Athletes competing in the unarmed combat sport of mixed martial arts (MMA) are at an increased risk for long-term neurological consequences due to repetitive head trauma. Mass differentials as well as reported differences in fight styles between Lightweight and Heavyweight fighters in MMA may affect head impact kinematics creating different levels of head injury risk. Factors that influence the risk for head injury include the frequency, magnitude and interval of head impacts. The purpose of this study was to compare differences in frequency, frequency distribution of impact magnitudes, and time interval between head impacts per match between Lightweight and Heavyweight fighters in the Ultimate Fighting Championship (UFC). Head impacts of 60 fighters were documented from 15 Lightweight and 15 Heavyweight MMA fight videos. Impact type, frequency, and interval were recorded for each fighter, followed by the reconstruction of 345 exemplar impacts in the laboratory using a Hybrid III headform and finite element modeling to determine impact magnitudes. Next, head impacts (punches, kicks, knees and elbows) from fight videos were visually estimated to determine their corresponding magnitude range and establish the frequency distribution of impact magnitudes. The study revealed no significant differences in overall impact frequency and interval between Lightweight and Heavyweight fighters. The frequency distribution of different impact magnitudes was significantly different, with Lightweights sustaining significantly more Very Low, and High magnitude impacts. Overall, both Lightweight and Heavyweight MMA fighters sustain similar impact characteristics as other high-risk athletes including professional boxers and football players. Understanding the different factors that create brain trauma allows for the monitoring, identification, and protection of higher-risk athletes within these two weight classes.

The current focus of research efforts in the area of the biomechanics of traumatic brain injury is the development of numerical (finite element) models of the human head. A validated numerical model of the human head may lead to better head injury criteria than those used currently in crashworthiness studies. A critical step in constructing a validated finite element model of the head is determining the mechanical threshold, should it exist, for various types of injury to brain tissue. This thesis describes a biomechanical study of axonal injury in the anaesthetised sheep. The study used the measurements of the mechanics of an impact to the living sheep, and a finite element model of the sheep skull and brain, to investigate the mechanics of the resulting axonal injury. Sheep were subjected to an impact to the left lateral region of the skull and were allowed to survive for four hours after the impact. The experiments were designed specifically with the numerical model in mind; sufficient data were collected to allow the mechanics of the impact to be faithfully reproduced in the numerical model. The axonal injury was identified using immunohistological methods and the injury was mapped and quantified. Axonal injury was produced consistently in all animals. Commonly injured regions included the sub-cortical and deep white matter, the hippocampi and the margins of the lateral ventricles. The degree of injury was closely related to the peak impact force and to kinematic measurements, particularly the peak change in linear and angular velocity. There was significantly more injury in animals receiving fractures. A three-dimensional finite element model of the sheep skull and brain was constructed to simulate the dynamics of the brain during the impact. The model was used to investigate different regimes of material properties and boundary conditions, in an effort to produce a realistic model of the skull and brain. Model validation was attempted by comparing pressure measurements in the experiment with those calculated by the model. The distribution of axonal injury was then compared with the output of the finite element model. The finite element model was able to account for approximately thirty per cent of the variation in the distribution and extent of axonal injury, using von Mises stress as the predictive variable. Logistic regression techniques were used to construct sets of curves which related the extent of injury, to the predictions of the finite element model, on a regional basis. The amount of observable axonal injury in the brains of the sheep was clearly related to the severity of the impact, and was related to the predictions of a finite element model of the impact. Future improvements to the fidelity of the finite element model may improve the degree to which the model can explain the variation in injury throughout the brain of the animal and variations between animals. This thesis presents results, and a methodological framework, that may be used to further our understanding of the limits of human endurance, in the tolerance of the brain to head impact. All experiments reported herein conformed with the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes. / Thesis (Ph.D.)--Mechanical Engineering, 2000.

The main objectives of the present thesis were to define the dimension of head injuries in Sweden over a longer period and to present a Finite Element (FE) model of the human head which can be used for preventive strategies in the future. The annual incidence of head injuries in Sweden between 1987 and 2000 was defined at over 22 000, cases most of which were mild head injuries. In contrast to traffic accidents, head injuriy due to fall was the most important etiology. Of special interest was that the number of hematoma cases has increased. A detailed and parameterized FE model of the human head was developed and used to evaluate the effects of head size, brain size and impact directions. The maximal effective stresses in the brain increased more than a fourfold, from 3.6 kPa for the smallest head size to 16.3 kPa for the largest head size using the same acceleration impulse. The size dependence of the intracranial stresses associated with injury is not predicted by the Head Injury Criterion (HIC). Simulations with various brain sizes indicated that the increased risk of Subdural Hematoma (SDH) in elderly people may to a part be explained by the reduced brain size resulting in a larger relative motion between the skull and the brain with distension of bridging veins. The consequences of this increased relative motion due to brain atrophy cannot be predicted by existing injury criteria. From studies of the influence of impact directions to the human head, the highest shear strain in the brain stem is found for a Superior-Inferior (SI) translational impulse, and in the corpus callosum for a lateral rotational impulse when imposing acceleration pulses corresponding to the same impact power. It was concluded that HIC is unable to predict consequences of a pure rotational impulse, while the Head Impact Power (HIP) criterion needs individual scaling coefficients for the different terms to account for differences in intracranial response due to a variation in load direction. It is also suggested that a further evaluation of synergic effects of the directional terms of the HIP is necessary to include combined terms and to improve the injuryprediction. Comparison of the model with experiments on localized motion of the brain shows that the magnitude and characteristics of the deformation are highly sensitive to the shear properties of the brain tissue. The results suggest that significantly lower values of these properties of the human brain than utilized in most 3D FE models today must be used to be able to predict the localised brain response of an impact to the human head. There is a symmetry in the motion of the superior and inferior markers for both the model and the experiments following a sagittal and a coronal impact. This can possibly be explained by the nearly incompressible properties of brain tissue. Larger relative motion between the skull and the brain is more apparent for an occipital impact than for a frontal one in both experiments and FE model. This correlates with clinical findings. Moreover, smaller relative motion between the skull and the brain is more apparent for a lateral impact than for a frontal one for both experiments and FE model. This is thought to be due to the supporting structure of the falx cerebri. Such a parametrized and detailed 3D model of the human head has not, to the best knowledge of the author, previously been developed. This 3D model is thought to be of significant value for looking into the effects of geometrical variations of the human head. / QC 20100428

Falls among the elderly population continue to be a growing concern in the healthcare industry and are marked by staggeringly high social and economic costs. The incidence of falls is known to increase with age, and currently the elderly population is growing at an astounding rate as baby-boomers are now entering this age group. Also, recovery following fall-related injuries decreases with increased age. These confounding factors currently make falls a very important area of research. Of the injuries typically seen in falls among the elderly, head injuries are one of the most debilitating. Death due to head trauma among the elderly is gaining national attention; head trauma is now considered the number one cause of death among elders who fall1. Among other technologies, medical helmets are often employed to protect against such injuries, but patient compliance with these helmets remains an issue. Current helmets use foams and cotton as padding, contributing to clumsy designs. Dilatent and honeycomb materials may be the future of this industry as their low weight and high efficacy per thickness make them ideal materials for thinner, lighter, less cumbersome head protection devices. This study outlines various modes of head injury and then highlights several head protection measures. The newer materials are tested using various methods to determine the most promising candidates for prototype designs. Next, three prototypes are assembled from the newer materials and compared directly based on the protection measures established. Finally, the top-performing prototype is compared against two existing medical helmets in a similar fashion. The results show that the best prototype significantly outperforms one of the existing medical helmets, and shows slight improvement over the other. These results establish the promise of these newer materials in the application of head protection devices.

Introduction-Physical activity can reduce the risk of contracting many of the 'diseases of the sedentary', such as coronary heart disease and cancer (Blair et al., 1996). Recognition of this protective effect has led to the development of many programmes designed to promote the benefit of participation in sport and physical exercise (Hillary Commission, 1993; Nicholl et aI., 1995). With participation in sport, especially contact sport, the risk for injuries increases, including injuries to the head and neck (Wilberger, 1993; Wekesa et al., 1996; Pettersen, 2002). Mild traumatic brain injuries (MTBI) or concussion as used interchangeably in the literature (Maroon et al., 2000; Wills & Leathem, 2001) are an important public health concern, due to the high incidence and frequently persisting symptomatology (Evans, 1992). Mild traumatic brain injury is defined as a complex patho-physiological process affecting the brain induced by traumatic biomechanical forces (Aubry et al., 2002; McCrory et al., 2004). A sub-concussive injury or very mild traumatic brain injury (vMTBI) may be defined as an apparent brain insult with insufficient force to cause hallmark symptoms of concussion (Jordan, 2000; Webbe & Bath, 2003). The high incidence of sport related head injuries in South Africa is alarming, although the prevalence thereof is unknown and difficult to assess, as the seemingly trivial injuries frequently remain unreported (Roux et al., 1987). This is especially applicable in sport where a milder form of head injury is common. This is cause for concern as cumulative head injuries traditionally regarded as trivial or 'minor' may result in players running the risk of increasingly negative consequences following repetitive 'minor' head injuries. In contact sport such as rugby, players are at great risk of sustaining repetitive mild traumatic brain injuries. The negative outcome following these repetitive minor head injuries has been demonstrated by numerous studies on boxers and other athletes exposed to repeated MTBI and vMTBI (McLatchie et aI., 1987). The incidence of vMTBI has not yet been researched in school rugby and this study is the first to report the incidence of vMTBI in a secondary school rugby team. Obiectives - The objectives of this study were to determine the incidence, the neuropsychological consequences and the effect on the academic performance of repeated mild (MTBI) and very mild traumatic brain injuries (vMTBI) in a secondary school rugby team during one playing season. Methods - A cohort of 35 secondary school male rugby players divided into a vMTBI (group 1) (n=26) and a MTBI (group 2) (n=9) from a local secondary school's first and second team, was followed for a full competitive season by a trained Biokineticist, who was present at all the games and contact sessions played. All vMTBI and MTBI and the severity of these injuries were documented. A control (group 3) that consisted of 10 secondary school non-rugby players were compared with the vMTBI and MTBI groups. The incidence of repeated MTBI and vMTBI in a secondary school rugby team were gathered by questionnaires and observation next to the field by a trained Biokineticist. Pre-season and post-season neuropsychological tests were conducted on the research groups and the control group. The neuropsychological tests that were conducted on the three groups were the Colour Trial Test 1 and 2 (CTT 1 + 2), the Symbol Digit Modalities Test (SDMT), the Wechsler Memory Scale-Revised (WMS-R) and the Standardised Assessment of Concussion (SAC). After each match played throughout the season the research group also completed a SAC test. The academic results of the final examination (year 1) of the year of the specific rugby season were obtained, as well as the academic results of the final examination of the preceding two years (year 2 and 3). The programme STATISTICA (version 7.0, Stat soft, Tulsa, OK) was used to analyse the data. Descriptive statistics, one-way ANOVA's, two-way repeated measures ANOVA's, Post-hoc Tuckey HSD analysis and Pearson's product moment correlation were used for all the statistical analyses. Results - This study of a secondary school rugby team has shown 726 vMTBI's and 18 MTBI's throughout one rugby season. This relates to 1951 vMTBI's per 1000 player hours and 48 MTBI's per 1000 player hours. Reductions in delayed memory (p=O.O1)from preseason to post-season in a group of players with repetitive vMTBI's during a single rugby season were found. This was the first evidence of possible neurocognitive deficits towards delayed memory in very mild traumatic brain injuries at secondary school level. Statistically significant (p<=0.05)results of the SAC test totals between both the vMTBI and MTBI groups were documented in the different games throughout the rugby season and compared with the baseline test. No statistically significant differences (p<=0.05) between the pre-season and post-season's scores of the SAC test totals were documented. A decrease in academic performance in the subject Afrikaans (year 1 compared with year 2) with a p-value of p=O.O17(group 1) and p=O.O16(group 2) respectively was found. Conclusion - The findings of this study indicate a high incidence of vMTBI in a cohort of secondary school rugby players in one season, a statistically significant reduction (p=O.O1 )in delayed memory of the vMTBI rugby players and a statistically significant decrease in academic performance p=O.O17 (group 1) and p=O.O16 (group 2) in the subject Afrikaans from year 1 to year 2 final examinations. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.

Background: There is currently no standard method of diagnosing the presence or severity of concussion in acute primary care settings. This pilot project is part of a larger study to develop a Computerized Concussion Assessment Tool (CCAT). Methods: A prospective observational clinical study was conducted to explore the validity of the CCAT among patients presenting to the Emergency Department at Kingston General Hospital and at Hotel Dieu Hospital (Kingston, Ontario) with minor head injury. Twenty-two patients with concussion and eighteen patients with head injury (but not diagnosed with concussion) were recruited to the study. All participants completed a background questionnaire, several neurocognitive tests and the CCAT assessment. Performance on the CCAT was compared between these two groups. Data collected during the development phase of the CCAT from a Normal Volunteers group (n=68) were used in an additional comparison. CCAT Scores for Selective Attention, Divided Attention and Memory were compared with standard neurocognitive tests through correlational analyses. In addition, the validity and clinical yield of the CCAT were investigated relative to gold standard measures. Results: After adjustment for covariates, no statistically significant differences were found between the three participant groups for any of the three primary CCAT Scores (Selective Attention, Divided Attention and Memory). Correlational analyses showed that the CCAT Selective Attention Score and the CCAT Memory Score are moderately correlated with standard neurocognitive tests. There was no correlation observed for the CCAT Divided Attention Score and its associated neurocognitive test. Conclusion: The CCAT was unable to discriminate between concussed patients and non-concussed individuals. However, moderate correlations observed between the CCAT Scores for Memory and Selective Attention and their respective neurocognitive tests support a view that there should be optimism for the future development of the CCAT. Issues related to the feasibility of the study and its administration in the emergency department setting are discussed. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2008-09-23 10:40:20.199

No description available.

Biofidelity of finite element head model (FEHM) includes geometric and material aspects. A FEHM with inhomogeneous material properties was proposed to improve material biofidelity. The proposed FEHM was validated against experimental data and good agreements were observed. The capability of the proposed model in simulating large tissue deformation was also demonstrated. Influences of inhomogeneous material properties on the mechanical responses of head were investigated by comparing with homogeneous material model. The inhomogeneous material properties induce large peak strains in head constituents, which are probably the cause of various brain injuries. Helmets are effective in preventing head injuries. Parametric studies were conducted to investigate how changes in helmet shell stiffness, foam density and pad thickness influence the performance of a helmet in protecting the brain. Results showed that strain energy absorbed by foam component, contact stress on the interfaces and intracranial responses are significantly affected by foam density and pad thickness.

Introduction-Physical activity can reduce the risk of contracting many of the 'diseases of the sedentary', such as coronary heart disease and cancer (Blair et al., 1996). Recognition of this protective effect has led to the development of many programmes designed to promote the benefit of participation in sport and physical exercise (Hillary Commission, 1993; Nicholl et aI., 1995). With participation in sport, especially contact sport, the risk for injuries increases, including injuries to the head and neck (Wilberger, 1993; Wekesa et al., 1996; Pettersen, 2002). Mild traumatic brain injuries (MTBI) or concussion as used interchangeably in the literature (Maroon et al., 2000; Wills & Leathem, 2001) are an important public health concern, due to the high incidence and frequently persisting symptomatology (Evans, 1992). Mild traumatic brain injury is defined as a complex patho-physiological process affecting the brain induced by traumatic biomechanical forces (Aubry et al., 2002; McCrory et al., 2004). A sub-concussive injury or very mild traumatic brain injury (vMTBI) may be defined as an apparent brain insult with insufficient force to cause hallmark symptoms of concussion (Jordan, 2000; Webbe & Bath, 2003). The high incidence of sport related head injuries in South Africa is alarming, although the prevalence thereof is unknown and difficult to assess, as the seemingly trivial injuries frequently remain unreported (Roux et al., 1987). This is especially applicable in sport where a milder form of head injury is common. This is cause for concern as cumulative head injuries traditionally regarded as trivial or 'minor' may result in players running the risk of increasingly negative consequences following repetitive 'minor' head injuries. In contact sport such as rugby, players are at great risk of sustaining repetitive mild traumatic brain injuries. The negative outcome following these repetitive minor head injuries has been demonstrated by numerous studies on boxers and other athletes exposed to repeated MTBI and vMTBI (McLatchie et aI., 1987). The incidence of vMTBI has not yet been researched in school rugby and this study is the first to report the incidence of vMTBI in a secondary school rugby team. Obiectives - The objectives of this study were to determine the incidence, the neuropsychological consequences and the effect on the academic performance of repeated mild (MTBI) and very mild traumatic brain injuries (vMTBI) in a secondary school rugby team during one playing season. Methods - A cohort of 35 secondary school male rugby players divided into a vMTBI (group 1) (n=26) and a MTBI (group 2) (n=9) from a local secondary school's first and second team, was followed for a full competitive season by a trained Biokineticist, who was present at all the games and contact sessions played. All vMTBI and MTBI and the severity of these injuries were documented. A control (group 3) that consisted of 10 secondary school non-rugby players were compared with the vMTBI and MTBI groups. The incidence of repeated MTBI and vMTBI in a secondary school rugby team were gathered by questionnaires and observation next to the field by a trained Biokineticist. Pre-season and post-season neuropsychological tests were conducted on the research groups and the control group. The neuropsychological tests that were conducted on the three groups were the Colour Trial Test 1 and 2 (CTT 1 + 2), the Symbol Digit Modalities Test (SDMT), the Wechsler Memory Scale-Revised (WMS-R) and the Standardised Assessment of Concussion (SAC). After each match played throughout the season the research group also completed a SAC test. The academic results of the final examination (year 1) of the year of the specific rugby season were obtained, as well as the academic results of the final examination of the preceding two years (year 2 and 3). The programme STATISTICA (version 7.0, Stat soft, Tulsa, OK) was used to analyse the data. Descriptive statistics, one-way ANOVA's, two-way repeated measures ANOVA's, Post-hoc Tuckey HSD analysis and Pearson's product moment correlation were used for all the statistical analyses. Results - This study of a secondary school rugby team has shown 726 vMTBI's and 18 MTBI's throughout one rugby season. This relates to 1951 vMTBI's per 1000 player hours and 48 MTBI's per 1000 player hours. Reductions in delayed memory (p=O.O1)from preseason to post-season in a group of players with repetitive vMTBI's during a single rugby season were found. This was the first evidence of possible neurocognitive deficits towards delayed memory in very mild traumatic brain injuries at secondary school level. Statistically significant (p<=0.05)results of the SAC test totals between both the vMTBI and MTBI groups were documented in the different games throughout the rugby season and compared with the baseline test. No statistically significant differences (p<=0.05) between the pre-season and post-season's scores of the SAC test totals were documented. A decrease in academic performance in the subject Afrikaans (year 1 compared with year 2) with a p-value of p=O.O17(group 1) and p=O.O16(group 2) respectively was found. Conclusion - The findings of this study indicate a high incidence of vMTBI in a cohort of secondary school rugby players in one season, a statistically significant reduction (p=O.O1 )in delayed memory of the vMTBI rugby players and a statistically significant decrease in academic performance p=O.O17 (group 1) and p=O.O16 (group 2) in the subject Afrikaans from year 1 to year 2 final examinations. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.

Biofidelity of finite element head model (FEHM) includes geometric and material aspects. A FEHM with inhomogeneous material properties was proposed to improve material biofidelity. The proposed FEHM was validated against experimental data and good agreements were observed. The capability of the proposed model in simulating large tissue deformation was also demonstrated. Influences of inhomogeneous material properties on the mechanical responses of head were investigated by comparing with homogeneous material model. The inhomogeneous material properties induce large peak strains in head constituents, which are probably the cause of various brain injuries. Helmets are effective in preventing head injuries. Parametric studies were conducted to investigate how changes in helmet shell stiffness, foam density and pad thickness influence the performance of a helmet in protecting the brain. Results showed that strain energy absorbed by foam component, contact stress on the interfaces and intracranial responses are significantly affected by foam density and pad thickness.