Protective capacity of an ice hockey goaltender helmet for three events associated with concussion

The purpose of this study was to assess the protective capacity of an ice hockey goaltender helmet for three concussive impact events. A helmeted and unhelmeted headform was used to test three common impact events in ice hockey (fall, puck impacts and shoulder collisions). Peak linear acceleration, rotational acceleration and rotational velocity as well as maximum principal strain and von Mises stress were measured for each impact condition. The results demonstrated the tested ice hockey goaltender helmet was well designed to manage fall and puck impacts but does not consistently protect against shoulder collisions and an opportunity may exist to improve helmet designs to better protect goaltenders from shoulder collisions.     

The biomechanics of concussion for ice hockey head impact events

The purpose of this research was to conduct reconstructions of concussive and non-concussive impacts in ice hockey to determine the biomechanics and thresholds of concussive injury in ice hockey. Videos of concussive and non-concussive impacts in an elite professional ice hockey league in North America were reconstructed using physical and finite element model methods. Eighty concussive and 45 non-concussive events were studied. Logistic regressions indicate significant thresholds for concussion for linear/rotational acceleration and CSDM_10%. Impacts in ice hockey were mostly long duration events, longer than 15?ms. These results have significant implications for helmet standards and development to prevent concussion.     

A comparison of the magnitude and duration of linear and rotational head accelerations generated during hand-, elbow- and shoulder-to-head checks delivered by hockey players

Ice hockey has the highest rates for concussion among team sports in Canada. In elite play, the most common mechanism is impact to the head by an opposing player’s upper limb, with shoulder-to-head impacts accounting for twice as many concussions as elbow- and hand-to-head impacts combined. Improved understanding of the biomechanics of head impacts in hockey may inform approaches to prevention. In this study, we measured the magnitude and duration of linear and rotational head accelerations when hockey players (n = 11; aged 21–25) delivered checks “as hard as comfortable” to the head of an instrumented dummy with their shoulder, elbow and hand. There were differences in both peak magnitude and duration of head accelerations across upper limb impact sites, based on repeated-measures ANOVA (p < 0.005). Peak linear head accelerations averaged 1.9-fold greater for hand and 1.3-fold greater for elbow than shoulder (mean values = 20.35, 14.23 and 10.55 g, respectively). Furthermore, peak rotational head accelerations averaged 2.1-fold greater for hand and 1.8-fold greater for elbow than shoulder (1097.9, 944.1 and 523.1 rad/s², respectively). However, times to peak linear head acceleration (a measure of the duration of the acceleration impulse) were 2.1-fold longer for shoulder than elbow, and 2.5-fold longer for shoulder than hand (12.26, 5.94 and 4.98 ms, respectively), and there were similar trends in the durations of rotational head acceleration. Our results show that, in body checks to the head delivered by varsity-level hockey players, shoulder-to-head impacts generated longer durations but lower magnitude of peak head acceleration than elbow- and hand-to-head impacts.     

Head impact exposure in male and female collegiate ice hockey players

The purpose of this study was to quantify head impact exposure (frequency, location and magnitude of head impacts) for individual male and female collegiate ice hockey players and to investigate differences in exposure by sex, player position, session type, and team. Ninety-nine (41 male, 58 female) players were enrolled and 37,411 impacts were recorded over three seasons. Frequency of impacts varied significantly by sex (males: 287 per season, females: 170, p<0.001) and helmet impact location (p<0.001), but not by player position (p=0.088). Head impact frequency also varied by session type; both male and female players sustained more impacts in games than in practices (p<0.001), however the magnitude of impacts did not differ between session types. There was no difference in 95th percentile peak linear acceleration between sexes (males: 41.6 g, females: 40.8 g), but 95th percentile peak rotational acceleration and HITsp (a composite severity measure) were greater for males than females (4424, 3409 rad/s², and 25.6, 22.3, respectively). Impacts to the back of the helmet resulted in the greatest 95th percentile peak linear accelerations for males (45.2 g) and females (50.4 g), while impacts to the side and back of the head were associated with the greatest 95th percentile peak rotational accelerations (males: 4719, 4256 rad/sec², females: 3567, 3784 rad/sec² respectively). It has been proposed that reducing an individual's head impact exposure is a practical approach for reducing the risk of brain injuries. Strategies to decrease an individual athlete's exposure need to be sport and gender specific, with considerations for team and session type.     

Peak linear and rotational acceleration magnitude and duration effects on maximum principal strain in the corpus callosum for sport impacts

Concussion has been linked to the presence of injurious strains in the brain tissues. Research investigating severe brain injury has reported that strains in the brain may be affected by two parameters: magnitude of the acceleration, and duration of that acceleration. However, little is known how this relationship changes in terms of creating risk for brain injury for magnitudes and durations of acceleration common in sporting environments. This has particular implications for the understanding and prevention of concussive risk of injury in sporting environments. The purpose of this research was to examine the interaction between linear and rotational acceleration and duration on maximum principal strain in the brain tissues for loading conditions incurred in sporting environments. Linear and rotational acceleration loading curves of magnitudes and durations similar to those from impact in sport were used as input to the University College Brain Trauma Model and maximum principal strain (MPS) was measured for the different curves. The results demonstrated that magnitude and duration do have an effect on the strain incurred by the brain tissue. As the duration of the acceleration increases, the magnitude required to achieve strains reflecting a high risk of concussion decreases, with rotational acceleration becoming the dominant contributor. The magnitude required to attain a magnitude of MPS representing risk of brain injury was found to be as low as 2500 rad/s² for impacts of 10–15 ms; indicating that interventions to reduce the risk of concussion in sport must consider the duration of the event while reducing the magnitude of acceleration the head incurs.     

Finite element modelling of equestrian helmet impacts exposes the need to address rotational kinematics in future helmet designs

Jockey head injuries, especially concussions, are common in horse racing. Current helmets do help to reduce the severity and incidences of head injury, but the high concussion incidence rates suggest that there may be scope to improve the performance of equestrian helmets. Finite element simulations in ABAQUS/Explicit were used to model a realistic helmet model during standard helmeted rigid headform impacts and helmeted head model University College Dublin Brain Trauma Model (UCDBTM) impacts.

Current helmet standards for impact determine helmet performance based solely on linear acceleration. Brain injury-related values (stress and strain) from the UCDBTM showed that a performance improvement based on linear acceleration does not imply the same improvement in head injury-related brain tissue loads. It is recommended that angular kinematics be considered in future equestrian helmet standards, as angular acceleration was seen to correlate with stress and strain in the brain.     

The influence of acceleration loading curve characteristics on traumatic brain injury

To prevent brain trauma, understanding the mechanism of injury is essential. Once the mechanism of brain injury has been identified, prevention technologies could then be developed to aid in their prevention. The incidence of brain injury is linked to how the kinematics of a brain injury event affects the internal structures of the brain. As a result it is essential that an attempt be made to describe how the characteristics of the linear and rotational acceleration influence specific traumatic brain injury lesions. As a result, the purpose of this study was to examine the influence of the characteristics of linear and rotational acceleration pulses and how they account for the variance in predicting the outcome of TBI lesions, namely contusion, subdural hematoma (SDH), subarachnoid hemorrhage (SAH), and epidural hematoma (EDH) using a principal components analysis (PCA). Monorail impacts were conducted which simulated falls which caused the TBI lesions. From these reconstructions, the characteristics of the linear and rotational acceleration were determined and used for a PCA analysis. The results indicated that peak resultant acceleration variables did not account for any of the variance in predicting TBI lesions. The majority of the variance was accounted for by duration of the resultant and component linear and rotational acceleration. In addition, the components of linear and rotational acceleration characteristics on the x, y, and z axes accounted for the majority of the remainder of the variance after duration.     

The influence of impact force redistribution and redirection on maximum principal strain for helmeted head impacts

Abstract

Sporting helmets with linear attenuating strategies are proficient at reducing the risk of traumatic brain injury. However, the continued high incidence of concussion in American football, has led researchers to investigate novel helmet liner strategies. These strategies typically supplement existing technologies by adding or integrating head-helmet decoupling mechanisms. Decoupling strategies aim to redirect or redistribute impact force around the head, reducing impact energy transferred to the brain. This results in decreased brain tissue strain, which is beneficial in injury risk reduction due to the link between tissue strain and concussive injury.

The purpose of this study was to mathematically demonstrate the effect of ten cases, representing theoretical redirection and redistribution helmet liner strategies, on brain tissue strain resulting from impacts to the head. The kinematic response data from twenty head impacts collected in the laboratory was mathematically modified to represent the altered response of the ten different cases and used as input parameters to determine the effect on maximum principal strain (MPS) values, calculated using finite element modeling. The results showed that a reduced dominant coordinate component (contributes the greatest to resultant) of rotational acceleration decreased maximum principal strain in American football helmets. The study theoretically demonstrates that liner strategies, if applied correctly, can influence brain motion, reduce brain tissue strain, and could decrease injury risk in an American football helmet.     

Lateral impacts correlate with falx cerebri displacement and corpus callosum trauma in sports-related concussions

Corpus callosum trauma has long been implicated in mild traumatic brain injury (mTBI), yet the mechanism by which forces penetrate this structure is unknown. We investigated the hypothesis that coronal and horizontal rotations produce motion of the falx cerebri that damages the corpus callosum. We analyzed previously published head kinematics of 115 sports impacts (2 diagnosed mTBI) measured with instrumented mouthguards and used finite element (FE) simulations to correlate falx displacement with corpus callosum deformation. Peak coronal accelerations were larger in impacts with mTBI (8592 rad/s² avg.) than those without (1412 rad/s² avg.). From FE simulations, coronal acceleration was strongly correlated with deep lateral motion of the falx center (r = 0.85), while horizontal acceleration was correlated with deep lateral motion of the falx periphery (r > 0.78). Larger lateral displacement at the falx center and periphery was correlated with higher tract-oriented strains in the corpus callosum body (r = 0.91) and genu/splenium (r > 0.72), respectively. The relationship between the corpus callosum and falx was unique: removing the falx from the FE model halved peak strains in the corpus callosum from 35% to 17%. Consistent with model results, we found indications of corpus callosum trauma in diffusion tensor imaging of the mTBI athletes. For a measured alteration of consciousness, depressed fractional anisotropy and increased mean diffusivity indicated possible damage to the mid-posterior corpus callosum. Our results suggest that the corpus callosum may be sensitive to coronal and horizontal rotations because they drive lateral motion of a relatively stiff membrane, the falx, in the direction of commissural fibers below.

     

Magnitude of head impact exposures in individual collegiate football players

The purpose of this study was to quantify the severity of head impacts sustained by individual collegiate football players and to investigate differences between impacts sustained during practice and game sessions, as well as by player position and impact location. Head impacts (N = 184,358) were analyzed for 254 collegiate players at three collegiate institutions. In practice, the 50th and 95th percentile values for individual players were 20.0 g and 49.5 g for peak linear acceleration, 1187 rad/s2 and 3147 rad/s2 for peak rotational acceleration, and 13.4 and 29.9 for HITsp, respectively. Only the 95th percentile HITsp increased significantly in games compared with practices (8.4%, p = .0002). Player position and impact location were the largest factors associated with differences in head impacts. Running backs consistently sustained the greatest impact magnitudes. Peak linear accelerations were greatest for impacts to the top of the helmet, whereas rotational accelerations were greatest for impacts to the front and back. The findings of this study provide essential data for future investigations that aim to establish the correlations between head impact exposure, acute brain injury, and long-term cognitive deficits.     

Influence of rapidly successive head impacts on brain strain in the vicinity of bridging veins

Acute subdural hematoma due to a bridging vein rupture is a devastating but rare injury. There has to date been no satisfactory biomechanical explanation for this infrequent but costly injury. We surmise that it may be associated with multiple head impacts. Though numerical models have been used to estimate vein strains in single impact events, none to date have examined the influence on localized brain strain of rapidly consecutive impacts. Using the Simulated Injury Monitor, we investigated the hypothesis that such double impacts can increase strain beyond that created by any single impact. Input to our parametric study comprised hypothetical biphasic rotational head accelerations producing a maximum angular velocity of 40 rad./s. In each of 19 simulations, two identical angular inputs are applied at right angles to each other but with time separations varying from 0 to 40 ms. For these double impacts, it has been generally found that strain in the region of the bridging veins is different, than what would be associated with any corresponding single impact. In some cases, the effect is to actually reduce the tissue strain. In others, the strain in the region of the bridging veins is increased markedly. The mechanistic explanation for the strain increase is that the tissue strain from the first impact has not diminished fully when strain from the second impact is initiated. Rapidly consecutive impacts could be a potential mechanism leading to vein rupture that warrants further investigation.     

Physiological,physical and on-ice performance criteria for selection of elite ice hockey teams

The purpose of this study was to examine physiological and physical determinants of ice-hockey performance in order to assess their impact on the result during a selection for ice hockey. A total of 42 ice hockey players took part in the selection camp. At the end of the camp 20 best players were selected by team of expert coaches to the ice hockey team and created group G1, while the second group (G2) consisted of not selected players (non-successful group Evaluation of goodness of fit of the model to the data was based on the Hosmer Lemeshow test. Ice hockey players selected to the team were taller 181.95±4.02 cm, had lower% body fat 13.17±3.17%, a shorter time to peak power 2.47±0.35 s, higher relative peak power 21.34±2.41 W·kg⁻¹ and higher relative total work 305.18±28.41 J·kg⁻¹. The results of the aerobic capacity test showed significant differences only in case of two variables. Ice hockey players in the G1 had higher VO₂max 4.07±0.31 l·min⁻¹ values than players in the G2 as well as ice hockey players in G1 showed a higher level of relative VO₂max 51.75±2.99 ml·min⁻¹·kg⁻¹ than athletes in G2. Ice hockey players selected to the team (G1) performed better in the 30 m Forwards Sprint 4.28±0.31 s; 6x9 Turns 12.19±0.75 s; 6x9 stops 12.79±0.49 s and Endurance test (6x30 m stops) 32.01±0.80 s than players in G2. The logistic regression model showed that the best predictors of success in the recruitment process of top level ice hockey players were time to peak power, relative peak power, VO₂max and 30 m sprint forwards on ice. On the basis of the constructed predictive logistic regression model it will be possible to determine the probability of success of the athletes during following the selection processes to the team.     

Proposing a Radial Basis Function and CSDM Indices to Predict the Traumatic Brain Injury Risk

BackgroundMany head injury indices and finite element (FE) head models have been proposed to predict traumatic brain injury (TBI). Although FE head models are suitable methods with high accuracy, they are computationally intensive. Head motion-based brain injury criteria are usually fast tools with lower accuracy. So, the objective of this study is to propose new criteria along with an artificial neural network model to predict TBI risks, which can be fast and accurate.MethodsFor this purpose, 250 FE head simulations have been carried out at 5 magnitudes and 50 rotational impact directions using the SIMon model. The effects of directions and magnitudes of rotational impacts were assessed for cumulative strain damage measure (CSDM) values. Next, statistical analysis and neural network were applied to predict CSDM values.ResultsThe results of the present research showed that the direction of rotation in the sagittal and frontal planes had a considerable effect on the CSDM values. Furthermore, new brain injury indices and a radial basis function neural network have been proposed to predict CSDM values which having high correlation coefficients with SIMon responses.ConclusionsThe results of this research demonstrated that rotational impact directions should be used to develop new head injury criteria being able to predict CSDM values. However, findings of present research proved that head motion-based brain injury criteria and RBF network can be used to predict FE head model responses with high speed and accuracy.     

Evaluation of the protective capacity of baseball helmets for concussive impacts

The purpose of this research was to examine how four different types of baseball helmets perform for baseball impacts when performance was measured using variables associated with concussion. A helmeted Hybrid III headform was impacted by a baseball, and linear and rotational acceleration as well as maximum principal strain were measured for each impact condition. The method was successful in distinguishing differences in design characteristics between the baseball helmets. The results indicated that there is a high risk of concussive injury from being hit by a ball regardless of helmet worn.     

Physical model simulations of brain injury in the primate

Diffuse brain injuries resulting from non-impact rotational acceleration are investigated with the aid of physical models of the skull-brain structure. These models provide a unique insight into the relationship between the kinematics of head motion and the associated deformation of the surrogate brain material. Human and baboon skulls filled with optically transparent surrogate brain tissue are subjected to lateral rotations like those shown to produce diffuse injury to the deep white matter in the brain of the baboon. High-speed cinematography captures the deformations of the grids embedded within the surrogate brain tissue during the applied load. The overall deformation pattern is compared to the pathological portrait of diffuse brain injury as determined from animal studies and autopsy reports. Shear strain and pathology spatial distributions mirror each other. Load levels and resulting surrogate brain tissue deformations are related from one species to the other. Increased primate brain mass magnified the strain amplified without significantly altering the spatial distribution. An empirically-derived value for a critical shear strain associated with the onset of severe diffuse axonal injury in primates is determined, assuming constitutive similarity between baboon and human brain tissue. The primate skull physical model data and the critical shear strain associated with the threshold for severe diffuse axonal injury were used to scale data obtained from previous studies to man, and thus derive a diffuse axonal injury tolerance for rotational acceleration for humans.     

Brain strain uncertainty due to shape variation in and simplification of head angular velocity profiles

Head angular velocity, instead of acceleration, is more predictive of brain strains. Surprisingly, no study exists that investigates how shape variation in angular velocity profiles affects brain strains, beyond characteristics such as peak magnitude and impulse duration. In this study, we evaluated brain strain uncertainty due to variation in angular velocity profiles and further compared with that resulting from simplifying the profiles into idealized shapes. To do so, we used reconstructed head impacts from American National Football League for shape extraction and simulated head uniaxial coronal rotations from onset to full stop. The velocity profiles were scaled to maintain an identical peak velocity magnitude and duration in order to isolate the shape for investigation. Element-wise peak maximum principal strains from 44 selected impacts were obtained. We found that the shape of angular velocity profile could significantly affect brain strain magnitude (e.g., percentage difference of 4.29–17.89 % in the whole brain relative to the group average, with cumulative strain damage measure (CSDM) uncertainty range of 23.9 %) but not pattern (correlation coefficient of 0.94–0.99). Strain differences resulting from simplifying angular velocity profiles into idealized shapes were largely within the range due to shape variation, in both percentage difference and CSDM (signed difference of 3.91 % on average, with a typical range of 0–6 %). These findings provide important insight into the uncertainty or confidence in the performance of kinematics-based injury metrics. More importantly, they suggest the feasibility to simplify head angular velocity profiles into idealized shapes, at least within the confinements of the profiles evaluated, to enable real-time strain estimation via pre-computation in the future.     

Effectiveness of interventions to reduce aggression and injuries among ice hockey players: a systematic review

Background:

The increasing incidence of injuries related to playing ice hockey is an important public health issue. We conducted a systematic review to evaluate the effectiveness of interventions designed to reduce injuries related to aggressive acts in ice hockey.

Methods:

We identified relevant articles by searching electronic databases from their inception through July 2012, by using Internet search engines, and by manually searching sports medicine journals, the book series Safety in Ice Hockey and reference lists of included articles. We included studies that evaluated interventions to reduce aggression-related injuries and reported ratings of aggressive behaviour or rates of penalties or injuries.

Results:

We identified 18 eligible studies. Most involved players in minor hockey leagues. Of 13 studies that evaluated changes in mandatory rules intended to lessen aggression (most commonly the restriction of body-checking), 11 observed a reduction in penalty or injury rates associated with rule changes, and 9 of these showed a statistically significant decrease. The mean number of penalties decreased by 1.2–5.9 per game, and injury rates decreased 3- to 12-fold. All 3 studies of educational interventions showed a reduction in penalty rates, but they were not powered or designed to show a change in injury rates. In 2 studies of cognitive behavioural interventions, reductions in aggressive behaviours were observed.

Interpretation:

Changes to mandatory rules were associated with reductions in penalties for aggressive acts and in injuries related to aggression among ice hockey players. Effects of educational and cognitive behavioural interventions on injury rates are less clear. Well-designed studies of multifaceted strategies that combine such approaches are required.Over the last 15 years, the incidence of brain and spinal cord injuries among ice hockey players has increased.¹ A recent study involving players in junior leagues found that, in the 2009/10 hockey season, the incidence of game-related concussions was 7 times higher than the highest rate previously reported in 1998/99.² Brain injuries frequently result from aggressive bodychecking³ and account for 15% of injuries among players 9–16 years of age.^4,5 In a study of a community-based hockey program involving boys aged 9–15 years, hostile aggressive acts, which have an intention to do harm,⁶ were the primary cause of injury in one-third of games in which an injury resulted.⁷ Among high school students in Minnesota who played varsity ice hockey, those who played to relieve aggression were 4 times more likely than other players to experience a concussion.⁸ These findings highlight the association between aggressive behaviour and injury in ice hockey. However, little is known about what can be done to reduce this behaviour to create a safer environment for the sport.Existing reviews about reducing injury in sport have primarily assessed equipment or risk factors associated with injury.^9–11 Recent systematic reviews highlighted the risks of bodychecking and renewed calls for policies to disallow bodychecking among youth playing ice hockey.^3,12 We conducted a systematic review to assess the effectiveness of interventions designed to reduce aggressive acts and related injuries among ice hockey players. We were particularly interested in evaluating the effectiveness of rule changes, educational interventions and behavioural modification in reducing aggressive acts and related injuries.     

Head impact accelerations for brain strain-related responses in contact sports: a model-based investigation

Both linear \((\mathbf{a}_{\mathrm{lin}})\) and rotational \((\mathbf{a}_{\mathrm{rot}} )\) accelerations contribute to head impacts on the field in contact sports; however, they are often isolated in injury studies. It is critical to evaluate the feasibility of estimating brain responses using isolated instead of full degrees-of-freedom (DOFs) accelerations. In this study, we investigated the sensitivities of regional brain strain-related responses to resultant \(\mathbf{a}_{\mathrm{lin}}\) and \(\mathbf{a}_{\mathrm{rot}}\) as well as the relative contributions of these acceleration components to the responses via random sampling and linear regression using parameterized, triangulated head impacts with kinematic variable values based on on-field measurements. Two independently established and validated finite element models of the human head were employed to evaluate model-consistency and dependency in results: the Dartmouth Head Injury Model and Simulated Injury Monitor. For the majority of the brain, volume-weighted regional peak strain, strain rate, and von Mises stress accumulated from the simulation significantly correlated with the product of the magnitude and duration of \(\mathbf{a}_{\mathrm{rot}}\) , or effectively, the rotational velocity, but not to \(\mathbf{a}_{\mathrm{lin}}\) . Responses from \(\mathbf{a}_{\mathrm{rot}}\) -only were comparable to the full-DOF counterparts especially when normalized by injury-causing thresholds (e.g., volume fractions of large differences virtually diminished (i.e., \(<\) 1 %) at typical difference percentage levels of 1–4 % on average). These model-consistent results support the inclusion of both rotational acceleration magnitude and duration into kinematics-based injury metrics and demonstrate the feasibility of estimating strain-related responses from isolated \(\mathbf{a}_{\mathrm{rot}}\) for analyses of strain-induced injury relevant to contact sports without significant loss of accuracy, especially for the cerebrum.     

Head impact exposure in collegiate football players

In American football, impacts to the helmet and the resulting head accelerations are the primary cause of concussion injury and potentially chronic brain injury. The purpose of this study was to quantify exposures to impacts to the head (frequency, location and magnitude) for individual collegiate football players and to investigate differences in head impact exposure by player position. A total of 314 players were enrolled at three institutions and 286,636 head impacts were recorded over three seasons. The 95th percentile peak linear and rotational acceleration and HITsp (a composite severity measure) were 62.7g, 4378rad/s(2) and 32.6, respectively. These exposure measures as well as the frequency of impacts varied significantly by player position and by helmet impact location. Running backs (RB) and quarter backs (QB) received the greatest magnitude head impacts, while defensive line (DL), offensive line (OL) and line backers (LB) received the most frequent head impacts (more than twice as many than any other position). Impacts to the top of the helmet had the lowest peak rotational acceleration (2387rad/s(2)), but the greatest peak linear acceleration (72.4g), and were the least frequent of all locations (13.7%) among all positions. OL and QB had the highest (49.2%) and the lowest (23.7%) frequency, respectively, of front impacts. QB received the greatest magnitude (70.8g and 5428rad/s(2)) and the most frequent (44% and 38.9%) impacts to the back of the helmet. This study quantified head impact exposure in collegiate football, providing data that is critical to advancing the understanding of the biomechanics of concussive injuries and sub-concussive head impacts.