relative to translations, rotations of the head generate higher brain tissue strains. Excessive strain has been implicated as a mechanical stimulus leading to traumatic brain injury (TBI). We hypothesized that the linear constrained drop test method of the ACH specification underreports the potential for TBI.

MATERIALS AND METHODS

To establish a baseline of translational acceleration time histories, we conducted linear constrained drop tests based on the ACH specification and then performed simulations of the same to verify agreement between experiment and simulation. We then produced a high-fidelity human head digital twin and verified that biological tissue responses matched experimental results. Next, we altered the ACH experimental configuration to use a helmeted Hybrid III headform, a freefall cradle, and an inclined anvil target. This new, modified configuration allowed both a translational and a rotational headform response. We applied this experimental rotation response to the skull of our human digital twin and compared brain deformation relative to the translational baseline.

RESULTS

The modified configuration produced brain strains that were 4.3 times the brain strains from the linear constrained configuration.

CONCLUSIONS

We provide a scientific basis to motivate revision of the ACH mil-spec to include a rotational component, which would enhance the test's relevance to TBI arising from severe head impacts.

A video analysis examination of the frequency and type of head impacts for player positions in youth ice hockey and FE estimation of their impact severity

This research employed head impact frequency and frequency of estimated strain to analyse the influence of player position on brain trauma in U15 and U18 youth ice hockey. The methods involved a video analysis of 30 U15 and 30 U18 games where frequency, type of head impact event, and player position during impact was recorded. These impacts were then simulated in the laboratory using physical reconstructions and finite element modelling to determine the brain strains for each impact category. U15 forwards experienced significantly higher head impact frequencies (139) when compared to defenceman (50), with goalies showing the lowest frequency (6) (p < 0.05). U18 forwards experienced significantly higher head impact frequencies (220) when compared to defenceman (92), with goalies having the least frequent head impacts (4) (p < 0.05). The U15 forwards had a significantly higher frequency of head impacts at the very low and med strains and the U18s had higher frequency of head impacts for the very low and low level strains (p < 0.05). Game rule changes and equipment innovation may be considered to mitigate the increased risk faced by forwards compared to other positions in U15 and U18 youth ice hockey.

In-Depth Bicycle Collision Reconstruction: From a Crash Helmet to Brain Injury Evaluation

Traumatic brain injury (TBI) is a prevalent injury among cyclists experiencing head collisions. In legal cases, reliable brain injury evaluation can be difficult and controversial as mild injuries cannot be diagnosed with conventional brain imaging methods. In such cases, accident reconstruction may be used to predict the risk of TBI. However, lack of collision details can render accident reconstruction nearly impossible. Here, we introduce a reconstruction method to evaluate the brain injury in a bicycle–vehicle collision using the crash helmet alone. Following a thorough inspection of the cyclist’s helmet, we identified a severe impact, a moderate impact and several scrapes, which helped us to determine the impact conditions. We used our helmet test rig and intact helmets identical to the cyclist’s helmet to replicate the damage seen on the cyclist’s helmet involved in the real-world collision. We performed both linear and oblique impacts, measured the translational and rotational kinematics of the head and predicted the strain and the strain rate across the brain using a computational head model. Our results proved the hypothesis that the cyclist sustained a severe impact followed by a moderate impact on the road surface. The estimated head accelerations and velocity (167 g, 40.7 rad/s and 13.2 krad/s2) and the brain strain and strain rate (0.541 and 415/s) confirmed that the severe impact was large enough to produce mild to moderate TBI. The method introduced in this study can guide future accident reconstructions, allowing for the evaluation of TBI using the crash helmet only.

Neurotrauma Prevention Review: Improving Helmet Design and Implementation

Neurotrauma continues to contribute to significant mortality and disability. The need for better protective equipment is apparent. This review focuses on improved helmet design and the necessity for continued research. We start by highlighting current innovations in helmet design for sport and subsequent utilization in the lay community for construction. The current standards by sport and organization are summarized. We then address current standards within the military environment. The pathophysiology is discussed with emphasis on how helmets provide protection. As innovative designs emerge, protection against secondary injury becomes apparent. Much research is needed, but this focused paper is intended to serve as a catalyst for improvement in helmet design and implementation to provide more efficient and reliable neuroprotection across broad arenas.

A Review of Head Injury Metrics Used in Automotive Safety and Sports Protective Equipment

Despite advances in the understanding of human tolerances to brain injury, injury metrics used in automotive safety and protective equipment standards have changed little since they were first implemented nearly a half-century ago. Although numerous metrics have been proposed as improvements over the ones currently used, evaluating the predictive capability of these metrics is challenging. The purpose of this review is to summarize existing head injury metrics that have been proposed for both severe head injuries, such as skull fractures and traumatic brain injuries (TBI), and mild traumatic brain injuries (mTBI) including concussions. Metrics have been developed based on head kinematics or intracranial parameters such as brain tissue stress and strain. Kinematic metrics are either based on translational motion, rotational motion, or a combination of the two. Tissue-based metrics are based on finite element model simulations or in vitro experiments. This review concludes with a discussion of the limitations of current metrics and how improvements can be made in the future.

Morphological changes in glial cells arrangement under mechanical loading: A quantitative study

The mechanical properties and microstructure of brain tissue, as its two main physical parameters, could be affected by mechanical stimuli. In previous studies, microstructural alterations due to mechanical loading have received less attention than the mechanical properties of the tissue. Therefore, the current study aimed to investigate the effect of ex-vivo mechanical forces on the micro-architecture of brain tissue including axons and glial cells. A three-step loading protocol (i.e., loading-recovery-loading) including eight strain levels from 5% to 40% was applied to bovine brain samples with axons aligned in one preferred direction (each sample experienced only one level of strain). After either the first or secondary loading step, the samples were fixed, cut in planes parallel and perpendicular to the loading direction, and stained for histology. The histological images were analyzed to measure the end-to-end length of axons and glial cell-cell distances. The results showed that after both loading steps, as the strain increased, the changes in the cell nuclei arrangement in the direction parallel to axons were more significant compared to the other two perpendicular directions. Based on this evidence, we hypothesized that the spatial pattern of glial cells is highly affected by the orientation of axonal fibers. Moreover, the results revealed that in both loading steps, the maximum cell-cell distance occurred at 15% strain, and this distance decreased for higher strains. Since 15% strain is close to the previously reported brain injury threshold, this evidence could suggest that at higher strains, the axons start to rupture, causing a reduction in the displacement of glial cells. Accordingly, it was concluded that more attention to glial cells' architecture during mechanical loading may lead to introduce a new biomarker for brain injury.

Viscoelastic damage evaluation of the axon

In this manuscript, we have studied the microstructure of the axonal cytoskeleton and adopted a bottom-up approach to evaluate the mechanical responses of axons. The cytoskeleton of the axon includes the microtubules (MT), Tau proteins (Tau), neurofilaments (NF), and microfilaments (MF). Although most of the rigidity of the axons is due to the MT, the viscoelastic response of axons comes from the Tau. Early studies have shown that NF and MF do not provide significant elasticity to the overall response of axons. Therefore, the most critical aspect of the mechanical response of axons is the microstructural topology of how MT and Tau are connected and construct the cross-linked network. Using a scanning electron microscope (SEM), the cross-sectional view of the axons revealed that the MTs are organized in a hexagonal array and cross-linked by Tau. Therefore, we have developed a hexagonal Representative Volume Element (RVE) of the axonal microstructure with MT and Tau as fibers. The matrix of the RVE is modeled by considering a combined effect of NF and MF. A parametric study is done by varying fiber geometric and mechanical properties. The Young’s modulus and spacing of MT are varied between 1.5 and 1.9 GPa and 20–38 nm, respectively. Tau is modeled as a 3-parameter General Maxwell viscoelastic material. The failure strains for MT and Tau are taken to be 50 and 40%, respectively. A total of 4 RVEs are prepared for finite element analysis, and six loading cases are inspected to quantify the three-dimensional (3D) viscoelastic relaxation response. The volume-averaged stress and strain are then used to fit the relaxation Prony series. Next, we imposed varying strain rates (between 10/sec to 50/sec) on the RVE and analyzed the axonal failure process. We have observed that the 40% failure strain of Tau is achieved in all strain rates before the MT reaches its failure strain of 50%. The corresponding axonal failure strain and stress vary between 6 and 11% and 5–19.8 MPa, respectively. This study can be used to model macroscale axonal aggregate typical of the white matter region of the brain tissue.

Finding the Spatial Co-Variation of Brain Deformation With Principal Component Analysis

OBJECTIVE

Strain and strain rate are effective traumatic brain injury metrics. In finite element (FE) head model, thousands of elements were used to represent the spatial distribution of these metrics. Owing that these metrics are resulted from brain inertia, their spatial distribution can be represented in more concise pattern. Since head kinematic features and brain deformation vary largely across head impact types (Zhan et al., 2021), we applied principal component analysis (PCA) to find the spatial co-variation of injury metrics (maximum principal strain (MPS), MPS rate (MPSR) and MPS × MPSR) in four impact types: simulation, football, mixed martial arts and car crashes, and used the PCA to find patterns in these metrics and improve the machine learning head model (MLHM).

METHODS

We applied PCA to decompose the injury metrics for all impacts in each impact type, and investigate the spatial co-variation using the first principal component (PC1). Furthermore, we developed a MLHM to predict PC1 and then inverse-transform to predict for all brain elements. The accuracy, the model complexity and the size of training dataset of PCA-MLHM are compared with previous MLHM (Zhan et al., 2021).

RESULTS

PC1 explained variance on the datasets. Based on PC1 coefficients, the corpus callosum and midbrain exhibit high variance on all datasets. Finally, the PCA-MLHM reduced model parameters by 74% with a similar MPS estimation accuracy.

CONCLUSION

The brain injury metric in a dataset can be decomposed into mean components and PC1 with high explained variance.

SIGNIFICANCE

The spatial co-variation analysis enables better interpretation of the patterns in brain injury metrics. It also improves the efficiency of MLHM.

Cerebral hemorrhage caused by shaking adult syndrome? Evidence from biomechanical analysis using 3D motion capture and finite element models

The present study combined three-dimensional (3D) motion capture with finite element simulation to reconstruct a real shaking adult syndrome (SAS) case and further explore the injury biomechanics of SAS. The frequency at which an adult male can shake the head of another person, head-shaking amplitude, and displacement curves was captured by the VICON 3D motion capture system. The captured shaking frequency and shaking curve were loaded on the total human model for safety (THUMS) head to simulate the biomechanical response of brain injury when a head was shaken in anterior-posterior, left-right, and left anterior-right posterior directions at frequencies of 4 Hz (Hz), 5 Hz, 6 Hz, and 7 Hz. The biomechanical response of the head on impact in the anterior, posterior, left, left anterior, and right posterior directions at the equivalent velocity of 6 Hz shaking was simulated. The violent shaking frequency of the adult male was 3.2-6.8 Hz; head shaking at these frequencies could result in serious cerebral injuries. SAS-related injuries have obvious directionality, and sagittal shaking can easily cause brain injuries. There was no significant difference between the brain injuries caused by shaking in the simulated frequency range (4-7 Hz). Impact and shaking at an equivalent velocity could cause brain injuries, though SAS more commonly occurred due to the cumulative deformation of brain tissue. Biomechanical studies of SAS should play a positive role in improving the accuracy of forensic identification and reducing this form of abuse and torture in detention or places of imprisonment.

Concussion Prone Scenarios: A Multi-Dimensional Exploration in Impact Directions, Brain Morphology, and Network Architectures Using Computational Models

While individual susceptibility to traumatic brain injury (TBI) has been speculated, past work does not provide an analysis considering how physical features of an individual's brain (e.g., brain size, shape), impact direction, and brain network features can holistically contribute to the risk of suffering a TBI from an impact. This work investigated each of these features simultaneously using computational modeling and analyses of simulated functional connectivity. Unlike the past studies that assess the severity of TBI based on the quantification of brain tissue damage (e.g., principal strain), we approached the brain as a complex network in which neuronal oscillations orchestrate to produce normal brain function (estimated by functional connectivity) and, to this end, both the anatomical damage location and its topological characteristics within the brain network contribute to the severity of brain function disruption and injury. To represent the variations in the population, we analyzed a publicly available database of brain imaging data and selected five distinct network architectures, seven different brain sizes, and three uniaxial head rotational conditions to study the consequences of 74 virtual impact scenarios. Results show impact direction produces the most significant change in connections across brain areas (structural connectome) and the functional coupling of activity across these brain areas (functional connectivity). Axial rotations were more injurious than those with sagittal and coronal rotations when the head kinematics were the same for each condition. When the impact direction was held constant, brain network architecture showed a significantly different vulnerability across axial and sagittal, but not coronal rotations. As expected, brain size significantly affected the expected change in structural and functional connectivity after impact. Together, these results provided groupings of predicted vulnerability to impact-a subgroup of male brain architectures exposed to axial impacts were most vulnerable, while a subgroup of female brain architectures was the most tolerant to the sagittal impacts studied. These findings lay essential groundwork for subject-specific analyses of concussion and provide invaluable guidance for designing personalized protection equipment.

Evaluation of muscle strain injury severity in active human body models

Even though significant efforts in the field of injury detection with finite element active human body models (FE AHBMs) have been made, injuries of the muscle-tendon unit (MTU) have not yet been taken into consideration. Therefore, the goal of this study was to define a muscle strain injury criterion (MSIC) to evaluate the damage sustained by the musculature during muscle driven movement scenarios. The MSIC was derived from biomechanical tests found in the literature and the proposed threshold values were substantiated through a comparison to an estimate of the ultimate tensile strength of human skeletal muscle and the forces acting on the biceps femoris long head muscle during one sprinting gait cycle. The application of the MSIC to state-of-the-art FE AHBMs was demonstrated by evaluating the strain injury severity of selected neck muscles of a full-body AHBM during two seat rotation load cases. The results of the MSIC substantiation suggest that all three injury threshold values proposed in this work fall in a plausible corridor of forces acting on the MTU. The combined results of the AHBM simulations indicate that neither of the two examined seat rotations are likely to cause strain injury to the neck muscles and that the proposed MSIC can easily be applied to current AHBMs without further modification of the model architecture or the muscle parameters. The MSIC was also used to formulate a hypothesis on the aetiology of muscle strain injuries, through which it was demonstrated that material inhomogeneities in the MTU might be the cause for strain injuries sustained during otherwise physiological movements. This work is a first step in the direction of the definition of a wholistic injury criterion for the human skeletal muscle fibre.

Oblique impact responses of Hybrid III and a new headform with more biofidelic coefficient of friction and moments of inertia

New oblique impact methods for evaluating head injury mitigation effects of helmets are emerging, which mandate measuring both translational and rotational kinematics of the headform. These methods need headforms with biofidelic mass, moments of inertia (MoIs), and coefficient of friction (CoF). To fulfill this need, working group 11 of the European standardization head protection committee (CEN/TC158) has been working on the development of a new headform with realistic MoIs and CoF, based on recent biomechanics research on the human head. In this study, we used a version of this headform (Cellbond) to test a motorcycle helmet under the oblique impact at 8 m/s at five different locations. We also used the Hybrid III headform, which is commonly used in the helmet oblique impact. We tested whether there is a difference between the predictions of the headforms in terms of injury metrics based on head kinematics, including peak translational and rotational acceleration, peak rotational velocity, and BrIC (brain injury criterion). We also used the Imperial College finite element model of the human head to predict the strain and strain rate across the brain and tested whether there is a difference between the headforms in terms of the predicted strain and strain rate. We found that the Cellbond headform produced similar or higher peak translational accelerations depending on the impact location (−3.2% in the front-side impact to 24.3% in the rear impact). The Cellbond headform, however, produced significantly lower peak rotational acceleration (−41.8% in a rear impact to −62.7% in a side impact), peak rotational velocity (−29.5% in a side impact to −47.6% in a rear impact), and BrIC (−29% in a rear-side impact to −45.3% in a rear impact). The 90th percentile values of the maximum brain strain and strain rate were also significantly lower using this headform. Our results suggest that MoIs and CoF have significant effects on headform rotational kinematics, and consequently brain deformation, during the helmeted oblique impact. Future helmet standards and rating methods should use headforms with realistic MoIs and CoF (e.g., the Cellbond headform) to ensure more accurate representation of the head in laboratory impact tests.

A biomechanical-based approach to scale blast-induced molecular changes in the brain

Animal studies provide valuable insights on how the interaction of blast waves with the head may injure the brain. However, there is no acceptable methodology to scale the findings from animals to humans. Here, we propose an experimental/computational approach to project observed blast-induced molecular changes in the rat brain to the human brain. Using a shock tube, we exposed rats to a range of blast overpressures (BOPs) and used a high-fidelity computational model of a rat head to correlate predicted biomechanical responses with measured changes in glial fibrillary acidic protein (GFAP) in rat brain tissues. Our analyses revealed correlates between model-predicted strain rate and measured GFAP changes in three brain regions. Using these correlates and a high-fidelity computational model of a human head, we determined the equivalent BOPs in rats and in humans that induced similar strain rates across the two species. We used the equivalent BOPs to project the measured GFAP changes in the rat brain to the human. Our results suggest that, relative to the rat, the human requires an exposure to a blast wave of a higher magnitude to elicit similar brain-tissue responses. Our proposed methodology could assist in the development of safety guidelines for blast exposure.

Brain architecture-based vulnerability to traumatic injury

The white matter tracts forming the intricate wiring of the brain are subject-specific; this heterogeneity can complicate studies of brain function and disease. Here we collapse tractography data from the Human Connectome Project (HCP) into structural connectivity (SC) matrices and identify groups of similarly wired brains from both sexes. To characterize the significance of these architectural groupings, we examined how similarly wired brains led to distinct groupings of neural activity dynamics estimated with Kuramoto oscillator models (KMs). We then lesioned our networks to simulate traumatic brain injury (TBI) and finally we tested whether these distinct architecture groups’ dynamics exhibited differing responses to simulated TBI. At each of these levels we found that brain structure, simulated dynamics, and injury susceptibility were all related to brain grouping. We found four primary brain architecture groupings (two male and two female), with similar architectures appearing across both sexes. Among these groupings of brain structure, two architecture types were significantly more vulnerable than the remaining two architecture types to lesions. These groups suggest that mesoscale brain architecture types exist, and these architectural differences may contribute to differential risks to TBI and clinical outcomes across the population.

Correlating the microstructural architecture and macrostructural behaviour of the brain

The computational simulation of pathological conditions and surgical procedures, for example the removal of cancerous tissue, can contribute crucially to the future of medicine. Especially for brain surgery, these methods can be important, as the ultra-soft tissue controls vital functions of the body. However, the microstructural interactions and their effects on macroscopic material properties remain incompletely understood. Therefore, we investigated the mechanical behaviour of brain tissue under three different deformation modes, axial tension, compression, and semi-confined compression, in different anatomical regions, and for varying axon orientation. In addition, we characterised the underlying microstructure in terms of myelin, cells, glial cells and neuron area fraction, and density. The correlation of these quantities with the material parameters of the anisotropic Ogden model reveals a decrease in shear modulus with increasing myelin area fraction. Strikingly, the tensile shear modulus correlates positively with cell and neuronal area fraction (Spearman's correlation coefficient of r_s=0.40 and r_s=0.33), whereas the compressive shear modulus decreases with increasing glial cell area (r_s=-0.33). Our study finds that tissue non-linearity significantly depends on the myelin area fraction (r_s=0.47), cell density (r_s=0.41) and glial cell area (r_s=0.49). Our results provide an important step towards understanding the micromechanical load transfer that leads to the non-linear macromechanical behaviour of the brain. STATEMENT OF SIGNIFICANCE: Within this article, we investigate the mechanical behaviour of brain tissue under three different deformation modes, in different anatomical regions, and for varying axon orientation. Further, we characterise the underlying microstructure in terms of various constituents. The correlation of these quantities with the material parameters of the anisotropic Ogden model reveals a decrease in shear modulus with increasing myelin area fraction. Strikingly, the tensile shear modulus correlates positively with cell and neuronal area fraction, whereas the compressive shear modulus decreases with increasing glial cell area. Our study finds that tissue non-linearity significantly depends on the myelin area fraction, cell density, and glial cell area. Our results provide an important step towards understanding the micromechanical load transfer that leads to the non-linear macromechanical behaviour of the brain.

Effect of degenerative factors on cervical spinal cord during flexion and extension: a dynamic finite element analysis

Spinal cord injury (SCI) is a global problem that brings a heavy burden to both patients and society. Recent investigations indicated degenerative disease is taking an increasing part in SCI with the growth of the aging population. However, little insight has been gained about the effect of cervical degenerative disease on the spinal cord during dynamic activities. In this work, a dynamic fluid-structure interaction model was developed and validated to investigate the effect of anterior and posterior encroachment caused by degenerative disease on the spinal cord during normal extension and flexion. Maximum von-Mises stress and maximum principal strain were observed at the end of extension and flexion. The abnormal stress distribution caused by degenerative factors was concentrated in the descending tracts of the spinal cord. Our finding indicates that the excessive motion of the cervical spine could potentially exacerbate spinal cord injury and enlarge injury areas. Stress and strain remained low compared to extension during moderate flexion. This suggests that patients with cervical degenerative disease should avoid frequent or excessive flexion and extension which could result in motor function impairment, whereas moderate flexion is safe. Besides, encroachment caused by degenerative factors that are not significant in static imaging could also cause cord compression during normal activities.

The Use of Digital Image Correlation for Measurement of Strain Fields in a Novel Wireless Intraspinal Microstimulation Interface

BACKGROUND

Intraspinal microstimulation (ISMS) has emerged as a promising neuromodulation technique for restoring standing and overground walking in individuals with spinal cord injury. Current and emerging ISMS implant designs connect the electrodes to the stimulator through lead wires that cross the dura mater. To reduce possible complications associated with transdural leads such as tethering and leakage of cerebrospinal fluid, we aim to develop a wireless, fully intradural ISMS implant based upon our prior work in the cortex with the Wireless Floating Microelectrode Array (WFMA). Although we have extensive data about WFMA cortical stability, its mechanical and electrical stability in the spinal cord remain unknown. One of the quantifiable metrics to assess long-term implant stability is mechanical strain.

OBJECTIVE

The aim of the current work is to develop a method to assess implant stability by measuring strain fields in a surrogate of the human spinal cord.

METHODS

A physical model of the spinal cord was studied using an electromechanical testing apparatus, simulating typical spinal cord motion. Strain fields were digitally analyzed using an optical method known as digital image correlation (DIC).

RESULTS

Displacement and strain were visualized using contour plots. The strain values in the vicinity of each WFMA device were significantly different from the strain values in the same locations in the control surrogate spinal cord.

CONCLUSION

The results demonstrate that DIC can be used for in-vitro screening of intraspinal implants. Accurate optical strain measurements will enable researchers to optimize implant design over a wide range of motion conditions.

The Protective Performance of Modern Motorcycle Helmets Under Oblique Impacts

Motorcyclists are at high risk of head injuries, including skull fractures, focal brain injuries, intracranial bleeding and diffuse brain injuries. New helmet technologies have been developed to mitigate head injuries in motorcycle collisions, but there is limited information on their performance under commonly occurring oblique impacts. We used an oblique impact method to assess the performance of seven modern motorcycle helmets at five impact locations. Four helmets were fitted with rotational management technologies: a low friction layer (MIPS), three-layer liner system (Flex) and dampers-connected liner system (ODS). Helmets were dropped onto a 45° anvil at 8 m/s at five locations. We determined peak translational and rotational accelerations (PTA and PRA), peak rotational velocity (PRV) and brain injury criteria (BrIC). In addition, we used a human head finite element model to predict strain distribution across the brain and in corpus callosum and sulci. We found that the impact location affected the injury metrics and brain strain, but this effect was not consistent. The rear impact produced lowest PTAs but highest PRAs. This impact produced highest strain in corpus callosum. The front impact produced the highest PRV and BrIC. The side impact produced the lowest PRV, BrIC and strain across the brain, sulci and corpus callosum. Among helmet technologies, MIPS reduced all injury metrics and brain strain compared with conventional helmets. Flex however was effective in reducing PRA only and ODS was not effective in reducing any injury metrics in comparison with conventional helmets. This study shows the importance of using different impact locations and injury metrics when assessing head protection effects of helmets. It also provides new data on the performance of modern motorcycle helmets. These results can help with improving helmet design and standard and rating test methods.

Tissue-Scale Biomechanical Testing of Brain Tissue for the Calibration of Nonlinear Material Models

Brain tissue is one of the most complex and softest tissues in the human body. Due to its ultrasoft and biphasic nature, it is difficult to control the deformation state during biomechanical testing and to quantify the highly nonlinear, time-dependent tissue response. In numerous experimental studies that have investigated the mechanical properties of brain tissue over the last decades, stiffness values have varied significantly. One reason for the observed discrepancies is the lack of standardized testing protocols and corresponding data analyses. The tissue properties have been tested on different length and time scales depending on the testing technique, and the corresponding data have been analyzed based on simplifying assumptions. In this review, we highlight the advantage of using nonlinear continuum mechanics based modeling and finite element simulations to carefully design experimental setups and protocols as well as to comprehensively analyze the corresponding experimental data. We review testing techniques and protocols that have been used to calibrate material model parameters and discuss artifacts that might falsify the measured properties. The aim of this work is to provide standardized procedures to reliably quantify the mechanical properties of brain tissue and to more accurately calibrate appropriate constitutive models for computational simulations of brain development, injury and disease. Computational models can not only be used to predictively understand brain tissue behavior, but can also serve as valuable tools to assist diagnosis and treatment of diseases or to plan neurosurgical procedures. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC.

Cavitation nucleation and its ductile-to-brittle shape transition in soft gels under translational mechanical impact

Cavitation bubbles in the human body, when subjected to impact, are being increasingly considered as a possible brain injury mechanism. However, the onset of cavitation and its complex dynamics in biological materials remain unclear. Our experimental results using soft gels as a tissue simulant show that the critical acceleration (a_cr) at cavitation nucleation monotonically increases with increasing stiffness of gelatin A/B, while a_cr for agarose and agar initially increases but is followed by a plateau or even decrease after stiffness reach to ∼100 kPa. Our image analyses of cavitation bubbles and theoretical work reveal that the observed trends in a_cr are directly linked to how bubbles grow in each gel. Gelatin A/B, regardless of their stiffness, form a localized damaged zone (tens of nanometers) at the gel-bubble interface during bubble growth. In contrary, the damaged zone in agar/agarose becomes significantly larger (> 100 times) with increasing shear modulus, which triggers the transition from formation of a small, damaged zone to activation of crack propagation. STATEMENT OF SIGNIFICANCE: We have studied cavitation nucleation and bubble growth in four different types of soft gels (i.e., tissue simulants) under translational impact. The critical linear acceleration for cavitation nucleation has been measured in the simulants by utilizing a recently developed method that mimics acceleration profiles of typical head blunt events. Each gel type exhibits significantly different trends in the critical acceleration and bubble shape (e.g., A gel-specific sphere-to-saucer transition) with increasing gel stiffness. Our theoretical framework, based on the concepts of a damaged zone and crack propagation in each gel, explains underlying mechanisms of the experimental observations. Our in-depth studies shed light on potential links between traumatic brain injuries and cavitation bubbles induced by translational acceleration, the overlooked mechanism in the literature.

Protective Performance of Helmets and Goggles in Mitigating Brain Biomechanical Response to Primary Blast Exposure

The current combat helmets are primarily designed to mitigate blunt impacts and ballistic loadings. Their protection against primary blast wave is not well studied. In this paper, we comprehensively assessed the protective capabilities of the advanced combat helmet and goggles against blast waves with different intensity and directions. Using a high-fidelity human head model, we compared the intracranial pressure (ICP), cerebrospinal fluid (CSF) cavitation, and brain strain and strain rate predicted from bare head, helmet-head and helmet-goggles-head simulations. The helmet was found to be effective in mitigating the positive ICP (24–57%) and strain rate (5–34%) in all blast scenarios. Goggles were found to be effective in mitigating the positive ICP in frontal (6–16%) and lateral (5–7%) blast exposures. However, the helmet and goggles had minimal effects on mitigating CSF cavitation and even increased brain strain. Further investigation showed that wearing a helmet leads to higher risk of cavitation. In addition, their presence increased the head kinetic energy, leading to larger strains in the brain. Our findings can improve our understanding of the protective effects of helmets and goggles and guide the design of helmet pads to mitigate brain responses to blast.

An interdisciplinary computational model for predicting traumatic brain injury: Linking biomechanics and functional neural networks

The brain is a complex network consisting of neuron cell bodies in the gray matter and their axonal projections, forming the white matter tracts. These neurons are supported by an equally complex vascular network as well as glial cells. Traumatic brain injury (TBI) can lead to the disruption of the structural and functional brain networks due to disruption of both neuronal cell bodies in the gray matter as well as their projections and supporting cells. To explore how an impact can alter the function of brain networks, we integrated a finite element (FE) brain mechanics model with linked models of brain dynamics (Kuramoto oscillator) and vascular perfusion (Balloon-Windkessel) in this study. We used empirical resting-state functional magnetic resonance imaging (MRI) data to optimize the fit of our brain dynamics and perfusion models to clinical data. Results from the FE model were used to mimic injury in these optimized brain dynamics models: injury to the nodes (gray matter) led to a decrease in the nodal oscillation frequency, while damage to the edges (axonal connections/white matter) progressively decreased coupling among connected nodes. A total of 53 cases, including 33 non-injurious and 20 concussive head impacts experienced by professional American football players were simulated using this integrated model. We examined the correlation of injury outcomes with global measures of structural connectivity, neural dynamics, and functional connectivity of the brain networks when using different lesion methods. Results show that injurious head impacts cause significant alterations in global network topology regardless of lesion methods. Changes between the disrupted and healthy functional connectivity (measured by Pearson correlation) consistently correlated well with injury outcomes (AUC≥0.75), although the predictive performance is not significantly different (p>0.05) to that of traditional kinematic measures (angular acceleration). Intriguingly, our lesion model for gray matter damage predicted increases in global efficiency and clustering coefficient with increases in injury risk, while disrupting axonal connections led to lower network efficiency and clustering. When both injury mechanisms were combined into a single injury prediction model, the injury prediction performance depended on the thresholds used to determine neurodegeneration and mechanical tolerance for axonal injury. Together, these results point towards complex effects of mechanical trauma to the brain and provide a new framework for understanding brain injury at a causal mechanistic level and developing more effective diagnostic methods and therapeutic interventions.