Abstract

In studying traumatic brain injury (TBI), it has been long hypothesized that the head is more vulnerable to injury from impacts in certain directions or locations, as the relationship between impact force and the resulting neurological outcome is complex and can vary significantly between individual cases. Many studies have identified head angular acceleration to be the putative cause of brain trauma, but it is not well understood how impact location can affect the resulting head kinematics and tissue strain. Here, we identify the susceptibility of the head to accelerations and brain strain from normal forces at contact points across the surface of the skull and jaw using a three-dimensional, 20-degree-of-freedom rigid-body head and cervical spine model. We find that head angular acceleration and brain tissue strain resulting from an input force can vary by orders of magnitude based on impact location on the skull, with the mandible as the most vulnerable region. Conversely, head linear acceleration is not sensitive to contact location. Using these analyses, we present an optimization scheme to distribute helmet padding thickness to minimize angular acceleration, resulting in a reduction of angular acceleration by an estimated 25% at the most vulnerable contact point compared to uniform thickness padding. This work gives intuition behind the relationship between input force and resulting brain injury risk, and presents a framework for developing and evaluating novel head protection gear.

References

1.
James
,
S. L.
,
2019
, “
Global, Regional, and National Burden of Traumatic Brain Injury and Spinal Cord Injury, 1990–2016: A Systematic Analysis for the Global Burden of Disease Study 2016
,”
Lancet Neurol.
,
18
(
1
), pp.
56
87
.10.1016/S1474-4422(18)30415-0
2.
Holbourn
,
A. H. S.
,
1943
, “
Mechanics of Head Injuries
,”
Lancet
,
242
(
6267
), pp.
438
441
.10.1016/S0140-6736(00)87453-X
3.
Ommaya
,
A. K.
, and
Gennarelli
,
T. A.
,
1974
, “
Cerebral Concussion and Traumatic Unconsciousness. Correlation of Experimental and Clinical Observations of Blunt Head Injuries
,”
Brain
,
97
(
1
), pp.
633
654
.10.1093/brain/97.1.633
4.
Gennarelli
,
T. A.
,
Thibault
,
L. E.
,
Tomei
,
G.
,
Wiser
,
R.
, and
Adams
,
D.
,
G.
, and
J.
,
2010
, “
Directional Dependence of Axonal Brain Injury Due to Centroidal and Non-Centroidal Acceleration
,”
SAE
Paper No. 872197.10.4271/872197
5.
Gennarelli
,
T. A.
,
Thibault
,
L. E.
,
Adams
,
J. H.
,
Graham
,
D. I.
,
Thompson
,
C. J.
, and
Marcincin
,
R. P.
,
1982
, “
Diffuse Axonal Injury and Traumatic Coma in the Primate
,”
Ann. Neurol.
,
12
(
6
), pp.
564
574
.10.1002/ana.410120611
6.
Margulies
,
S. S.
,
Thibault
,
L. E.
, and
Gennarelli
,
T. A.
,
1990
, “
Physical Model Simulations of Brain Injury in the Primate
,”
J. Biomech.
,
23
(
8
), pp.
823
836
.10.1016/0021-9290(90)90029-3
7.
Kleiven
,
S.
,
2006
, “
Evaluation of Head Injury Criteria Using a Finite Element Model Validated Against Experiments on Localized Brain Motion, Intracerebral Acceleration, and Intracranial Pressure
,”
Int. J. Crashworthines
,
11
(
1
), pp.
65
79
.10.1533/ijcr.2005.0384
8.
Hernandez
,
F.
,
Wu
,
L. C.
,
Yip
,
M. C.
,
Laksari
,
K.
,
Hoffman
,
A. R.
,
Lopez
,
J. R.
,
Grant
,
G.
,
Kleiven
,
S.
, and
Camarillo
,
D. B.
,
2015
, “
Six Degree-of-Freedom Measurements of Human Mild Traumatic Brain Injury
,”
Ann. Biomed. Eng.
,
43
(
8
), pp.
1918
1934
.10.1007/s10439-014-1212-4
9.
Margulies
,
S. S.
, and
Thibault
,
L. E.
,
1992
, “
A Proposed Tolerance Criterion for Diffuse Axonal Injury in Man
,”
J. Biomech.
,
25
(
8
), pp.
917
923
.10.1016/0021-9290(92)90231-O
10.
Laksari
,
K.
,
Fanton
,
M.
,
Wu
,
L. C.
,
Nguyen
,
T. H.
,
Kurt
,
M.
,
Giordano
,
C.
,
Kelly
,
E.
,
O'Keeffe
,
E.
,
Wallace
,
E.
, and
Doherty
,
C.
,
2018
, “
Multi-Directional Dynamic Model for Traumatic Brain Injury Detection
,” J. Neurotrauma, epub.
11.
Post
,
A.
,
Kendall
,
M.
,
Cournoyer
,
J.
,
Karton
,
C.
,
Oeur
,
R. A.
,
Dawson
,
L.
, and
Hoshizaki
,
T. B.
,
2018
, “
Brain Tissue Analysis of Impacts to American Football Helmets
,”
Comput. Methods Biomech. Biomed. Eng.
,
21
(
3
), pp.
264
277
.10.1080/10255842.2018.1445229
12.
Elkin
,
B. S.
,
Gabler
,
L. F.
,
Panzer
,
M. B.
, and
Siegmund
,
G. P.
,
2018
, “
Brain Tissue Strains Vary With Head Impact Location: A Possible Explanation for Increased Concussion Risk in Struck Versus Striking Football Players
,”
Clin. Biomech.
,
64
, pp.
49
57
.10.1016/j.clinbiomech.2018.03.021
13.
Hodgson
,
V. R.
,
Thomas
,
L. M.
, and
Khalil
,
T. B.
,
1983
, “
The Role of Impact Location in Reversible Cerebral Concussion
,”
SAE Trans.
, 92, pp.
512
527
.10.4271/831618
14.
Eucker
,
S. A.
,
Smith
,
C.
,
Ralston
,
J.
,
Friess
,
S. H.
, and
Margulies
,
S. S.
,
2011
, “
Physiological and Histopathological Responses Following Closed Rotational Head Injury Depend on Direction of Head Motion
,”
Exp. Neurol.
,
227
(
1
), pp.
79
88
.10.1016/j.expneurol.2010.09.015
15.
Gennarelli
,
T. A.
,
Thibault
,
L. E.
, and
Graham
,
D. I.
,
1998
, “
Diffuse Axonal Injury: An Important Form of Traumatic Brain Damage
,”
Neuroscience
,
4
(
3
), pp.
202
215
.10.1177/107385849800400316
16.
Weaver
,
A. A.
,
Danelson
,
K. A.
, and
Stitzel
,
J. D.
,
2012
, “
Modeling Brain Injury Response for Rotational Velocities of Varying Directions and Magnitudes
,”
Ann. Biomed. Eng.
,
40
(
9
), pp.
2005
2018
.10.1007/s10439-012-0553-0
17.
Fanton
,
M.
,
Kuo
,
C.
,
Sganga
,
J.
,
Hernandez
,
F.
, and
Camarillo
,
D. B.
,
2019
, “
Dependency of Head Impact Rotation on Head-Neck Positioning and Soft Tissue Forces
,”
IEEE Trans. Biomed. Eng.
,
66
(
4
), pp.
988
999
.10.1109/TBME.2018.2866147
18.
Mortensen
,
J. D.
,
Vasavada
,
A. N.
, and
Merryweather
,
A. S.
,
2018
, “
The Inclusion of Hyoid Muscles Improve Moment Generating Capacity and Dynamic Simulations in Musculoskeletal Models of the Head and Neck
,”
PLoS One
,
13
(
6
), p.
e0199912
.10.1371/journal.pone.0199912
19.
Williams
,
J. L.
, and
Belytschko
,
T. B.
,
1983
, “
A Three-Dimensional Model of the Human Cervical Spine for Impact Simulation
,”
ASME J. Biomech. Eng.
,
105
(
4
), p.
321
.10.1115/1.3138428
20.
Kuo
,
C.
,
Sheffels
,
J.
,
Fanton
,
M.
,
Yu
,
I. B.
,
Hamalainen
,
R.
, and
Camarillo
,
D.
,
2019
, “
Passive Cervical Spine Ligaments Provide Stability During Head Impacts
,”
J. R. Soc. Interface
,
16
(
154
), p.
20190086
.10.1098/rsif.2019.0086
21.
Eckersley
,
C. P.
,
Nightingale
,
R. W.
,
Luck
,
J. F.
, and
Bass
,
C. R.
,
2019
, “
The Role of Cervical Muscles in Mitigating Concussion
,”
J. Sci. Med. Sport
,
22
(
6
), pp.
667
671
.10.1016/j.jsams.2019.01.009
22.
Dixit
,
P.
, and
Liu
,
G. R.
,
2017
, “
A Review on Recent Development of Finite Element Models for Head Injury Simulations
,”
Arch. Comput. Methods Eng.
,
24
(
4
), pp.
979
1031
.10.1007/s11831-016-9196-x
23.
Hernandez
,
F.
,
Giordano
,
C.
,
Goubran
,
M.
,
Parivash
,
S.
,
Grant
,
G.
,
Zeineh
,
M.
, and
Camarillo
,
D.
,
2019
, “
Lateral Impacts Correlate With Falx Cerebri Displacement and Corpus Callosum Trauma in Sports-Related Concussions
,”
Biomech. Model. Mechanobiol.
,
18
(
3
), pp.
631
649
.https://link.springer.com/article/10.1007/s10237-018-01106-0
24.
Giordano
,
C.
, and
Kleiven
,
S.
,
2014
, “
Evaluation of Axonal Strain as a Predictor for Mild Traumatic Brain Injuries Using Finite Element Modeling
,”
Stapp Car Crash J.
,
58
(
14
), epub.https://www.ncbi.nlm.nih.gov/pubmed/26192949
25.
Versace
,
J.
,
1971
, “
A Review of the Severity Index
,”
SAE
Paper No. 710881.10.4271/710881
26.
Hutchinson
,
J.
,
Kaiser
,
M. J.
, and
Lankarani
,
H. M.
,
1998
, “
The Head Injury Criterion (HIC) Functional
,”
Appl. Math. Comput.
,
96
(
1
), pp.
1
16
.10.1016/S0096-3003(97)10106-0
27.
Gurdjian
,
E. S.
,
Roberts
,
V. L.
, and
Thomas
,
L. M.
,
1966
, “
Tolerance Curves of Acceleration and Intracranial Pressure and Protective Index in Experimental Head Injury
,”
J. Trauma
,
6
(
5
), pp.
600
604
.10.1097/00005373-196609000-00005
28.
Department of Transportation NHTSA
,
1971
, “
Occupant Crash Protection—Head Injury Criterion
,” Department of Transportation National Highway Traffic Safety Administration, Washington, DC.
29.
Hernandez
,
F.
,
Shull
,
P. B.
, and
Camarillo
,
D. B.
,
2015
, “
Evaluation of a Laboratory Model of Human Head Impact Biomechanics
,”
J. Biomech.
,
48
(
12
), pp.
3469
3477
.10.1016/j.jbiomech.2015.05.034
30.
Boden
,
B. P.
,
Tacchetti
,
R. L.
,
Cantu
,
R. C.
,
Knowles
,
S. B.
, and
Mueller
,
F. O.
,
2007
, “
Catastrophic Head Injuries in High School and College Football Players
,”
Am. J. Sports Med.
,
35
(
7
), pp.
1075
1081
.10.1177/0363546507299239
31.
Lincoln
,
A. E.
,
Caswell
,
S. V.
,
Almquist
,
J. L.
,
Dunn
,
R. E.
,
Norris
,
J. B.
, and
Hinton
,
R. Y.
,
2011
, “
Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study
,”
Am. J. Sports Med.
,
39
(
5
), pp.
958
963
.10.1177/0363546510392326
32.
Langlois
,
J. A.
,
Rutland-Brown
,
W.
, and
Wald
,
M. M.
,
2006
, “
The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview
,”
J. Head Trauma Rehabil.
,
21
(
5
), pp.
375
378
.10.1097/00001199-200609000-00001
33.
Gessel
,
L. M.
,
Fields
,
S. K.
,
Collins
,
C. L.
,
Dick
,
R. W.
, and
Comstock
,
R. D.
,
2007
, “
Concussions Among United States High School and Collegiate Athletes
,”
42
(
4
), pp.
495
503
.
34.
Coronado
,
V. G.
,
Haileyesus
,
T.
,
Cheng
,
T. A.
,
Bell
,
J. M.
,
Haarbauer-Krupa
,
J.
,
Lionbarger
,
M. R.
,
Flores-Herrera
,
J.
,
McGuire
,
L. C.
, and
Gilchrist
,
J.
,
2015
, “
Trends in Sports-and Recreation-Related Traumatic Brain Injuries Treated in US Emergency Departments: The National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001-2012
,”
J. Head Trauma Rehabil.
,
30
(
3
), p.
185
.10.1097/HTR.0000000000000156
35.
NOCSAE
,
2015
, “
Standard Performance Specification for Newly Manufactured Football Helmets
,” National Operating Committee on Standards for Athletic Equipment, Overland Park, KS, Standard No. (ND)002-13m15.
36.
Commission, U. S. C. P. S.
,
1998
, “
16CFR Part 1203 Safety Standard for Bicycle Helmets
,” U.S. Federal Register, Bethesda, MD.
37.
Funk
,
J.
,
Crandall
,
J.
,
Wonnacott
,
M.
,
Withnall
,
C.
, and
Drive
,
D. R.
,
2017
, “
NFL Linear Impactor Helmet Test Protocol
,” Biocore, Charlottesville, VA, accessed Feb. 1, 2019, http//biocorellc.com/wp-content/uploads/2018/01/NFL-linear-impact-helmet-test-protocol.pdf
38.
Tyson
,
A. M.
, and
Rowson
,
S.
,
2018
, “
Varsity Football Helmet STAR Protocol
,” accessed Feb, 1, 2019, http://hdl.handle.net/10919/82953
39.
Vasavada
,
A. N.
,
Li
,
S.
, and
Delp
,
S. L.
,
1998
, “
Influence of Muscle Morphometry and Moment Arms on the Moment-Generating Capacity of Human Neck Muscles
,”
Spine
,
23
(
4
), pp.
412
422
.10.1097/00007632-199802150-00002
40.
Kuo
,
C.
,
Fanton
,
M.
,
Wu
,
L.
, and
Camarillo
,
D.
,
2018
, “
Spinal Constraint Modulates Head Instantaneous Center of Rotation and Dictates Head Angular Motion
,”
J. Biomech
.,
76
, pp.
220
228
.10.1016/j.jbiomech.2018.05.024
41.
Giudice
,
J. S.
,
Park
,
G.
,
Kong
,
K.
,
Bailey
,
A.
,
Kent
,
R.
, and
Panzer
,
M. B.
,
2019
, “
Development of Open-Source Dummy and Impactor Models for the Assessment of American Football Helmet Finite Element Models
,”
Ann. Biomed. Eng.
,
47
(
2
), pp.
464
474
.10.1007/s10439-018-02155-3
42.
Khatib
,
O.
,
1995
, “
Inertial Properties in Robotic Manipulation: An Object Level Framework
,”
Int. J. Rob. Res.
,
13
(
1
), pp.
19
36
.
43.
Walilko
,
T. J.
,
Viano
,
D. C.
, and
Bir
,
C. A.
,
2005
, “
Biomechanics of the Head for Olympic Boxer Punches to the Face
,”
Br. J. Sports Med.
,
39
(
10
), pp.
710
719
.10.1136/bjsm.2004.014126
44.
Pellman
,
E. J.
,
Viano
,
D. C.
,
Tucker
,
A. M.
,
Casson
,
I. R.
, and
Waeckerle
,
J. F.
,
2003
, “
Concussion in Professional Football—Part 1: Reconstruction of Game Impacts and Injuries
,”
Neurosurgery
,
53
(
4
), pp.
799
812
.10.1093/neurosurgery/53.3.799
45.
Kleiven
,
S.
, and
Hardy
,
W. N.
,
2002
, “
Correlation of an FE Model of the Human Head With Local Brain Motion–Consequences for Injury Prediction
,”
Stapp Car Crash J.
,
46
, pp.
123
144
.https://www.ncbi.nlm.nih.gov/pubmed/17096222
46.
Bain
,
A. C. A. C.
, and
Meaney
,
D. F. D. F.
,
2000
, “
Tissue-Level Thresholds for Axonal Damage in an Nervous System White Matter Injury
,”
ASME J. Biomech. Eng.
,
122
(
6
), pp.
615
622
.https://www.ncbi.nlm.nih.gov/pubmed/11192383
47.
Moss
,
W.
, and
King
,
M. J.
,
2011
, “
Impact Response of U.S. Army and NFL Helmet Pad Systems
,” Lawrence Livermore National Laboratory, Livermore, CA.
48.
Kochenderfer
,
M. J.
, and
Wheeler
,
T. A.
,
2019
,
Algorithms for Optimization
,
MIT Press
, Cambridge, MA.
49.
Yoganandan
,
N.
,
Pintar
,
F. A.
,
Zhang
,
J.
, and
Baisden
,
J. L.
,
2009
, “
Physical Properties of the Human Head: Mass, Center of Gravity and Moment of Inertia
,”
J. Biomech.
,
42
(
9
), pp.
1177
1192
.10.1016/j.jbiomech.2009.03.029
50.
Kurt
,
M.
,
Laksari
,
K.
,
Kuo
,
C.
,
Grant
,
G. A.
, and
Camarillo
,
D. B.
,
2017
, “
Modeling and Optimization of Airbag Helmets for Preventing Head Injuries in Bicycling
,”
Ann. Biomed. Eng.
,
45
(
4
), pp.
1148
1160
.10.1007/s10439-016-1732-1
51.
Ewing
,
C.
,
Thomas
,
D.
,
Lustick
,
L.
,
Muzzy
,
W.
,
Willems
,
G.
, and
Majewski
,
P.
,
1978
, “
Effect of Initial Position on the Human Head and Neck Response to +Y Impact Acceleration
,”
SAE
Paper No. 780888.10.4271/780888
52.
Viano
,
D. C.
, and
Pellman
,
E. J.
,
2005
, “
Concussion in Professional Football: Biomechanics of the Striking Player—Part 8
,”
Neurosurgery
,
56
(
2
), pp.
266
278
.10.1227/01.NEU.0000150035.54230.3C
53.
Heck
,
J. F.
,
Clarke
,
K. S.
,
Peterson
,
T. R.
,
Torg
,
J. S.
, and
Weis
,
M. P.
,
2004
, “
National Athletic Trainers' Association Position Statement: Head-Down Contact and Spearing in Tackle Football
,”
J. Athletic Train.
,
39
(
1
), pp.
101
111
.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC385269/
54.
Cournoyer
,
J.
,
Kinetics
,
I. H.
,
Hoshizaki
,
T. B.
,
Sveistrup
,
H.
,
Bishop
,
P.
, and
Tator
,
C.
,
2019
, “Head Dynamic Response and Brain Tissue Deformation for Boxing Punches With and Without Loss of Consciousness,”
Clin. Biomech.
,
67
, pp.
96
101
.10.1016/j.clinbiomech.2019.05.003
55.
Rowson
,
S.
,
Duma
,
S. M.
,
Beckwith
,
J. G.
,
Chu
,
J. J.
,
Greenwald
,
R. M.
,
Crisco
,
J. J.
,
Brolinson
,
P. G.
,
Duhaime
,
A.-C.
,
McAllister
,
T. W.
, and
Maerlender
,
A. C.
,
2012
, “
Rotational Head Kinematics in Football Impacts: An Injury Risk Function for Concussion
,”
Ann. Biomed. Eng.
,
40
(
1
), pp.
1
13
.10.1007/s10439-011-0392-4
56.
Takhounts
,
E. G.
,
Craig
,
M. J.
,
Moorhouse
,
K.
,
McFadden
,
J.
, and
Hasija
,
V.
,
2013
, “
Development of Brain Injury Criteria (BrIC)
,”
Stapp Car Crash J.
,
57
, pp.
243
266
.
57.
Gennarelli
,
T. A.
,
Thibault
,
L. E.
, and
Ommaya
,
A. K.
,
2010
, “
Pathophysiologic Responses to Rotational and Translational Accelerations of the Head
,”
SAE
Paper No. 720970.10.4271/720970
58.
Kuo
,
C.
,
Wu
,
L. C.
,
Loza
,
J.
,
Senif
,
D.
,
Anderson
,
S.
, and
Camarillo
,
D. B.
,
2018
, “
Comparison of Video-Based and Sensor-Based Head Impact Exposure
,”
PLoS One
,
13
(6), p. e0199238.10.1371/journal.pone.0199238
59.
Taylor
,
K.
,
2018
, “
The Use of Decoupling Structures in Helmet Liners to Reduce Maximum Principal Brain Tissue Strain for Head Impacts Acknowledgment
,”
Doctoral dissertation
, University of Ottawa, Ottawa, ON.
60.
Bliven
,
E.
,
Rouhier
,
A.
,
Tsai
,
S.
,
Willinger
,
R.
,
Bourdet
,
N.
,
Deck
,
C.
,
Madey
,
S. M.
, and
Bottlang
,
M.
,
2019
, “
Evaluation of a Novel Bicycle Helmet Concept in Oblique Impact Testing
,”
Accid. Anal. Prev.
,
124
, pp.
58
65
.10.1016/j.aap.2018.12.017
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