Title: Reliability of Child SCAT 3 Component Scores in Children at Rest and Following Exercise Author Names: Jeff Billeck, BPE, CAT(C)1, Mike Ellis, MD2, Jeff Leiter, PhD2, Joanne Parsons, PhD, BPT3. Jason Peeler, PhD, CAT(C)4 Problem: A lack of research exists regarding the test-retest reliability of the Child Sport Concussion Assessment Tool 3 (Child SCAT 3) in healthy non-concussed adolescent females in both baseline and post-exercise settings. Method: This study consisted of two testing sessions. Within each session the Child Sport Concussion Assessment Tool 3 (Child SCAT 3) was administered once prior to exercise and once after a bout of exercise. Results: Individual component scores displayed a wide range of reliability and response stability values. A positive correlation existed within one session, between child symptom scores and slower rates of heart rate recovery after exercise. Conclusions: Overall, the Child SCAT 3 appears to be a moderately reliable assessment tool when used to evaluate uninjured female children. However, further research is required to clarify the exact sources of method error within individual Child SCAT 3 component scores. / May 2016

The purpose of the present study was to investigate the efficacy of a memory and metamemory training program on memory performance and metamemory judgement accuracy in adults with a closed head injury. A multiple baseline across subjects design was used with six subjects. All subjects were seen at least two years post-injury. Training included general metamemory information about the nature of memory, use of a specific memory strategy to assist verbal recall (to Preview, Question, Read, State and Test- PQRST), specific metamemory information about the strategy, and a self instruction procedure (WTSC- What is the task, Select a strategy to use, Try out strategy, Check to evaluate strategy effectiveness). During the training period all subjects recalled greater than fifty percent of paragraph ideas while using PQRST. Follow-up tests showed that five of the six subjects maintained recall levels but a gradual decrease in slope was observed over eight weeks post-training. Tests of recall, recognition and metamemory judgements on Sentence and Action Tasks were used to evaluate generalisation of training. Two subjects showed improved recall and two subjects showed improved recognition performance. In addition, four subjects demonstrated greater metamemory judgement accuracy about recognition performance following training. Improved performance post-training was also observed for three subjects on the Rivermead Behavioral Memory Test and the Logical Memory subtest of the Wechsler Memory Scale-Revised, greater than that expected for repeated testing. Several factors were identified as having a role in subjects’ ability to benefit from training.

The massive number of injuries sustained in trafficaccidents is a growing problem worldwide, especially indeveloping countries. In 1998, more than one million peoplewere killed in traffic accidents worldwide, while about tentimes as many people were injured. Injuries to the centralnervous system and in particular to the headare especiallycritical to human life. This thesis contains five researchpapers looking at head injuries and head protection, proposingnew and more efficient ways of protecting the head, especiallyin traffic accidents. In order to define the national dimensions of the patternsof injuries incurred in motorcycle and moped accidents inSweden, a statistical survey was performed on data spanning a13-year period (Paper A). In Sweden, 27,100 individualsreceived in-patient care for motorcycle and moped accidentinjuries between 1987 and 1999. The motorcycle and moped injuryrate reduced in the second half of the study period, so toowere the total number of days of treatment per year. Males hadeight times the incidence of injuries of females. Head injurieswere the single most frequent diagnosis, followed by fracturesof the lower limbs. Concussion was the most frequent headinjury. These statistics clearly show the need for better headinjury prevention systems. According to the statistics, the most common type of impactto the head in motorcycle and moped accidents is an obliqueimpact. Oblique impacts generate rotations of the head, whichare a common cause of the most severe head injuries. Thereforea new test rig was constructed to reproduce oblique impacts toa helmeted dummy head, simulating those occurring in real lifeaccidents (Paper B). The new test rig was shown to provideuseful data at speeds of up to 50 km/h and with impact anglesvarying from purely tangential to purely radial. Thisinnovative test rig appears to provide an accurate method formeasuring accelerations in oblique impacts to helmets. When testing the performances of motorcycle helmets,discrepancies are usually seen in the test results. In order toevaluate these discrepancies, the finite element method (FEM)was used for simulations of a few oblique helmet impacts (PaperC). Amongthe parameters studied, the coefficients of frictionbetween the impacting surface and the helmet and between thehead and the helmet had the most significant influence on therotational accelerations. Additionally, a thinner andconsequently also weaker shell and a weaker liner, providedbetter protection for the impacts studied. Since there are no generally accepted global injurythresholds for oblique impacts to the human head, a study wasdesigned to propose new injury tolerances accounting for bothtranslations and rotations of the head (Paper D). In thatstudy, FE models of (a) a human head, (b) a Hybrid III dummyhead, and (c) the experimental helmet were used. Differentcriteria were proposed for different impact scenarios. Both thetranslational and the rotational effects were found to beimportant when proposing a predictor equation for the strainlevels experienced by the human brain in simulated impacts tothe head. In order to reduce the level of head injuries in society andto better understand helmet impacts from different aspect, aballistic impact was also studied (Paper E). The effects ofdifferent helmet shell stiffness and different angles ofimpacts were simulated. In this study, the same FE head modelfrom Paper D was used, however here it was protected with amodel of a composite ballistic helmet. It was concluded thatthe helmet shell should be stiff enough to prevent the insideof the shell from striking the skull, and that the strainsarising in the brain tissue were higher for some obliqueimpacts than for purely radial ones. In conclusion, this thesis describes the injury pattern ofmotorcycle and moped accidents in Sweden. This thesis showsthat the injuries sustained from these accidents can bereduced. In order to study both translational as well asrotational impacts, a new laboratory test rig was designed. Byusing the finite element method, it is possible to simulaterealistic impacts to the head and also to predict how severehead injuries may potentially be prevented.

The varied impact parameters that characterize an impact to the head have shown to influence the resulting type and severity of outcome injury, both in terms of the dynamic response, and the corresponding deformation of neural tissue. Therefore, when determining head injury risks through event reconstruction, it is important to understand how individual impact characteristics influence these responses. The effect of inbound mass had not yet been documented in the literature. The purpose of this study was to determine the effects of inbound mass on the dynamic impact response and brain tissue deformation. A 50th percentile Hybrid III adult male head form was impacted using a simple pendulum system. Impacts to a centric and a non-centric impact location were performed with six varied inbound masses at a velocity of 4.0 m/s. The peak linear and peak angular accelerations were measured. A finite element model, (UCDBTM) was used to determine brain deformation, namely peak maximum principal strain and peak von Mises stress. Inbound mass produced significant differences for peak linear acceleration for centric (F(5, 24) = 217.55, p=.0005) and non-centric (F(5, 24) = 161.98, p=.0005), and for peak angular acceleration for centric (F(5, 24) = 52.51, p=.0005) and non-centric (F(5, 24) = 4.18, p=.007) impact locations. A change in inbound mass also had a significant effect on peak maximum principal strain for centric (F(5, 24) = 11.04, p=.0005) and non-centric (F(5, 24) = 5.87, p =.001), and for peak von Mises stress for centric (F(5, 24) = 24.01, p=.0005) and non-centric (F(5, 24) = 4.62, p=.004) impact locations. These results indicate the inbound mass of an impact should be of consideration when determining risks and prevention to head and brain injury.

<p>The massive number of injuries sustained in trafficaccidents is a growing problem worldwide, especially indeveloping countries. In 1998, more than one million peoplewere killed in traffic accidents worldwide, while about tentimes as many people were injured. Injuries to the centralnervous system and in particular to the headare especiallycritical to human life. This thesis contains five researchpapers looking at head injuries and head protection, proposingnew and more efficient ways of protecting the head, especiallyin traffic accidents.</p><p>In order to define the national dimensions of the patternsof injuries incurred in motorcycle and moped accidents inSweden, a statistical survey was performed on data spanning a13-year period (Paper A). In Sweden, 27,100 individualsreceived in-patient care for motorcycle and moped accidentinjuries between 1987 and 1999. The motorcycle and moped injuryrate reduced in the second half of the study period, so toowere the total number of days of treatment per year. Males hadeight times the incidence of injuries of females. Head injurieswere the single most frequent diagnosis, followed by fracturesof the lower limbs. Concussion was the most frequent headinjury. These statistics clearly show the need for better headinjury prevention systems.</p><p>According to the statistics, the most common type of impactto the head in motorcycle and moped accidents is an obliqueimpact. Oblique impacts generate rotations of the head, whichare a common cause of the most severe head injuries. Thereforea new test rig was constructed to reproduce oblique impacts toa helmeted dummy head, simulating those occurring in real lifeaccidents (Paper B). The new test rig was shown to provideuseful data at speeds of up to 50 km/h and with impact anglesvarying from purely tangential to purely radial. Thisinnovative test rig appears to provide an accurate method formeasuring accelerations in oblique impacts to helmets.</p><p>When testing the performances of motorcycle helmets,discrepancies are usually seen in the test results. In order toevaluate these discrepancies, the finite element method (FEM)was used for simulations of a few oblique helmet impacts (PaperC). Amongthe parameters studied, the coefficients of frictionbetween the impacting surface and the helmet and between thehead and the helmet had the most significant influence on therotational accelerations. Additionally, a thinner andconsequently also weaker shell and a weaker liner, providedbetter protection for the impacts studied.</p><p>Since there are no generally accepted global injurythresholds for oblique impacts to the human head, a study wasdesigned to propose new injury tolerances accounting for bothtranslations and rotations of the head (Paper D). In thatstudy, FE models of (a) a human head, (b) a Hybrid III dummyhead, and (c) the experimental helmet were used. Differentcriteria were proposed for different impact scenarios. Both thetranslational and the rotational effects were found to beimportant when proposing a predictor equation for the strainlevels experienced by the human brain in simulated impacts tothe head.</p><p>In order to reduce the level of head injuries in society andto better understand helmet impacts from different aspect, aballistic impact was also studied (Paper E). The effects ofdifferent helmet shell stiffness and different angles ofimpacts were simulated. In this study, the same FE head modelfrom Paper D was used, however here it was protected with amodel of a composite ballistic helmet. It was concluded thatthe helmet shell should be stiff enough to prevent the insideof the shell from striking the skull, and that the strainsarising in the brain tissue were higher for some obliqueimpacts than for purely radial ones.</p><p>In conclusion, this thesis describes the injury pattern ofmotorcycle and moped accidents in Sweden. This thesis showsthat the injuries sustained from these accidents can bereduced. In order to study both translational as well asrotational impacts, a new laboratory test rig was designed. Byusing the finite element method, it is possible to simulaterealistic impacts to the head and also to predict how severehead injuries may potentially be prevented.</p>

The varied impact parameters that characterize an impact to the head have shown to influence the resulting type and severity of outcome injury, both in terms of the dynamic response, and the corresponding deformation of neural tissue. Therefore, when determining head injury risks through event reconstruction, it is important to understand how individual impact characteristics influence these responses. The effect of inbound mass had not yet been documented in the literature. The purpose of this study was to determine the effects of inbound mass on the dynamic impact response and brain tissue deformation. A 50th percentile Hybrid III adult male head form was impacted using a simple pendulum system. Impacts to a centric and a non-centric impact location were performed with six varied inbound masses at a velocity of 4.0 m/s. The peak linear and peak angular accelerations were measured. A finite element model, (UCDBTM) was used to determine brain deformation, namely peak maximum principal strain and peak von Mises stress. Inbound mass produced significant differences for peak linear acceleration for centric (F(5, 24) = 217.55, p=.0005) and non-centric (F(5, 24) = 161.98, p=.0005), and for peak angular acceleration for centric (F(5, 24) = 52.51, p=.0005) and non-centric (F(5, 24) = 4.18, p=.007) impact locations. A change in inbound mass also had a significant effect on peak maximum principal strain for centric (F(5, 24) = 11.04, p=.0005) and non-centric (F(5, 24) = 5.87, p =.001), and for peak von Mises stress for centric (F(5, 24) = 24.01, p=.0005) and non-centric (F(5, 24) = 4.62, p=.004) impact locations. These results indicate the inbound mass of an impact should be of consideration when determining risks and prevention to head and brain injury.

The varied impact parameters that characterize an impact to the head have shown to influence the resulting type and severity of outcome injury, both in terms of the dynamic response, and the corresponding deformation of neural tissue. Therefore, when determining head injury risks through event reconstruction, it is important to understand how individual impact characteristics influence these responses. The effect of inbound mass had not yet been documented in the literature. The purpose of this study was to determine the effects of inbound mass on the dynamic impact response and brain tissue deformation. A 50th percentile Hybrid III adult male head form was impacted using a simple pendulum system. Impacts to a centric and a non-centric impact location were performed with six varied inbound masses at a velocity of 4.0 m/s. The peak linear and peak angular accelerations were measured. A finite element model, (UCDBTM) was used to determine brain deformation, namely peak maximum principal strain and peak von Mises stress. Inbound mass produced significant differences for peak linear acceleration for centric (F(5, 24) = 217.55, p=.0005) and non-centric (F(5, 24) = 161.98, p=.0005), and for peak angular acceleration for centric (F(5, 24) = 52.51, p=.0005) and non-centric (F(5, 24) = 4.18, p=.007) impact locations. A change in inbound mass also had a significant effect on peak maximum principal strain for centric (F(5, 24) = 11.04, p=.0005) and non-centric (F(5, 24) = 5.87, p =.001), and for peak von Mises stress for centric (F(5, 24) = 24.01, p=.0005) and non-centric (F(5, 24) = 4.62, p=.004) impact locations. These results indicate the inbound mass of an impact should be of consideration when determining risks and prevention to head and brain injury.

Objectives Motorcycle helmet laws vary by state, with Kentucky requiring helmets only for younger riders. We hypothesized that motorcyclists injured in Kentucky and seen at a Tennessee trauma center would be more likely to be unhelmeted, have more severe head injuries, and sustain more fatal injuries than those injured in Tennessee or Virginia. Methods A Trauma Registry review of 729 injured motorcyclists from January 2005 through June 2015 examined state location of crash, demographics, helmet use, and clinical outcomes. Multivariate logistic regression analysis evaluated predictors for head injury severity and death. Results Unhelmeted motorcycle rider status predicted more severe head injuries (relative risk 15.3, P < 0.001) and death (relative risk 4.2, P < 0.001). Motorcyclists injured in the state of Kentucky were more likely to be unhelmeted, require an operative procedure, have more severe head injuries, have longer lengths of stay, and sustain more fatal injuries (all with < 0.001) than motorcyclists injured in Tennessee or Virginia. Conclusions This study lends support for maintaining and enforcing current universal motorcycle helmet laws for all ages in states where they are in effect and for upgrading helmet laws that apply only to some riders.

Ice hockey helmet standards are employed to test ice hockey helmets to ensure that they mitigate the risk of traumatic brain injuries. These standards primarily reflect adult ice hockey players' anthropometrics and play styles; however, they may not address youth ice hockey players anthropometrics and play styles. This study created a youth helmet test protocol using head impact characteristics specific to the Learn to Play (5-8 years old) youth ice hockey age group environment. The youth helmet test protocol was compared to a general helmet test protocol with the head mass, shoulder mass, and impacting velocities modified to reflect real-world conditions. The dependent variables used in the study included peak resultant linear acceleration, peak resultant rotational velocity, peak resultant rotational acceleration, and maximal principal strain (MPS). Two-way ANOVA identified significant interactions between the test protocols and two helmets tested in this study. This was followed by ANOVA to test for significance across the levels of the independent variables followed by paired t-tests to identify significant differences between the test protocols for each dependent variable for the head to boards and shoulder to head condition (p<0.05). The only significant difference identified between the test protocols for the head to ice condition was linear acceleration. The paired t-tests identified significant differences between the two helmets for all dependent variables for the head to ice and head to boards conditions (p<0.05). The results from this study revealed that youth are being exposed to similar amounts of brain trauma when compared to adults for the head to ice event. The head to ice condition is one of the most common types of impact events in the Learn to Play age group supporting the need to consider a youth specific ice hockey helmet standard test. This study demonstrated that the CCM FL 500 provided better protection for youth ice hockey players, and helmet companies could employ similar technologies to better protect youth from the risk of brain injuries.

Objective Adolescence is recognised as a risk period for offending and head injury (HI), with higher rates of HI found in the young offender (YO) population compared to the general population. Drug and alcohol use has also been associated with increased risk of offending. This study aims to explore the relationships between HI, Post-concussion symptoms (PCS), reactive and proactive aggression, and offending behaviour in YOs, whilst considering the effects of drug and alcohol use on these relationships. Participants A sample of ninety eight males was recruited from a Young Offender Institute: the age range was 16-18 years of age with an average age of 17. Design A between subjects cross sectional design was employed. Participants were recruited using an opportunistic sampling strategy. Main Measures Self-rated/report measures of: HI, Post-Concussion Symptoms (Adapted Rivermead Post-Concussion Symptom Questionnaire), Aggression (Reactive-Proactive Scale), criminal histories, and drug and alcohol history. Results HI was reported by 73.5% of the overall sample, with 61.1% reporting a “knock out”. Frequency and severity of HI was associated with significantly higher PCS scores. Examination of covariate- drug and alcohol use did not affect these relationships. PCS were a significant predictor of reactive aggression, total number of convictions and number of previous violent convictions. However, dosage of HI (severity and frequency) was not a significant predictor of reactive aggression or criminal profiles. Conclusions There appears to be a dose-response effect of severity and frequency of HI on PCS, with PCS predicting reactive aggression. Such symptoms may compromise functions and lead to increased aggression. This highlights the need for better screening and interventions for HI and on-going symptoms in YOs.