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Abstract

The paper reports on a symposium on sports helmets and presents a synthesis of information and opinion from a range of presenters and disciplines. A review of the literature shows that helmets play an important role in head injury prevention and control. Helmets have been shown to be very efficacious and effective in a range of sports and in preventing specific head injury risks, especially moderate to severe head injury. The symposium emphasised the importance of helmet standards and the need for further development. There are calls for helmets that address the needs of competitive (elite) athletes separate to helmets for recreational athletes. Deficiencies in the evidence base for head injury risks and helmet efficacy and effectiveness were identified in some sports. Issues in designing helmets that are suitable to prevent severe head injuries and concussion were discussed and explained from biomechanical and engineering perspectives. The need to evaluate helmet performance in oblique impacts and incorporate this into standards was covered in a number of presentations. There are emerging opportunities with in-helmet technology to improve impact performance or to measure impact exposure. In-helmet technology as it matures may provide critical information on the severity of the impact, the location of the injured athlete, for example, snowboarder, and assist in the retrieval and immediate, as well as the long-term medical management of the athlete. It was identified that athletes, families and sports organisations can benefit from access to information on helmet performance. The importance of selecting the appropriate-sized helmet and ensuring that the helmet and visor were adjusted and restrained optimally was emphasised. The translation pathway from the science to new and better helmets is the development of appropriate helmet standards and the requirement for only helmets to be used that are certified to those standards.

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... Current sports helmets are designed to protect against punches, falls, projectiles, collisions, and abrasion, and can be grossly organized into two main categories-singleimpact and multi-impact helmets [13]. However, virtually all current sports helmets have the basic design of an inner comfort liner, an impact energy attenuating liner, a restraint system, and an outer shell [14]. Single-impact helmets are designed to withstand highimpact encounters only once. ...
... Sports helmet standards ('x' indicates standard)[14,21]. ...
... Sport helmets categorized by activity[14,21]. ...
Article
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Neurotrauma continues to contribute to significant mortality and disability. The need for better protective equipment is apparent. This review focuses on improved helmet design and the necessity for continued research. We start by highlighting current innovations in helmet design for sport and subsequent utilization in the lay community for construction. The current standards by sport and organization are summarized. We then address current standards within the military environment. The pathophysiology is discussed with emphasis on how helmets provide protection. As innovative designs emerge, protection against secondary injury becomes apparent. Much research is needed, but this focused paper is intended to serve as a catalyst for improvement in helmet design and implementation to provide more efficient and reliable neuroprotection across broad arenas.
... Concussion accounts for up to about 15% of all sports injuries (Mcintosh, Andersen, Bahr, & Greenwald, 2011) and is an injury that affects adolescents of all backgrounds, and can occur during sporting events, fights, accidents, or other physical activities. It affects students' academic performance and can lead to time lost from school, athletics, and other extracurricular activities as well. ...
... As research on concussion advances, so does the demand for advancing helmet technology to protect against these injuries. Emerging in-helmet technology may be able to provide critical information on the severity of impacts (Mcintosh et al., 2011). A range of standards has been developed for sports helmets by different organizations. ...
... A range of standards has been developed for sports helmets by different organizations. Manufacturers currently rely on scientific data, standards, market research, input from sports organizations in the development of helmets (Mcintosh et al., 2011). Potential technology solutions for the prevention of brain injury should rely on research identifying the mechanism of sports-related brain trauma (Mcintosh et al., 2011). ...
... The introduction and development of sports headgear was typically in reaction to events of catastrophic head trauma such as death or severe brain injury [2,3]. Headgear has been remarkably successful in preventing these types of head injuries, with significant risk reductions realized in bicycling, American football (subsequently referred to as football), ice hockey (subsequently referred to as hockey), skiing, and snowboarding [4][5][6][7]. This success is primarily related to preventing skull fractures, a role for which hard shell helmets have demonstrated effectiveness in literature dating back to the 1960s [8]. ...
... The rate of sports-related mild traumatic brain injury (mTBI) has been steadily increasing over the past two decades, likely due to improvements in detection but possibly due to a true increase in incidence [9]. The evidence for headgear effectiveness in preventing mTBI is inconclusive in most sports [4,5,[10][11][12][13], motivating new research efforts into evaluating headgear for reducing the risk of mTBI. ...
... (7) Set effective allowable threshold for assessment metric (4). Clinical injury data paired with biomechanical test data. ...
Article
Standards for sports headgear were introduced as far back as the 1960s and many have remained substantially unchanged to present day. Since this time, headgear has virtually eliminated catastrophic head injuries such as skull fractures and changed the landscape of head injuries in sports. Mild traumatic brain injury (mTBI) is now a prevalent concern and the effectiveness of headgear in mitigating mTBI is inconclusive for most sports. Given that most current headgear standards are confined to attenuating linear head mechanics and recent brain injury studies have underscored the importance of angular mechanics in the genesis of mTBI, new or expanded standards are needed to foster headgear development and assess headgear performance that addresses all types of sport-related head and brain injuries. The aim of this review was to provide a basis for developing new sports headgear impact tests for standards by summarizing and critiquing the following: (1) impact testing procedures currently codified in published headgear standards for sports and (2) new or proposed headgear impact test procedures in published literature and/or relevant conferences. Research areas identified as needing further knowledge to support standards test development include defining sports-specific head impact conditions, establishing injury and age appropriate headgear assessment criteria, and the development of headgear specific head and neck surrogates for at-risk populations.
... As an example of equipment not meeting expectations, attenuation of rotational acceleration is thought to be critical in protection from concussion in sports [66,67]. Standards, however, typically assess helmets based upon their attenuation of linear accelerations (e.g., EN1077 & ASTM F2040, & F1446 [54,56,68]) and resistance to penetration (e.g., EN1077 [56]) based upon direct impacts [69,70]. Standards can be updated or replaced, for example BSI 6685-1985 for motorised vehicle helmets (a previous revision of Reference [71]) replaced BS2495:1977 and BS5361:1976 to include oblique impacts. ...
... Non-Newtonian materials in isolation can pass certification tests for sporting PE and PPE [18,44,47,48,50]. Scientific literature highlights limitations in standards, as well as associated certified products including helmets [69,[79][80][81], back protectors [18,50] and wrist protectors [51,84,85]. Recent trends look to include the use of more representative surrogates rather than rigid anvils [84,86,87] and tests designed for specific sports [50,51] to replace proxy standards (e.g., [61]). ...
... When used in place of a comfort layer in a helmet, auxetic foam can significantly reduce the severity of direct impacts in comparison to its conventional counterpart [320]. Helmets and helmet certification standards have been criticised for focussing solely on direct rather than both direct and oblique impacts [69]. Controlling shear modulus by changing Poisson's ratio (to negative or positive values) of any layer within the helmet could contribute to solutions to reduce rotational acceleration (i.e., in combination with or instead of slip plane technology [77]). ...
Article
Full-text available
Following high profile, life changing long term mental illnesses and fatalities in sports such as skiing, cricket and American football-sports injuries feature regularly in national and international news. A mismatch between equipment certification tests, user expectations and infield falls and collisions is thought to affect risk perception, increasing the prevalence and severity of injuries. Auxetic foams, structures and textiles have been suggested for application to sporting goods, particularly protective equipment, due to their unique form-fitting deformation and curvature, high energy absorption and high indentation resistance. The purpose of this critical review is to communicate how auxetics could be useful to sports equipment (with a focus on injury prevention), and clearly lay out the steps required to realise their expected benefits. Initial overviews of auxetic materials and sporting protective equipment are followed by a description of common auxetic materials and structures, and how to produce them in foams, textiles and Additively Manufactured structures. Beneficial characteristics, limitations and commercial prospects are discussed, leading to a consideration of possible further work required to realise potential uses (such as in personal protective equipment and highly conformable garments).
... 21 22 Previous research has documented the need to target future injury reduction strategies in snowsport helmet design towards both severe head injuries and concussions. 23 The new helmet rule represents an attempt to reduce the rate of severe head injuries. Helmets are predominantly designed for impacts on rigid surfaces (such as roads or pavements) and not for impacts on more compliant surfaces such as snow or ice. ...
... 24 Therefore, future helmets should be developed and evaluated also with regard to realistic impact conditions, such as impacts onto snow and ice for skiing and snowboarding helmets. 23 Recent studies based on numerical modelling or anthropomorphic test devices have described snowboarding normal-to-slope head impact velocities of 7.8±1.7 m/s and 8.11 m/s. 25 26 These studies indicate that head impact velocities might be slightly higher than the new strictest helmet testing rule. 25 26 However, how these studies, and the increased helmet testing speed, relate to head impact velocities in real head injury situations on snow is unclear. ...
... The current direction in helmet development and testing is to consider the capacity of helmets to manage the head's angular kinematics (acceleration and/or velocity). 23 27 28 At present, angular kinematic management is not considered in any national or sports-specific standard. Therefore, it is of interest to describe angular kinematics during helmeted real-world impacts in as much detail as possible, with the data obtained from this video analysis. ...
Article
Introduction Prior to the 2013–2014 season, the International Ski Federation (FIS) increased the helmet testing speed from a minimum requirement of 5.4 to 6.8 m/s for alpine downhill, super-G and giant slalom and for freestyle ski cross, but not for the other freestyle disciplines or snowboarding. Whether this increased testing speed reflects impact velocities in real head injury situations on snow is unclear. We therefore investigated the injury mechanisms and gross head impact biomechanics in four real head injury situations among World Cup (WC) snowboard and freestyle athletes and compared these with helmet homologation laboratory test requirements. The helmets in the four cases complied with at least European Standards (EN) 1077 (Class B) or American Society for Testing and Materials (ASTM) F2040. Methods We analysed four head injury videos from the FIS Injury Surveillance System throughout eight WC seasons (2006–2014) in detail. We used motion analysis software to digitize the helmet’s trajectory and estimated the head’s kinematics in two dimensions, including directly preimpact and postimpact. Results All four impacts were to the occiput. In the four cases, the normal-to-slope preimpact velocity ranged from 7.0(±SD 0.2) m/s to 10.5±0.5 m/s and the normal-to-slope velocity change ranged from 8.4±0.6 m/s to 11.7±0.7 m/s. The sagittal plane helmet angular velocity estimates indicated a large change in angular velocity (25.0±2.9 rad/s to 49.1±0.3 rad/s). Conclusion The estimated normal-to-slope preimpact velocity was higher than the current strictest helmet testing rule of 6.8 m/s in all four cases.
... A fundamental understanding of human tolerance to head impacts is a prerequisite for the evaluation of concussion risk and the design of methods, such as helmets, to mitigate those risks. 32 The specific aims of the study were to (1) investigate the dynamics, impact location and kinematics, of no-injury and concussive impacts to the unprotected human head and (2) consider concussion tolerance values. ...
... Linear acceleration is currently used in the assessment of helmets and padded headgear. 32 The 50% and 75% likelihood of concussion values for resultant linear head acceleration in this study were 65.1 and 88.5 g, respectively (table 3). These levels are indicative of the extent to which helmets are required to manage linear acceleration in an impact if they are to reduce the likelihood of concussion. ...
... By considering relevant injury mechanisms, human tolerance values, pass-fail criteria for a device and impact severity, a test method can be developed that provides a performance target for equipment manufacturers and policy makers. 32 Second, the kinematic parameters can also be measured within a helmet or head mounted package, which provides opportunities for on-field monitoring and/or research, as evidenced already by the wide use of instrumented helmets. [13][14][15][16][17][18][19][20][21][22][23][24] Finally, observation of where the player is struck in the head may assist sideline management of concussion, where other technologies are absent. ...
Article
Background: Concussion is a prevalent brain injury in sport and the wider community. Despite this, little research has been conducted investigating the dynamics of impacts to the unprotected human head and injury causation in vivo, in particular the roles of linear and angular head acceleration. Methods: The dynamics of no-injury head impact cases from elite Australian football were estimated using quantitative video measurement methods and rigid body simulations using pedestrian human facet models. The 13 no-injury head impact cases were collated with 27 previously analysed concussion cases. Logistic regression analyses were conducted to investigate associations between head impact kinematics and concussion. Results: Qualitative analysis showed that the head was vulnerable to lateral impacts. Logistic regression analyses of head acceleration and velocity components revealed that angular acceleration of the head in the coronal plane had the strongest association with concussion. Tentative tolerance levels of 1747 rad·s-2 and 2296 rad·s-2 47 were reported for a 50% and 75% likelihood of concussion, respectively. Conclusion: As hypothesised by Holbourn over 70 years ago, angular acceleration plays an important role in the pathomechanics of concussion, which has major ramifications in terms of helmet design and other efforts to prevent and manage concussion.
... Well-designed helmets that are the correct size, properly fitted and fit for purpose are highly effective in preventing head injury, including skull and brain injury [1][2][3]. However, when one or more of these prerequisites are violated, helmets are less or not effective. ...
... Ultimately, this means that there is confidence that the helmet worn by the athlete is fit for purpose and complies with the sport's regulations. The risk management process within the sport establishes the safety and business cases for new equipment, revising standards, developing helmet tests methods or mandating equipment [3,4]. Many sports do not know what the injury risks are in the sport. ...
... A typical helmet comprises the following components: shell, impact attenuating liner, comfort/ sizing pads and restraint system [3,5,6]. Some helmets have no shell or the shell is moulded into the liner, e.g. ...
Chapter
Helmets have been developed to be effective in preventing and/or reducing the severity of head injury for a number of activities, e.g. bicycle and motorcycle helmets. As a result of safety policies, health concerns and economics, both in terms of health costs and the supply of helmets, there is an understanding of impact exposure and helmet performance requirements, as well as systems to supply standard compliant helmets. The performance demands placed on helmets for sporting activities further away from the mainstream may be substantially different, although the principles governing helmet design and performance are the same. Knowledge regarding impact exposure in extreme sports, the economics of helmet development and the absence of standards mean that the helmets in extreme sports may not be optimal or meet the athletes’ expectations. The chapter will focus on the topic of fit for purpose in the context of extreme sports. Fit for purpose means that the helmet is functional for the activities in which it is worn and protects the head within a sport’s injury risk management objectives. The chapter will explain how helmets function to prevent injury and where decisions are required for extreme sports. The challenge of designing helmets for extreme sports will be addressed, e.g. producing helmets that are lightweight, affordable, aero- or hydrodynamically suitable, climate suitable and aesthetically acceptable, which prevent injury in high-energy impacts.
... 7 Therefore, future helmets should be developed and evaluated with regard to realistic impact conditions, including impact speed(s) and surfaces, such as snow and ice. 8 The current direction in helmet development and testing is to consider the capacity of helmets to manage the head's angular kinematics (acceleration and/or velocity). [8][9][10] At present, angular kinematic management is not considered in any national or sports-specific standard, except through general construction requirements that consider surface characteristics and external projections. ...
... 8 The current direction in helmet development and testing is to consider the capacity of helmets to manage the head's angular kinematics (acceleration and/or velocity). [8][9][10] At present, angular kinematic management is not considered in any national or sports-specific standard, except through general construction requirements that consider surface characteristics and external projections. Therefore, it is of interest to describe angular kinematics during helmeted realworld impacts in as much detail as possible, with the data obtained from this video analysis. ...
Article
Introduction Prior to the 2013/2014 season, the International Ski Federation (FIS) increased the helmet testing speed from 5.4 to 6.8 m/s for alpine downhill, super-G and giant slalom. Whether this increased testing speed reflects head impact velocities in real head injury situations on snow is unclear. We therefore investigated the injury mechanisms and gross head impact biomechanics in seven real head injury situations among World Cup (WC) alpine skiers. Methods We analysed nine head impacts from seven head injury videos from the FIS Injury Surveillance System, throughout nine WC seasons (2006–2015) in detail. We used commercial video-based motion analysis software to estimate head impact kinematics in two dimensions, including directly preimpact and postimpact, from broadcast video. The sagittal plane angular movement of the head was also measured using angle measurement software. Results In seven of nine head impacts, the estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s (mean 8.1 (±SD 0.6) m/s, range 1.9±0.8 to 12.1±0.4 m/s). The nine head impacts had a mean normal to slope velocity change of 9.3±1.0 m/s, range 5.2±1.1 to 13.5±1.3 m/s. There was a large change in sagittal plane angular velocity (mean 43.3±2.9 rad/s (range 21.2±1.5 to 64.2±3.0 rad/s)) during impact. Conclusion The estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s in seven of nine head impacts.
... Some helmets contain additional parts to protect the face and eyes. An example is of the various parts of motorcycle helmet is shown in figure 18. Apart from being made of shock-absorbing materials and having a retention system that sufficiently fixates the helmet during use, the helmet should properly fit the human head in order to be effective [78]. The helmet should be fixed on the frontal and occipital regions, because the skull is thicker in these areas and they are less likely to fracture [79,80]. ...
... As little pressure as possible should be placed on the thinner temporal and fontanel regions [80,81]. Various organizations publish standards for the characteristics, design and testing of different types of helmets [78,82]. The most well-known are the US-based DOT (Department of Transport) and Snell Memorial Foundation, and the European Committee for Standardization (CEN) and the United Nations Economic Commission for Europe (ECE) [83]. ...
Thesis
Full-text available
In this doctorate, the possibilities of 3D anthropometry for product development were explored by applying a statistical shape model of the human scalp to the design of more ergonomic brain-computer interface (BCI) headsets. First, a statistical shape model of the human scalp was created from a set of 100 MRI scans. This model was parametrized by intuitive anthropometric measurements and evaluated in terms of its ability to predict complete scalp surfaces given a set of anthropometric measurements. Using eight anthropometric measurements resulted in an average prediction error of only 1.60 ± 0.36 mm, indicating the model accurately represents the underlying population. The choice of parametrization measurements should be based on their combined prediction errors, their sensitivity to variation in input measurements and a minimum population percentage that remains below a predetermined prediction error threshold. Next, the use of the statistical shape model for comparing the morphological differences between subpopulations and the application to the design of BCI headsets were briefly discussed. After this, the shape model of the scalp was used for the design of one- size-fits-all BCI headset with 14 electrode channels. Electrode placement, stability and reliability of the prototype headset were evaluated and compared to current EEG practices, as well as to a commercial BCI headset. The prototype met all design standards and performed well within EEG practices. It also offered 10% improvement in electrode placement according to the international 10-20 system and a 15% increase in reliability. A functional headset of this type would therefore be more consistent in longitudinal BCI studies and between studies of different research groups. The results prove that 3D anthropometry is a feasible design method for a one-size-fits-all BCI headset. Following this observation, the application of 3D anthropometry for product sizing was considered. Whereas sizing systems are usually based on statistical clustering of one-dimensional head measurements, a new method for 3D head shape clustering was proposed, taking into account the need for intuitive sizing and simple sizing tables. The method was labeled "constrained clustering" and was compared to clustering of traditional anthropometric features as well as unconstrained k-medoids clustering of the 3D shapes. Intra- and inter-cluster scalp shape variability and within-cluster point-to- point distances were used as criteria. The results of constrained clustering were similar to those of unconstrained k-medoids clustering of head shapes and offered a 20.69% improvement in cluster validity index and a decrease of size-weighted variances by 6.6% compared viito traditional feature-based clustering. This research resulted in three journal publications that form the main part of this thesis. This doctorate proves that head-based products that require accurate shape and size fit would benefit from a design process in which 3D shape models are included, and that 3D anthropometry has a place in the product design process. Compared to traditional anthropometry, the use of 3D anthropometry will result in devices that are better fitting, more comfortable and potentially even more functional.
... McIntosh et al. 57 assessed the head injury risks in a range of sports, including soccer and rugby union, which was updated during the current review to include Australian football and rugby league (Table 3). Studies investigating injury incidence in unhelmeted contact football codes, that is, Australian football, 20,26,27 rugby league [28][29][30][31][32][33][34][35][36][37] and rugby union, 23,[38][39][40][41][42] have identified concussion as a commonly occurring head injury. ...
... Summary of head injury risks, based on McIntosh et al.57 ...
Article
Full-text available
Laboratory and epidemiological research in Australian football, rugby league and rugby union has demonstrated that commercially available soft-shell padded headgear is currently ineffective in reducing the risk of concussion. However, modified headgear studies have demonstrated that significant improvements in impact energy attenuation performance are possible with small design changes, such as increases in foam density and thickness. A literature review of the design, performance and use of headgear in Australian football, rugby league and rugby union was conducted. A total of 23 articles were identified using primary and secondary search strategies, which included epidemiological field studies, laboratory impact test studies and studies investigating the behaviours and attitudes of players. The results of the review were synthesised and used to identify injury reduction objectives and appropriate design criteria. The need for a headgear standard was identified and performance requirements were discussed, which drew upon human tolerance and sports-specific head impact exposure data. Usability and behavioural issues, which require consideration during the design process, were also assessed.
... Impacts to the face/jaw region of the head had significantly higher peak kinematics compared to impacts to the other regions of the head, which may be due to the interaction of the impacting surface, or the lower jaw, and the sensor. The current study provides initial data on the frequency, magnitude and site of impacts sustained in female high school lacrosse, which are important considerations when designing effective protective headwear and developing valid performance standards (McIntosh et al., 2011). A larger sample size of head impact data in female lacrosse is required to confirm these findings. ...
Article
Background There is growing concern for the neurological effects of repetitive head impacts in sports, and girls’ lacrosse represents a popular but understudied sport regarding head impact exposure. Current debate exists over the need for enhanced protective equipment, and it is important to quantify head impact exposure and biomechanics to inform policy discussions and rule changes for improved protection. Purpose To quantify the head impact biomechanics, by impact mechanism and direction, of female high school lacrosse players during games using an instrumented mouthguard. Methods A female high school varsity lacrosse team wore the Stanford Instrumented Mouthguard during competitive games for the 2019 season. Video footage was reviewed to confirm head impact events and remove false-positive recordings. For each impact event, the mechanism was coded as stick contact, player contact, fall, or ball contact, and the site was coded as face/jaw, forehead, crown, side, rear or indirect (i.e. body impact with no head contact). Head impact rates were calculated per athlete exposure (AE, defined as a single player participating in a game). Results Sensor data were recorded for 15 players for 14 games and 97 AEs. During games, 31 sensor-recorded head impacts were video-confirmed resulting in a pooled average head impact rate of 0.32 impacts/AE. The 31 video-confirmed impacts were distributed among stick contacts (17, 54.8%), player contacts (12, 38.7%), and falls (2, 6.5%). There were no ball impacts. The associated peak kinematics are presented in Figure 1.1. The most common impact site was the side (11, 35.5%), followed by face/jaw (8, 25.8%), forehead (2, 6.5%), and crown (2, 6.5%). There were no impacts to the rear of the head and 8 (25.8%) impacts were indirect. The associated peak kinematics are presented in Figure 1.2. Conclusion Stick impacts were the most common impact mechanism and resulted in the highest peak linear and angular kinematics, which may help explain why they are the most common cause of head injury in female lacrosse. By quantifying the head impact exposure, kinematics and mechanisms in female high school lacrosse, targeted injury preventions can be developed, such as rule changes and protective equipment. [Figure: see text][Figure: see text]
... Impacts to the face/jaw region of the head had significantly higher peak kinematics compared to impacts to the other regions of the head, which may be due to the interaction of the impacting surface, or the lower jaw, and the sensor. The current study provides initial data on the frequency, magnitude and site of impacts sustained in female high school lacrosse, which are important considerations when designing effective protective headwear and developing valid performance standards (McIntosh et al., 2011). A larger sample size of head impact data in female lacrosse is required to confirm these findings. ...
Article
Current debate exists regarding the need for protective headwear in female lacrosse. To inform this issue, the current study quantified head impact exposure, mechanisms and kinematics in female lacrosse using instrumented mouthguards. A female high school varsity lacrosse team of 17 players wore the Stanford Instrumented Mouthguard (MiG) during 14 competitive games. Video footage was reviewed to remove false-positive recordings and verify head impacts, which resulted in a rate of 0.32 head impacts per athlete-exposure. Of the 31 video-confirmed head impacts, 54.8% were identified as stick contacts, 38.7% were player contacts and 6.5% were falls. Stick contacts had the greatest peak head kinematics. The most common impact site was the side of the head (35.5%), followed by the face/jaw (25.8%), forehead (6.5%), and crown (6.5%). Impacts to the face/jaw region of the head had significantly (p < 0.05) greater peak kinematics compared to other regions of the head, which may have resulted from the interaction of the impacting surface, or the lower jaw, and the sensor. The current study provides initial data regarding the frequency, magnitude and site of impacts sustained in female high school lacrosse. A larger sample size of high quality head impact data in female lacrosse is required to confirm these findings.
... 2 Junior Australian football carries a risk of non-SRC head injury (e.g., bruising, lacerations external to the skull) and SRC, 3 leading to frequent debate regarding whether padded headgear (HG) should be mandated. 4 Regarding the scientific evidence, reduced SRC and non-SRC had injury rates among HG users have been documented in some low-level evidence studies, 5,6 while no such effect is evident in higher level evidence studies. [7][8][9] With regard to Australian football, no in-vivo studies have successfully evaluated HG effectiveness partially due to low compliance among players adhering to HG interventions. 10 Due to the high-level evidence on the topic and the lack of alternative HG designs to those already studied, current Australian football community guidelines do not support or explicitly refute HG use. ...
Article
Objectives To assess whether padded headgear (HG) was associated with incidence of suspected sports-related concussion (SRC), non-SRC head injury, and injuries to other body regions in junior Australian football. Design Prospective cohort injury surveillance. Methods There were 400 junior players (42.5% female) enrolled across two seasons. Suspected SRC was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected SRC. Non-SRC head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match. Results There were 22 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated HG throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected SRC was 3.17 (95% CI: 3.04–3.30) per 1000 player-hours and no differences were observed between males and females (RR 1.11; 95% CI: 0.40–3.06). HG use was not associated with suspected SRC (RR 1.09; 95% CI: 0.41–2.97), non-SRC head injury (RR 0.27; 95% CI: 0.06–1.31), or injuries to other body regions (RR 1.41; 95% CI: 0.79–2.53). Conclusions HG use was not associated with reduced risk of suspected SRC, non-SRC head injury or injuries to other body regions. There was no difference in rate of suspected SRC in female compared to male players, however, rates of non-SRC head injury and injuries to other body regions were higher in male players.
... The risks of a sedentary lifestyle include developing cardiovascular disease, being overweight or obese, and lead to high blood pressure. Rather, these results suggest that protective sports equipment, such as hand and wrist protectors or helmets, may minimise injury due to sports activities [34] . ...
Article
Background Fractures represent the most common injury-related hospitalisations of children. Injured children often miss days from school, may experience ongoing pain and disability, as well as a reduced quality of life. To monitor temporal trends, and to enable targeted strategies to prevent fracture-related hospitalisation, an examination of the characteristics of hospitalisations by fracture-type is needed. The aim of this study was to investigate the characteristics, health outcomes and hospital treatment costs of fracture hospitalisations and readmissions of children aged ≤16 years in Australia across a 10-year period for the five most common types of fractures. Method Linked Australian hospitalisation and mortality records during 1 July 2002 to 30 June 2012 were analysed. Hospital treatment costs and length of stay were estimated, and the number and causes of hospital readmissions were identified. Results There were 287,646 fracture-related hospital admissions in Australia for children ≤16 years. The five most common fracture regions were the forearm (48.1%), shoulder and upper arm (14.1%), lower leg including the ankle (11.3%), wrist and hand (10.4%), and the skull and face (9.0%). There was a decrease in hospitalisation rate for all fractures over the 10-year period. The hospitalisation rate for males was at least double that of females. Falls, particularly those from playground equipment, were the most common injury mechanism. Hospital readmissions within 28 days of hospitalisation were mostly due to further orthopaedic care or rehabilitation. Total treatment costs for fracture-related hospitalisations amounted to over AUD$732 million, with the median cost of readmissions being AUD$2,474. Conclusion While there is a decline in the rate of hospitalised fractures in Australian children, continued efforts are required if the rate of fractures and their associated economic costs are to be reduced. The identification of the prevalence and causes of various fracture types provides policymakers with evidence to target preventive initiatives.
... More recently, Porter et al. (83) found helmet use was associated with higher injury severity although helmet users were less likely to sustain a skull fracture. For helmets to reduce the risk of head injury, the mechanisms of head injuries are required to be well understood (84,85). ...
... Despite cycling's popularity, cyclists have been described as the most unprotected road user groups, where the majority of severe injuries in accidents occur to the head [2,3]. As stated by McIntosh et al., head injury alone is the cause of death in 69-93% of fatal bicycle accidents [4]. Previous literature has suggested that oblique head impacts in cycling and motorcycling are a common mechanism that induces mild-to-severe brain injuries [1,[5][6][7][8]]. ...
Article
In cycling, oblique head impacts from a fall cause rotational motion of a cyclist’s head and it is rotational kinematics that are most commonly associated with mild and severe brain injuries. This study aims to compare the head kinematics and brain strain response between two oblique test protocols for simulating fall impact events in cycling. (1) The Angular Launched Impact (ALI) protocol simulates a head impact for realistic and typical falling events in cycling such as falling over the bicycle handle bars or laterally falling, and (2) EN13087-11 is a currently proposed standard test that simulates a head impact from a vertical fall onto an angled surface. EN13087-11 reported greater rotational head kinematics and brain tissue strain than occurs in the more frequent and realistic falling events simulated by the ALI. Differences in response are attributed to the different vector of impact forces associated with the ALI and EN13087-11. When considering how best to test a helmet under oblique impact conditions, it is recommended that a certification test should closely mimic real-world kinematics of cycling accidents.
... Instrumented helmet systems, however, are not suitable for other forms of contact sport, such as Australian Football and Soccer/Football, where helmets, if worn, are shell-less padded headgear. 8 Previous research has been conducted on wearable head accelerometer systems that can be worn without a helmet. The current study reports on a protocol to assess the utility and functionality of wearable head accelerometers and applies the protocol in a pilot study of the first generation X2 Biosystems X-Patch ® accelerometer device. ...
Article
Objectives: To assess the utility and functionality of the X-Patch® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined. Designs: Laboratory tests and prospective observational study. Methods: Laboratory tests on X-Patch® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch® and reference data were analysed. Australian Football players wore the X-Patch® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch® head acceleration events. Wearability of the X-Patch® was assessed using the Comfort Rating Scale for Wearable Computers. Results: Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p<0.05 for all). On average, the X-Patch®-recorded peak linear acceleration (PLA) was 17% greater than the reference PLA, 28% less for peak rotational acceleration (PRA) and 101% greater for the Head Injury Criterion (HIC). For video analysis, 118 head acceleration events (HAE) were included with PLA ≥30g across 53 players. Video recordings of X-Patch®-measured HAEs (PLA ≥30g) determined that 31.4% were direct head impacts, 9.3% were indirect impacts, 44.1% were unknown or unclear and 15.3% were neither direct nor indirect head impacts. The X-Patch® system was deemed wearable by 95-100% of respondents. Conclusions: This study reinforces evidence that use of the current X-Patch® devices should be limited to research only and in conjunction with video analysis.
... A helmet test standard shall be in a simplified and robust way to replicate common real-world accident situations [9] and be able to evaluate helmet protection performance [10]. This requires the basic understanding of real-world accidents and head impact biomechanics. ...
Conference Paper
The impact velocity angle determined by the normal and tangential velocity has been shown to be an important description of head impact conditions but can vary in real-world accidents. The objective of this paper was to investigate the effect of impact velocity angle on helmeted head impact severity indicated by the brain tissue strain. The human body model coupled with a validated motorcycle helmet model was propelled at a constant resultant velocity but varying angle relative to a rigid surface. Different body angles, impact directions and helmet designs have also been incorporated in the simulation matrix (n=300). The results show an influence of impact velocity angle on brain tissue strain response. By aggregating all simulation cases into different impact velocity angle groups, i.e., 15, 30, 45, 60 and 75 degrees, a 30- or 45-degree angle group give the highest median and inter-quartile range of the peak brain tissue strain. Comparisons of strain pattern and its peak value between individual cases give consistent results. The brain tissue strain is less sensitive to the body angle than to the velocity angle. The study suggests that UN/ECE 22.05 can be improved by increasing the current ‘oblique’ angle, i.e. 15 degrees inclined to vertical axis, to a level that can produce sufficient normal velocity component and hence angular head motion. This study also underline the importance of understanding post-impact head kinematics, and the need for further evaluation of human body models.
... Foam stiffness is the key parameter to balance out: for a given impact, too stiff of a foam may not deform nor absorb energy, whereas too soft of a foam may deform too quickly and ''bottom out,'' transmitting the remaining energy to the head (8). It is thus necessary to design helmets with regard to realistic or priority impact conditions (9). Currently, impact conditions targeted by helmet manufacturers are standardized tests, whose representativeness has been repeatedly questioned (6,10,11). ...
Article
Purpose: Proper evaluation of ski helmet designs and safety standards should rely on head impact conditions involved in skiing and snowboarding head injuries. In order to study these impacts, main crash scenarios involving head injuries are numerically replicated. Methods: Multibody models of skiers and snowboarders were developed to investigate 5 common crash scenarios involved in traumatic brain injury: forward and sideways skiing falls, snowboarding backward falls, collisions between users and collisions with obstacles. For each scenario, the influence of crash conditions on head impact (location, speed, linear and rotational accelerations) and risk of injury are evaluated. Crash conditions were initial velocity, user height, position and approach angle, slope steepness, obstacles and snow stiffness. Results: 1149 crashes were simulated and three significant levels of impact conditions were discriminated over the investigated crash scenarios: 1) the smallest normal-to-slope impact velocities [6 km/h; 22 km/h] and peak linear accelerations [42 G; 75 G] were obtained during forward and sideways skiing falls; 2) Snowboarding backward falls and collisions between users were associated with high normal-to-surface impact velocities [26 km/h; 32 km/h] and head accelerations [80 G; 149 G] above one published threshold for mild traumatic brain injury but below the pass/fail criteria of helmet standard tests; 3) Collisions with obstacles were associated with high normal-to-surface impact velocities [19 km/h; 35 km/h] and the highest head accelerations [626 G; 1885 G]. Conclusion: Current impact conditions of helmet standard evaluations consistently replicate collisions with obstacles, but need to be revised to better reflect other significant crash scenarios leading to traumatic brain injury.
... The helmet is a vital piece of equipment for preventing head injuries in activities such as motorcycling, bicycling, skiing and horse riding [1][2][3][4][5]. The shock absorption test in voluntary and mandatory helmet standards provides a means to evaluate impact performance of the helmet in reducing the peak linear acceleration and possibly duration such as dwell time [6] and Head Injury Criterion (HIC) [7,8]. ...
Article
Nowadays crash helmets are tested by dropping a free or unrestrained headform in Europe but a guided or restrained headform in the United States. It remains unclear whether the free fall and the guided fall produce similar impact kinematics that cause head injury. A finite element helmet model is developed and compared with experimental tests. The resulting head kinematics from virtual tests are input for a finite element head model to compute the brain tissue strain. The guided fall produces higher peak force and linear acceleration than the free fall. Eccentric impact in the free fall test induces angular head motion which directs some of the impact energy into rotational kinetic energy. Consequently, the brain tissue strain in the free fall test is up to 6.3 times more than that in the guided fall. This study recommends a supplemental procedure that records angular head motion in the free fall test.
... If tests are not appropriate, equipment limitations are unclear and differences between equipment limitations and user expectations can occur, affecting risk perception and potentially putting people in danger [2]. An example of the effect misunderstanding limitations can have is in snow-sports helmets, where standards (EN1077 [8] and ASTMF2040 [9]) test for linear but not rotational acceleration (which is thought to significantly increase the risk of concussion) [10]. Helmet use in snow-sports has increased dramatically over the past twenty years due to greater awareness of the long term effects of head injury [11], but head injury rates have not notably decreased [11,12]. ...
Article
Full-text available
Foams are commonly used for cushioning in protective sporting equipment. Volumetrically compressing open-cell polyurethane foam buckles cell ribs creating a re-entrant structure—set by heating then cooling—which can impart auxetic behaviour. Theoretically, auxetic materials improve impact protection by increasing indentation resistance and energy absorption, potentially reducing sporting injuries and burdens on individuals, health services and national economies. In previous work, auxetic foam exhibited ~3 to ~8 times lower peak force (compared to its conventional counterpart) under impacts adopted from tests used to certify protective sporting equipment. Increases to the foam’s density and changes to stress/strain relationships (from fabrication) mean Poisson’s ratio’s contribution to reduced peak forces under impact is unclear. This work presents a simple fabrication method for foam samples with comparable density and linear stress/strain relationship, but different Poisson’s ratios ranging between 0.1 and −0.3, an important step in assessing the Poisson’s ratio’s contribution to impact force attenuation.
... DAI is due to angular accelerations and occurs when the head moves coronally and decelerates laterally rather than frontally (De Beaumont L, 2009. Gennarelli TA, 1983. Zwahlen RA, 2007. Wang HC, 2010. McIntosh AS 2011. ...
Technical Report
Full-text available
Paramotoring is a sport clearly distinct from paragliding in which the pilot flies using a special wing and wearing a motor on his back to take off. Generally paramotoring is not considered a high risk sport but since it is a relatively new sport, there aren't any reports in literature about injuries associated with its practice. We report the case of a 48 year old healthy professional athlete which had an accident during takeoff in one of his training flights and received diffuse axonal injury, vertebral fractures and anterior shoulder sprain with associated humeral trochiter fracture. We compared injuries to those connected to the practice of other aerial sports: paragliding in particular. Probably in paramotoring, unlike in paragliding, takeoff is the more critical phase of flight and the use of the motor may aggravate the dynamics of trauma in case of accident. Although the patient was wearing a helmet at the time of the incident, he suffered a diffuse axonal injury: probably the impact location and impact speed compromised the effectiveness of helmet. So more research about the biomechanics of traumatic brain injuries in paramotoring is necessary to improve protection systems, such as helmets, to reduce injury risks in this sport. Furthermore padded back protection should be made obligatory when flying with power paragliding.
... Toutefois, l'efficacité des différentes méthodes utilisées pour se protéger la tête reste encore incertaine. Bien que les casques réduisent le risque de subir un traumatisme crânien moyen ou grave, il peut ne pas empêcher les commotions, compte tenu de la façon dont ils sont conçus actuellement [16][17][18] . En outre, bien que notre sondage ait révélé que la plupart des curleurs considèrent les casques comme importants, ceux qui le portent à l'heure Notre sondage complémentaire a été rempli par seulement 54 % de ceux à qui nous l'avons envoyé. ...
Article
Introduction Notre étude s’intéresse à une population de joueurs de curling et vise à décrire la fréquence des blessures, à estimer le risque de se blesser et à évaluer l’opinion des joueurs à l’égard des stratégies de prévention axées sur l’équipement. Méthodologie Dans le cadre d’une étude de série de cas rétrospective, nous avons fait des recherches dans le Système canadien hospitalier d’information et de recherche en prévention des traumatismes (SCHIRPT), une base de données nationale pour la surveillance des blessures, en vue d’y repérer les blessures subies au curling répertoriées entre 1993 et 2011. L’Hôpital général de Kingston et l’Hôpital Hôtel-Dieu sont les deux hôpitaux de Kingston (Ontario) qui offrent des services d’urgence et qui font partie du réseau du SCHIRPT. Pour chaque entrée trouvée, nous avons procédé à l’analyse du dossier du patient. Un sondage complémentaire a été envoyé à certaines personnes ayant subi des blessures au curling afin d’en connaître les détails et de savoir ce qu’elles pensent du port d’un équipement comme mesure de prévention. Nous avons utilisé des statistiques descriptives pour les taux et les proportions. Résultats Plus de 90 % des blessures graves au curling résultent d’une chute et 31,7 % des cas de blessures graves sont constitués de choc à la tête. Nous avons calculé que le taux de blessures graves qui nécessitent une consultation aux services d’urgence est approximativement de 0,17 pour 1 000 athlètes exposés (intervalle de confiance à 95 % : de 0,12 à 0,22). Le sondage complémentaire a été rempli par 54 % des joueurs blessés ciblés. Parmi eux, 41,3 % attribuent leur chute à l’absence de chaussures appropriées. Concernant les stratégies de prévention, 73,5 % des répondants étaient d’accord avec la suggestion du port obligatoire de chaussures spécialisées, mais seulement 8 % avec celle du port obligatoire du casque. Conclusion Bien que les blessures subies au curling qui nécessitent des soins médicaux ne soient pas courantes, les traumatismes crâniens représentent une proportion importante de ces blessures. Le port obligatoire de chaussures appropriées semble constituer la mesure de prévention la plus efficace et la plus acceptable pour les joueurs.
... ates between 20 and 40 kg. For these reasons paramotor accidents must be considered major traumas and an appropriate diagnostic protocol is mandatory. DAI is due to angular accelerations and occurs when the head moves coronally and decelerates laterally rather than frontally (De Beaumont L, 2009. Gennarelli TA, 1983. Zwahlen RA, 2007. Wang HC, 2010. McIntosh AS 2011). In the case reported the patient was wearing a helmet at the time of the incident but the effectiveness of helmets may be compromised due to the impact location and impact speed. It is known that the helmet decreases the linear head accelerations with limited effects in side impact conditions: similarly it has also been reported that ...
... The energy absorption capacity of the helmet is dependent on the speed of impact and the affected area (6). Therefore, to better prevent TBI, protection must be designed and tested under realistic impact conditions (22). This study allowed us to refine the knowledge of these impact conditions. ...
Article
Purpose: Mechanisms of injury and description of head impacts leading to traumatic brain injury (TBI) in skiers and snowboarders have not been extensively documented. We investigate snow-sport crashes leading to TBI in order to (1) Identify typical mechanisms leading to TBI to better target prevention measures and (2) Identify the injury mechanisms and the head impact conditions. Methods: The subjects were skiers and snowboarders diagnosed of TBI and admitted between 2013 and 2015 to one of the 15 medical offices and 3 hospital centers involved in the study. The survey includes the description of the patients (age, sex, practice, skill-level, and helmet use), of the crash (type, location, estimated speed, causes, and fall description) and of the injuries sustained (symptoms, head trauma scores, other injuries). Sketches were used to describe the crash and impact locations. Clustering methods were used to distinguish profiles of injured participants. Results: 295 skiers and 71 snowboarders were interviewed. The most frequent type of mechanism was falls (54%), followed by collision between users (18%), and jumps (15%). Collision with obstacle (13%) caused the most serious TBI. 3 categories of patients were identified. First, men aged 16-25 years are more involved in crash at high speed or in connection with a jump. Second, women, children (<16 years) and beginners are particularly injured in collisions between users. Third, aged more than 50 years, usually non-helmeted, are frequently involved in falls. Ten crash scenarios were identified. Falling head first is the most frequent of skiers' falls (28%). Conclusion: Crash scenarios leading to TBI were identified and associated with profiles of injured participants. Those results should help to better target TBI prevention and protection campaigns.
... Earlier literature reviews have presented similar findings on helmet efficacy against TBI and concussion; that is to say, helmets do not provide the necessary protection from such traumatic intracranial injuries. 9,14,28,67 Older Literature on Helmet Efficacy Studies published between 2000 and 2009 also presented consistent evidence that helmets are limited or ineffective in their protection against concussion. Three studies on rugby players in the sports medicine literature showed that the use of headgear did not reduce the rates of concussion or head injury, or result in any statistically significant differences between helmeted and unhelmeted groups. ...
Article
Full-text available
Helmets are one of the earliest and most enduring methods of personal protection in human civilization. Although primarily developed for combat purposes in ancient times, modern helmets have become highly diversified to sports, recreation, and transportation. History and the scientific literature exhibit that helmets continue to be the primary and most effective prevention method against traumatic brain injury (TBI), which presents high mortality and morbidity rates in the US. The neurosurgical and neurotrauma literature on helmets and TBI indicate that helmets provide effectual protection against moderate to severe head trauma resulting in severe disability or death. However, there is a dearth of scientific data on helmet efficacy against concussion in both civilian and military aspects. The objective of this literature review was to explore the historical evolution of helmets, consider the effectiveness of helmets in protecting against severe intracranial injuries, and examine recent evidence on helmet efficacy against concussion. It was also the goal of this report to emphasize the need for more research on helmet efficacy with improved experimental design and quantitative standardization of assessments for concussion and TBI, and to promote expanded involvement of neurosurgery in studying the quantitative diagnostics of concussion and TBI. Recent evidence summarized by this literature review suggests that helmeted patients do not have better relative clinical outcome and protection against concussion than unhelmeted patients.
... According to epidemiological studies, helmets significantly reduce the risk of head injury (Sulheim et al., 2006). For continued improvement in head injury protection for skiers and snowboarders, helmets should be developed and evaluated with regard "to realistic or priority impact conditions" (McIntosh et al., 2011). Indeed, the energy absorption capacity of the foam used in the design of most helmets is dependent on the velocity of the impact (Di Landro et al., 2002). ...
Article
To effectively prevent sport traumatic brain injury (TBI), means of protection need to be designed and tested in relation to the reality of head impact. This study quantifies head impacts during a typical snowboarding accident to evaluate helmet standards. A snowboarder numerical model was proposed, validated against experimental data, and used to quantify the influence of accident conditions (speed, snow stiffness, morphology, and position) on head impacts (locations, velocities, and accelerations) and injury risk during snowboarding backward falls. Three hundred twenty-four scenarios were simulated: 70% presented a high risk of mild TBI (head peak acceleration >80 g) and 15% presented a high risk of severe TBI (head injury criterion >1000). Snow stiffness, speed, and snowboarder morphology were the main factors influencing head impact metrics. Mean normal head impact speed (28 ± 6 km/h) was higher than equivalent impact speed used in American standard helmet test (ASTM F2040), and mean tangential impact speed, not included in standard tests, was 13.8 (±7 km/h). In 97% of simulated impacts, the peak head acceleration was below 300 g, which is the pass/fail criteria used in standard tests. Results suggest that initial speed, impacted surface, and pass/fail criteria used in helmet standard performance tests do not fully reflect magnitude and variability of snowboarding backward-fall impacts.
... Bicycle helmets reduce the frequency and severity of head and brain injuries from bicycle crashes (Thompson et al., 1999;McIntosh et al., 2011;Persaud et al., 2012;Elvik, 2013;Bambach et al., 2013;Cripton et al., 2014). They achieve this reduction by attenuating head acceleration, increasing impact duration, and distributing the impact force over a larger area of the head than without a helmet. ...
... As guidelines to manufacturers and consumers alike, impact collision standards for ice hockey helmets have been established to evaluate their efficacy in buffering the head from high impact decelerations of newly manufactured helmets. 2,3 Ice hockey helmets characteristically consist of a hard outer shell and an inner foam liner. Helmets must be certified according to rigorous performance standards required by various community sporting leagues and national organizations. ...
Article
This longitudinal 10-year study investigated the effects of inventory aging on ice hockey helmets’ impact attenuation characteristics. Three unused helmet models with different foam padding materials (vinyl nitrile, multi-density vinyl nitrile, and expanded polypropylene) were impact tested at six sites around a surrogate headform on years 2, 6, and 10 (Y2, Y6, and Y10) after the date of manufacture. In general, peak acceleration (g) Y10 measures were greater than those reported in Y2 and Y6, although well below standard impact criteria levels. Visual inspection of helmets post-impact showed no conspicuous damage to liner or shell, although in several instances the binding glue had disintegrated allowing liners to shift or fall away from the shell. In summary, contemporary ice hockey helmets retain most of their robust impact attenuation characteristics 10 years in storage after manufacture date; however, adhesive tearing of padding from the shell needs to be addressed. Regular inspection of the helmet integrity by players, coaches, and trainers is paramount. Further testing of used helmets in a similar prospective manner is carried out to ensure safe helmet function.
... As this study is motivated by an interest in sub concussive accelerations, the choice made was to explore those accelerations that would have a low risk of resulting in a concussion, thus a choice of a threshold below 60g but above that that may be a result of normal activity/behavior patterns. At head accelerations of just 40g the likelihood of experiencing a concussion is around 15%, while head accelerations >150g have a 100% likelihood of resulting in a concussion (McIntosh et al., 2011). Thus the inclusion criteria for a verified head acceleration that was an on-snow event warranting further investigation was: @BULLET Head linear accelerations greater than 40g; @BULLET Confirmation via geospatial data from the SPI Elite unit that it was an on-snow event; @BULLET Body impact greater than 2g recorded by the SPI Elite within .05 ...
Article
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Objective: This study applied a human factors approach to snowsport resort systems to contribute to the understanding of the incidence and severity of pediatric snowsport head accelerations. Background: Previous research indicates low magnitude head accelerations are common among snowsport participants. This study adds to the knowledge of snowsport safety by measuring aspects of participants' snowsport behavior and linking this with head acceleration data. Method: School-aged students (n = 107) wore telemetry-fitted helmets and Global Positioning System (GPS) devices during snowsport activity. Data was collected over 159 sessions (total hours 701). Head accelerations recorded by the telemetry units were compared with GPS-generated data. Results: This study found speeds attained normally exceed the testing rating for which helmets are designed; lower rates of head accelerations compared to earlier studies and that when head accelerations did occur they were generally below the threshold for concussions. Conclusion: Pediatric snowsport head accelerations are rare and are generally of low magnitude. Those most at risk of a head acceleration >40 g were male snowboarders. Given the recorded speeds in first time participants, increased targeting of novice snowsport participants to encourage education about the use of protective equipment, including helmets, is warranted. Post event recall was not a good indicator of having experienced a head impact. Consideration should be given to raising the standard design speed testing for snowsport helmet protective devices to reflect actual snowsport behaviors.
Article
Background Professional horse racing is an activity known for its high risk of injuries, especially in the cranio-facial area. Nevertheless, despite the long history of horse races and the severity of the injuries sustained by professional jockeys, only very few epidemiological studies have been published to date. Cranio-maxillo-facial injuries in jockeys appear to be one of the main causes of retirement or even death. Objective This study aimed to describe the epidemiology and distribution of cranio-facial injuries in professional jockeys through a PRISMA systematic review of the recent English literature and the description of case reports. Methods Relevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases using the following MeSH terms: “athletic injuries” OR “athletic injuries/epidemiology” AND “Horses” on PubMed; or the following keywords “jockey, injury, epidemiology” on ScienceDirect and “jockey, injury” on Cochrane Library. Only studies with epidemiological data of cranio-facial injuries or total injuries in professional jockeys were included. In addition, recent data, supplied by the French racing authority from official reports about injuries that occurred during professional horse races in France, are analyzed. Results A total of 10 relevant articles were retained. The injury rate, in flat horse racing, was 0.6 to 1.8 per 1000 rides. The cranio-facial region was involved in 11.96 to 27.63% of cases. In jump horse racing, the injury rate was 5.1 to 15.8 per 1000 rides, involving the cranio-facial region in 10.6 to 26.7% of cases. Cranio-facial injuries are illustrated by impressive pictures and case reports. Conclusion This systematic review highlights the high risk of cranio-facial injuries in jockeys.
Article
Background: Horse-related activities are increasingly popular among young people but are frequently associated with severe injuries requiring hospital treatment. There are few data on the incidence of equestrian injuries, especially in child populations, or on means of prevention. Thus, this study's purpose was to highlight the epidemiological data on specific injuries due to equestrianism and serve as the groundwork for future studies on the prevention of equestrian accidents. Methods: A retrospective study collected data on all children younger than 16 years old who attended our regional emergency department after involvement in an equestrian accident. The study covered the periods from 1990 to 2003 and 2011 to 2018. Twenty-two years of data on trauma circumstances, injury patterns (mechanism, anatomic site, and severity), treatment protocols, and hospital lengths of stay were analyzed. Results: This study confirmed that more young females participating in equestrian sports attended our emergency department than males. The leading cause of equestrian injury was falling from a horse (80.2%). Orthopaedic injuries represented around 60% of all reported lesions, far ahead of head injuries (30%). More than half of the injured children required hospitalization for inpatient medical care, and almost 50% of these underwent a surgical procedure, especially for upper extremity fractures (72% of all fractures). One patient died due to severe cerebral injury. Conclusions: Horse riding injuries occur more frequently and are more serious than in many other sporting activities. There is an urgent need to reassess preventive measures to reduce the incidence and severity of equestrian injuries. Level of evidence: Level IV.
Article
Finite element simulation was used to analyse the response of an elastomeric pre-buckled honeycomb structure under impact loading, to establish its suitability for use in helmet liners. A finite element-based optimisation was performed using a search algorithm based on a radial basis function. This approach identified optimisation configurations of a pre-buckled honeycomb structure, based on structural bounds subject to impact loading conditions. Furthermore, the influence of objective function, peak acceleration and head injury criterion was analysed with respect to the resultant mechanical behaviour of the structure. Numerical results demonstrate that this class of structure can exceed the performance threshold of a common helmet design standard and minimise the resultant injury index. Experimental testing, facilitated through laser sintering of thermoplastic polyurethane powder, validated the output of the numerical optimisation. When subject to initial impact loading, the fabricated samples satisfied their objective functions. Successive impact loading was performed to assess the performance and degradation. Samples optimised for peak acceleration demonstrated superior performance after stabilisation, relative to their initial response. The culmination of this study establishes a numerical design pathway for future optimisation of candidate structures for head impact protection. Furthermore, the optimised pre-buckled honeycomb structure represents a new class of energy absorbing structure, which can exceed the thresholds prescribed by the design standard.
Chapter
There has been an increasing focus on the role of helmets in reducing the risk of sport-related concussion. Helmets in some sports and recreational activities have a well-established effect on reducing the risk of moderate-to-severe head injury, but the additional potential for helmets that have satisfied that objective to prevent concussion is unclear. In many contact and collision sports, there is a clear risk of concussion but with the minimal likelihood of moderate-to-severe head injury. This represents an opportunity for helmets to mitigate the risk of concussion only. This chapter addresses the biomechanical studies of impacts and helmet protection in sport settings, with a specific focus on padded or “soft shell” headgear.
Article
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Work-related traumatic brain injuries (wrTBIs) in the construction industry have been studied in North America but, to the best of our knowledge, not in Europe. This study analyzed sets of public data on head injuries occurring in the construction industry from the workers’ compensation systems in Sweden and Germany, 2014 – 2018. The ratio of wrTBI varied from 11% to 61% of all head injuries, with higher ratios for more severe injuries. The average yearly incidence (per 100,000 FTE) of wrTBI resulting in more than four days absence from work was nine in Sweden and 117 in Germany, as compared to 22–212 in North American studies. A limitation of studies based on workers’ compensation claims is that they underestimate the true burden of wrTBI. The most frequent events leading to wrTBI were falls, followed by loss of control, failure of material agents, and body movements without stress. Falls from a height caused 35% of all wrTBI with more than 14 days off work in Sweden and 57% of all new injury pensions granted in Germany. In North American studies, 52–78% of the wrTBI were caused by falls. This highlights the relevance of fall safety measures to reduce wrTBI in the construction industry, such as avoiding work at heights, use of safety nets, education, and etcetera. The energy absorption of safety helmets mainly protects the head excluding face of which 49–62% were wrTBI, indicating that helmet testing standards should evaluate protection against TBI as well as skull fractures.
Conference Paper
Avoiding injury and increasing the safety and protection of the athletes and sports enthusiasts is the driving force for the development of protective equipment (PE) and personal protective equipment (PPE). In addition, as opposed to medical intervention, employing sports safety equipment is the cost effective solution. However, the implementation of sports safety equipment involves several challenges with lack of standard for the protective gear being the principal challenge. In order to overcome the competition in the market for sports safety equipment, manufacturers try to achieve higher standards (or overdesign). In the domain of materials development for sports safety equipment, one important candidate that cannot be overlooked is auxetic materials. Auxetic materials have a negative Poisson ratio (NPR) that gives them high tolerance to indentation and resilience to fractures. Recent advances in the manufacturing of auxetic materials give more influence over the cell framework created by the producers, thereby enabling the production of auxetic materials with outstanding characteristics and improved safety standards. Specific manufacturing techniques used to generate auxetic foams and textiles have been studied, while also discussing the effect of combining finite element analysis (FEA) and additive manufacturing (AM) on auxetic materials manufacturing
Article
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Auxetic materials behave unconventionally under deformation, which enhances material properties such as resistance to indentation and energy absorption. Auxetics, therefore, have the potential to enhance sporting protective equipment. This study explores finite element modeling, additive manufacturing and impact testing of three auxetic lattices, and a conventional equivalent, with a view to advance auxetic implementation within sports equipment. The lattices are modeled and impacts are simulated between 1 J and 5 J, for flat and hemispherical drop hammers. Simulation outputs, including peak impact force, impact duration, maximum axial strain and Poisson’s ratio are compared to experimental results from equivalent impact energies on additively manufactured lattices, using an instrumented drop tower and a high‐speed camera. The simulation and experimental results show broad agreement for all lattices and scenarios, demonstrated by comparative force vs time plots and maximum compression images. The benefits of developing and validating finite element models of three auxetic lattices (as well as the conventional honeycomb lattice) under various impact scenarios as a process is discussed, including material characterization of an exemplar thermoplastic polyurethane. Future work could use the models to investigate auxetic lattices further, selecting and tailoring candidates to further explore their potential application to specific personal protective equipment in sport. This article is protected by copyright. All rights reserved.
Article
Background: Head injury occurs in up to 47% of skiing or snowboarding injuries and is the predominant cause of death in these sports. In most existing literature reporting injury type and prevalence, head injury mechanisms are underreported. Thus, protective equipment design relies on safety evaluation test protocols that are likely oversimplified. This study aims to characterize severity and mechanism of head injuries suffered while skiing and snowboarding in a form appropriate to supplement existing helmet evaluation methods. Methods: A 6-year, multicentre, retrospective clinical record review used emergency databases from two major trauma centres and Coroner's reports to identify relevant cases which indicated head impact. Records were investigated to understand the relationships between helmet use, injury type and severity, and injury mechanism. Descriptive statistics and odds ratios aided interpretation of the data. Findings: The snow sport head injury database included 766 cases. "Simple fall", "jump impact" and "impact with object" were the most common injury mechanisms while concussion was observed to be the most common injury type. Compared to "edge catch", moderate or serious head injury was more common for "fall from height" (OR = 4.69; 95% CI = 1.44-16.23; P = 0.05), "jump impact" (OR = 3.18; 95% CI = 1.48-7.26; P = 0.01) and "impact with object" (OR = 2.44; 95% CI = 1.14-5.56; P = 0.05). Occipital head impact was associated with increased odds of concussion (OR = 7.46; 95% CI = 4.55-12.56; P = 0.001). Interpretation: Snow sport head injury mechanisms are complex and cannot be represented through a single impact scenario. By relating clinical data to injury mechanism, improved evaluation methods for protective measures and ultimately better protection can be achieved.
Article
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Background/aim Horse riding is a popular sport, which bears the risk of serious injuries. This study aims to assess whether individual factors influence the risk to sustain major injuries. Methods Retrospective data were collected from all equine-related accidents at a German Level I Trauma Centre between 2004 and 2014. Logistic regression was used to identify the risk factors for major injures. Results 770 patients were included (87.9% females). Falling off the horse (67.7%) and being kicked by the horse (16.5%) were the two main injury mechanisms. Men and individuals of higher age showed higher odds for all tested parameters of serious injury. Patients falling off a horse had higher odds for being treated as inpatients, whereas patients who were kicked had higher odds for a surgical therapy (OR 1.7) and intensive care unit/intermediate care unit (ICU/IMC) treatment (OR 1.2). The head was the body region most often injured (32.6%) and operated (32.9%). Patients with head injuries had the highest odds for being hospitalised (OR 6.13). Head or trunk injuries lead to the highest odds for an ICU/IMC treatment (head: OR 4.37; trunk: OR 2.47). Upper and lower limb injuries showed the highest odds for a surgical therapy (upper limb: OR 2.61; lower limb: OR 1.7). Conclusion Risk prevention programmes should include older individuals and males as target groups. Thus a rethinking of the overall risk assessment is necessary. Not only horseback riding itself, but also handling a horse bears a relevant risk for major injuries. Serious head injures remain frequent, serious and an important issue to be handled in equestrians sports.
Article
Objective Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS. Methods The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season. Results Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (β=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders. Conclusions Exposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.
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Background: Concussions in adolescents are a public health concern with the growing popularity of high school sports. Recent legislation mandates that athletes who are suspected of a concussion be cleared to return-to-play by a clinician. More research is needed to develop a concussion predictive model to identify populations at risk for more severe and prolonged symptoms and long-term neurologic deficits. Aims: The aims of this study were to (1) examine the effect of race and gender on neurocognitive and symptom scores and (2) determine which clinical (e.g., number of concussions, migraine history, learning disabilities/ attention deficit disorders) and demographic factors (e.g., age, gender, race/ ethnicity, health insurance, mechanism of injury/ sport, education) predict prolonged recovery times. Methods: This was an observational cohort study of clinical data reviewed retrospectively in adolescents aged 13 to 19 years who were evaluated for an acute concussion (≤ 10 days from injury) at a university-based concussion clinic between January 1, 2012 to August 1, 2015. Multivariate analysis of variance was used to examine the role of gender and race on Immediate Post-concussion Assessment and Cognitive Testing composite scores. Logistic regression, Kaplan-Meier analysis, and Cox regression proportional hazards model were utilized to examine predictors of concussion recovery times. Results: The sample (N = 118) was primarily male (71.2%) with a median age of 16 (range 13-19 years old). Ethnic minorities (Blacks and Hispanics) constituted 40% of the sample. Univariate analyses revealed that females had slower reaction times than males (p = .04) and minority females performed significantly worse on verbal memory (p = .04) than other groups. Predictors of protracted recovery included ADHD (p < .001) and prior concussion history (p = .03). Predictors of shorter recovery times included student athletic insurance (p = .02) and public insurance (Medicaid or Chips) (p = .03) as compared with private or no insurance. Conclusions: The findings showed that there was a gender difference on reaction time and there was an interaction of race and gender on verbal memory after a concussion. This study also identified key risk factors that may be used prognosticate concussion recovery times in adolescents.
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Einer kurzen Zusammenfassung der relevanten anatomischen Strukturen des Kopfes folgt eine Beschreibung und Klassifikation möglicher Kopfverletzungen und der entsprechenden Verletzungsmechanismen. Anschliessend werden das biomechanische Verhalten des Kopfes, das in verschiedenen Experimenten untersucht wurde, sowie daraus abgeleitete Verletzungskriterien, mit deren Hilfe die Belastungen des Kopfes in Crashtests quantifiziert werden, diskutiert. Spezielle Aspekte von Kopfverletzungen im Sport werden in einem eigenen Kapitel behandelt. Abschliessend werden grundlegende Prinzipien zur Prävention von Kopfverletzungen vorgestellt. Sicherheitsgurte und Airbags können Kopfverletzungen durch das Vermeiden eines Kopfanpralls verhindern. Helme oder deformierbare Strukturen im Fahrzeuginnenraum bzw. an äusseren Fahrzeugstrukturen können die Folgen eines Kopfanpralls durch Verteilung der Anprallkraft auf eine grössere Fläche und durch Energieabsorption mildern.
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The term foot-launched flying covers a number of sports, including hang gliding, paragliding, powered paragliding, and powered hang-gliding. The medical literature on injuries in these sports is scarce and fragmented, and these activities are often generically grouped together despite their differences in types of flight, equipment, and conditions of practice. Instead, these sports should probably be considered as sharply distinct due to their different injury dynamics and patterns. Most of the injury events in powered paragliding occur during takeoff, while in paragliding and hang-gliding they mainly occur during landing. In motorized sports, weather conditions seem to be implicated less often as a cause of incidents. Rather the engine and its thrust may be their primary cause, or may aggravate the outcome. In hang-gliding, the pilot stays in a prone position, while in paragliding the harness offers support in both standing and sitting positions. As a result, injuries to the head, the upper limbs, and cervical spine are more common in hang-gliding, while injuries to the ankle and thoracolumbar spine are more common in paragliding. Serious hand lesions caused by contact with the engine prop are specific to powered paragliding, while the head and face seem frequently affected by injuries in powered hang-gliding. These differences lead experts to believe that foot-launched flying sports should be considered separately in future studies.
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There has been an increasing focus on the role of helmets in reducing the risk of concussion in sport. Helmets in some sports have a well-established effect on reducing the risk of moderate to severe head injury, but the additional potential for helmets that have satisfied that objective to prevent concussion is unclear. Furthermore, the risk of moderate to severe head injury in some sports is low, e.g., rugby union and Australian rules football; however, there is clear risk of concussion in these sports, which presents an opportunity for helmets to mitigate that risk only. This chapter addresses the biomechanical studies of impact and helmet protection in sport.
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In high school athletics, concussion comprises more than 10 % of sport-related injuries [1]. Approximately 7 % of paraplegia or quadriplegia cases occur during sport participation [2]. More than a third of life-threatening injuries to the head and neck sustained by children are sport-related, and 12 % of those sustained by adults are sport-related [3]. This includes nearly a quarter of cervical spine fractures sustained by children [3]. Therefore, seeking out proactive methods for preventing head and neck injuries sustained during sports is crucial to preserving the safety of young athletes. Although the prevention of head and neck injuries has proven a difficult task, substantial gains have been made over the last 50 years. Although there are no empirically proven methods to eliminate head and neck injury risk, researchers have employed various intervention programs and treatment protocols in order to investigate the best ways to keep athletes safe. Thus, the purpose of this chapter is to briefly review the mechanism and epidemiology of common head and neck injuries sustained during sports participation and discuss various proposed methods for preventing those injuries.
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For the 4th edition of Trauma Biomechanics all existing chapters referring to traffic and sports have been revised and updated. New scientific knowledge and changes in legal defaults (such as norms and standards of crash tests) have been integrated. Additionally one chapter has been added where biomechanical aspects of injuries affected by high energies are communicated in a new way. The mechanical basics for ballistics and explosions are described and the respective impacts on human bodies are discussed. The new edition with the additional chapter therefore is addressed to a broader audience than the previous one. © Springer-Verlag Berlin Heidelberg 2014. All rights are reserved.
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Head and orofacial injuries in sports are common, but serious injuries are rare. At present, there is substantial interest in concussion and its management in sport. Many sports give rise to the potential for the athlete to be struck in the head or face, often by relatively rigid high-speed projectiles or body parts. The bony contours of the face combined with the soft tissue covering makes the face vulnerable to fractures and lacerations when it is exposed to impacts. The dimensions of many projectiles, e.g. squash balls and cricket balls, mean that they can impact the eye or damage the orbit. In the context of the range of normal impacts in team sports, skull fractures are not common. Head impacts against rigid pieces of infrastructure, e.g. posts, concrete footings and hard floors, can give rise to skull fractures. In powered sports or high-speed individual sports, e.g. cycling, skiing and horse racing, the unprotected head is exposed to a measurable risk of skull fracture and severe intracranial injury. The brain, however, is vulnerable to the range of head impact severities that athletes are exposed to in sport, with the most frequent manifestation being concussion. Consensus guidelines on the management of concussion indicate that athletes should not return to match play in the event in which they have been concussed and their future return to play must occur after resolution of symptoms and cognitive function. The application of risk management approaches to prevent head and facial injury is successful. The application of rules that prevent and limit head contact is important. Improving the infrastructure to remove hazards is another element. Personal protective equipment, such as helmets and mouthguards, has been shown in some sports to protect the head and mouth. Immediate medical management of injuries and evidence-based return-to-play processes are also essential.
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General prevention of injuries is a fundamental part to be completed and respected for all people involved in sports activity.
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To identify those risk factors that have the greatest impact on the incidence of head and neck injuries in international football. A case-control study of players sustaining head and neck injuries during 20 FIFA tournaments (men and women) from 1998 to 2004. Video recordings of incidents were used to identify a range of parameters associated with the incidents. Team physicians provided medical reports describing the nature of each injury. chi2 tests (p< or =0.01) and 95% confidence intervals were used to assess differences in distribution and incidence of injury, respectively. In total, 248 head and neck injuries were recorded of which 163 were identified and analysed on video sequences. The commonest injuries were contusions (53%), lacerations (20%), and concussions (11%). The incidence of all head and neck injuries was 12.5/1000 player hours (men 12.8, women 11.5) and 3.7 for lost-time injuries (men 3.5, women 4.1). The commonest causes of injury involved aerial challenges (55%) and the use of the upper extremity (33%) or head (30%). The unfair use of the upper extremity was significantly more likely to cause an injury than any other player action. Only one injury (a neck muscle strain) occurred as a result of heading the ball throughout the 20 tournaments equivalent to 0.05 injuries/1000 player hours. Players' actions most likely to cause a head or neck injury were the use of the upper extremity or the head but in the majority of cases these challenges were deemed to be fair and within the laws of the game.
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In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland.Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. RETROSPECTIVE SURVEY: A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. CASE-CONTROL SURVEY: 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury. Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index.
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Measuring head impact exposure is a critical step toward understanding the mechanism and prevention of sport-related mild traumatic brain (concussion) injury, as well as the possible effects of repeated subconcussive impacts. To quantify the frequency and location of head impacts that individual players received in 1 season among 3 collegiate teams, between practice and game sessions, and among player positions. Cohort study. Collegiate football field. One hundred eighty-eight players from 3 National Collegiate Athletic Association football teams. Participants wore football helmets instrumented with an accelerometer-based system during the 2007 fall season. The number of head impacts greater than 10 g and location of the impacts on the player's helmet were recorded and analyzed for trends and interactions among teams (A, B, or C), session types, and player positions using Kaplan-Meier survival curves. The total number of impacts players received was nonnormally distributed and varied by team, session type, and player position. The maximum number of head impacts for a single player on each team was 1022 (team A), 1412 (team B), and 1444 (team C). The median number of head impacts on each team was 4.8 (team A), 7.5 (team B), and 6.6 (team C) impacts per practice and 12.1 (team A), 14.6 (team B), and 16.3 (team C) impacts per game. Linemen and linebackers had the largest number of impacts per practice and per game. Offensive linemen had a higher percentage of impacts to the front than to the back of the helmet, whereas quarterbacks had a higher percentage to the back than to the front of the helmet. The frequency of head impacts and the location on the helmet where the impacts occur are functions of player position and session type. These data provide a basis for quantifying specific head impact exposure for studies related to understanding the biomechanics and clinical aspects of concussion injury, as well as the possible effects of repeated subconcussive impacts in football.
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Identification of high-risk sports, including their most common and severe injuries and illnesses, will facilitate the identification of sports and athletes at risk at an early stage. To analyse the frequencies and characteristics of injuries and illnesses during the XXI Winter Olympic Games in Vancouver 2010. All National Olympic Committees' (NOC) head physicians were asked to report daily the occurrence (or non-occurrence) of newly sustained injuries and illnesses on a standardised reporting form. In addition, the medical centres at the Vancouver and Whistler Olympic clinics reported daily on all athletes treated for injuries and illnesses. Physicians covering 2567 athletes (1045 females, 1522 males) from 82 NOCs participated in the study. The reported 287 injuries and 185 illnesses resulted in an incidence of 111.8 injuries and 72.1 illnesses per 1000 registered athletes. In relation to the number of registered athletes, the risk of sustaining an injury was highest for bobsleigh, ice hockey, short track, alpine freestyle and snowboard cross (15-35% of registered athletes were affected in each sport). The injury risk was lowest for the Nordic skiing events (biathlon, cross country skiing, ski jumping, Nordic combined), luge, curling, speed skating and freestyle moguls (less than 5% of registered athletes). Head/cervical spine and knee were the most common injury locations. Injuries were evenly distributed between training (54.0%) and competition (46.0%; p=0.18), and 22.6% of the injuries resulted in an absence from training or competition. In skeleton, figure and speed skating, curling, snowboard cross and biathlon, every 10th athlete suffered from at least one illness. In 113 illnesses (62.8%), the respiratory system was affected. At least 11% of the athletes incurred an injury during the games, and 7% of the athletes an illness. The incidence of injuries and illnesses varied substantially between sports. Analyses of injury mechanisms in high-risk Olympic winter sports are essential to better direct injury-prevention strategies.
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The prevention of head injuries in alpine activities has focused on helmets. However, no systematic review has examined the effect of helmets on head and neck injuries among skiers and snowboarders. We searched electronic databases, conference proceedings and reference lists using a combination of the key words "head injury or head trauma," "helmet" and "skiing or snowboarding." We included studies that used a control group; compared skiers or snowboarders with and without helmets; and measured at least one objectively quantified outcome (e.g., head injury, and neck or cervical injury). We included 10 case-control, 1 case-control/case-crossover and 1 cohort study in our analysis. The pooled odds ratio (OR) indicated that skiers and snowboarders with a helmet were significantly less likely than those without a helmet to have a head injury (OR 0.65, 95% confidence interval [CI] 0.55-0.79). The result was similar for studies that used controls without an injury (OR 0.61, 95% CI 0.36-0.92), those that used controls with an injury other than a head or neck injury (OR 0.63, 95% CI 0.52-0.80) and studies that included children under the age of 13 years (OR 0.41, 95% CI 0.27-0.59). Helmets were not associated with an increased risk of neck injury (OR 0.89, 95% CI 0.72-1.09). Our findings show that helmets reduce the risk of head injury among skiers and snowboarders with no evidence of an increased risk of neck injury.
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To investigate the incidence of bicycling injuries and bicycle injury characteristics in the Victorian population. Review of prospectively collected data. Bicycling injury data were extracted from four datasets for the period July 2001 to June 2006: (i) emergency department (ED) presentations from the Victorian Emergency Minimum Dataset; (ii) hospital admissions from the Victorian Admitted Episodes Data Set; (iii) major trauma cases from the Victorian State Trauma Registry (VSTR); and (iv) deaths from the National Coroners Information System. The profile and incidence of bicycling injuries across the datasets and years. In the 5 years, 25 920 bicycle-related ED presentations were recorded, 10 552 bicyclists were admitted to hospital, 298 bicycling injuries were classified as major trauma (VSTR), and there were 47 bicycling fatalities. From 2001 to 2006, the incidence of bicycle-related ED presentations (incidence rate ratio [IRR] = 1.42; 95% CI, 1.37-1.48), hospital admissions (IRR = 1.16; 95% CI, 1.09-1.23) and major trauma (IRR = 1.76; 95% CI, 1.22-2.55) increased significantly. Most of those injured were males, aged < 35 years, with road-related injuries. Patients classified as having major trauma had a significantly higher incidence of trunk and head/face/neck injuries compared with those presenting to an ED or admitted to hospital. The incidence of serious bicycling injury has risen over recent years, highlighting the need for targeted prevention programs. Accurate data on cycling participation, use of injury prevention strategies, and injury profiles would assist in reducing bicycle-related injury.
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The number of minor traumatic brain injury (mTBI), cerebral concussions, is increasing and cannot be eliminated by any kind of equipment. Prevention strategies, such as the introduction of "checking from behind" rules have become effective in decreasing the number of severe spinal injuries. A new "head checking" rule should reduce mTBI in the same way in the following years. Mouthguards should be mandatory as an effective device for the prevention of dental and orofacial injuries, as well as reducing the incidence and severity of mTBI. A new internet database system, the International Sports Injury System (ISIS) should improve epidemiological analysis of head, face, and spinal injuries worldwide. ISIS should provide an internationally compatible system for continuous monitoring of risk factors, protective effects of equipment, and protective effects of equipment and effects of changes in rules through the years.
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To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.
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To better understand the risk and safety of heading a soccer ball, the author created a set of simple mathematical models based upon Newton's second law of motion to describe the physics of heading. These models describe the player, the ball, the flight of the ball before impact, the motion of the head and ball during impact, and the effects of all of these upon the intensity and the duration of acceleration of the head. The calculated head accelerations were compared to those during presumably safe daily activities of jumping, dancing, and head nodding and also were related to established criteria for serious head injury from the motor vehicle crash literature. The results suggest heading is usually safe but occasionally dangerous, depending on key characteristics of both the player and the ball. Safety is greatly improved when players head the ball with greater effective body mass, which is determined by a player"s size, strength, and technique. Smaller youth players, because of their lesser body mass, are more at risk of potentially dangerous headers than are adults, even when using current youth size balls. Lower ball inflation pressure reduces risk of dangerous head accelerations. Lower pressure balls also have greater "touch" and "playability", measured in terms of contact time and contact area between foot and ball during a kick. Focus on teaching proper technique, the re-design of age-appropriate balls for young players with reduced weight and inflation pressure, and avoidance of head contact with fast, rising balls kicked at close range can substantially reduce risk of subtle brain injury in players who head soccer balls.
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Protective helmets in sport are important for reducing the risk of head and facial injury. In cricket and other sports with projectiles, national test standards control the minimum helmet performance. However, there are few field data showing if helmets are effective in reducing head injury. (a) To examine the performance of cricket helmets in laboratory tests; (b) to examine performance with regard to test standards, game hazards, and helmet construction; (c) to compare and contrast these findings with baseball and ice hockey helmets. Impact tests were conducted on a selection of helmet models: five cricket, two baseball, and two ice hockey. Ball to helmet impacts at speeds of 19, 27, 36, and 45 m/s were produced using an air cannon and a Hybrid III dummy headform and neck unit. Free fall drop tests with a rigid headform on to a selection of anvils (flat rigid, flat deformable, and hemispherical rigid) were conducted. Resultant headform acceleration was measured and compared between tests. At the lower speed impacts, all helmets produced a good reduction in headform acceleration, and thus injury risk. At the higher speed impacts, the effectiveness was less. For example, the mean maximum headform accelerations for all cricket helmets at each speed were: 67, 160, 316, and 438 g for 19, 27, 36, and 45 m/s ball speeds respectively. Drop tests on to a hemispherical anvil produced the highest accelerations. The variation in performance increased as the magnitude of the impact energy increased, in both types of testing. The test method used for baseball helmets in which the projectile is fired at the helmet may be superior to helmet drop tests. Cricket helmet performance is satisfactory for low speed impacts, but not for impacts at higher, more realistic, speeds. Baseball and ice hockey helmets offer slightly better relative and absolute performance at the 27 m/s ball and puck impacts.
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This study describes the characteristics of injuries and high risk situations in the Norwegian professional football league during one competitive season using Football Incident Analysis (FIA), a video based method. Videotapes and injury information were collected prospectively for 174 of 182 (96%) regular league matches during the 2000 season. Incidents where the match was interrupted due to an assumed injury were analysed using FIA to examine the characteristics of the playing situation causing the incident. Club medical staff prospectively recorded all acute injuries on a specific injury questionnaire. Each incident identified on the videotapes was cross referenced with the injury report. During the 174 matches, 425 incidents were recorded and 121 acute injuries were reported. Of these 121 injuries, 52 (43%) were identified on video including all head injuries, 58% of knee injuries, 56% of ankle injuries, and 29% of thigh injuries. Strikers were more susceptible to injury than other players and although most of the incidents and injuries resulted from duels, no single classic injury situation typical for football injuries or incidents could be recognised. However, in most cases the exposed player seemed to be unaware of the opponent challenging him for ball possession. This study shows that in spite of a thorough video analysis less than half of the injuries are identified on video. It is difficult to identify typical patterns in the playing events leading to incidents and injuries, but players seemed to be unaware of the opponent challenging them for ball possession.
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The aim of this study was to describe, using video analysis, the mechanisms of head injuries and of incidents with a high risk of head injury in elite football. Videotapes and injury information were collected prospectively for 313 of the 409 matches played in the Norwegian (2000 season) and Icelandic (1999 and 2000 season) professional leagues. Video recordings of incidents where a player appeared to be hit in the head and the match was consequently interrupted by the referee were analysed and cross referenced with reports of acute time loss injuries from the team medical staff. The video analysis revealed 192 incidents (18.8 per 1000 player hours). Of the 297 acute injuries reported, 17 (6%) were head injuries, which corresponds to an incidence of 1.7 per 1000 player hours (concussion incidence 0.5 per 1000 player hours). The most common playing action was a heading duel with 112 cases (58%). The body part that hit the injured player's head was the elbow/arm/hand in 79 cases (41%), the head in 62 cases (32%), and the foot in 25 cases (13%). In 67 of the elbow/arm/hand impacts, the upper arm of the player causing the incident was at or above shoulder level, and the arm use was considered to be active in 61 incidents (77%) and intentional in 16 incidents (20%). This study suggests that video analysis provides detailed information about the mechanisms for head injuries in football. The most frequent injury mechanism was elbow to head contact, followed by head to head contact in heading duels. In the majority of the elbow to head incidents, the elbow was used actively at or above shoulder level, and stricter rule enforcement or even changes in the laws of the game concerning elbow use should perhaps be considered, in order to reduce the risk of head injury.
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There has been recent concern about neuropsychological injuries experienced by soccer players, particularly related to the purposeful heading of the ball. There are few population based analyses examining whether this is a legitimate concern. To explore, using an existing injury surveillance system, one of many parts of this issue: acute injuries requiring emergency medical care experienced by youth soccer players. Descriptive epidemiological analysis of emergency department injury surveillance data (1996-2001) for youths aged 10-24 years from the Kingston sites of the Canadian Hospital Injury Reporting and Prevention Program. A total of 1714 cases of soccer injury were identified (mean 286 a year); 235 (13.7%) involved diagnoses of injuries to the head. Leading mechanical factors resulting in head injury were contact with other players or persons (153/235; 65.1%) and balls (62/235; 26.4%). Heading was reported in 4/62 (6%) of the ball contact injuries, and attempted heading was reported in 15/153 (9.8%) of the cases involving person to person contact. Unspecified head to head contact between players was reported in 39 cases. Minor head injuries that result in emergency medical treatment do not happen often in youth soccer, and very few can be attributed to the purposeful heading of the ball. Player contact injuries appear to be a more important injury control concern. This study informs one of many aspects of the soccer heading injury debate.
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Cross-sectional studies have indicated that neurocognitive performance may be impaired among football players. Heading the ball has been suggested as the cause, but recent reviews state that the reported deficits are more likely to be the result of head injuries. To examine the association between previous concussions and heading exposure with performance on computer based neuropsychological tests among professional Norwegian football players. Players in the Norwegian professional football league (Tippeligaen) performed two consecutive baseline neuropsychological tests (Cogsport) before the 2004 season (90.3% participation, n = 271) and completed a questionnaire assessing previous concussions, match heading exposure (self-reported number of heading actions per match), player career, etc. Heading actions for 18 players observed in two to four matches were counted and correlated with their self-reported values. Neither match nor lifetime heading exposure was associated with neuropsychological test performance. Nineteen players scored below the 95% confidence interval for one or more subtasks, but they did not differ from the rest regarding the number of previous concussions or lifetime or match heading exposure. The number of previous concussions was positively associated with lifetime heading exposure (exponent (B) = 1.97(1.03-3.75), p = 0.039), but there was no relation between previous concussions and test performance. Self-reported number of headings correlated well with the observed values (Spearman's rho = 0.77, p < 0.001). Computerised neuropsychological testing revealed no evidence of neuropsychological impairment due to heading exposure or previous concussions in a cohort of Norwegian professional football players.
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Commercial headgear is currently being used by football players of all ages and skill levels to provide protection from heading and direct impact. The clinical and biomechanical effectiveness of the headgear in attenuating these types of impact is not well defined or understood. This study was conducted to determine whether football headgear has an effect on head impact responses. Controlled laboratory tests were conducted with a human volunteer and surrogate head/neck system. The impact attenuation of three commercial headgears during ball impact speeds of 6-30 m/s and in head to head contact with a closing speed of 2-5 m/s was quantified. The human subject, instrumented to measure linear and angular head accelerations, was exposed to low severity impacts during heading in the unprotected and protected states. High severity heading contact and head to head impacts were studied with a biofidelic surrogate headform instrumented to measure linear and angular head responses. Subject and surrogate responses were compared with published injury assessment functions associated with mild traumatic brain injury (MTBI). For ball impacts, none of the headgear provided attenuation over the full range of impact speeds. Head responses with or without headgear were not significantly different (p>0.05) and remained well below levels associated with MTBI. In head to head impact tests the headgear provided an overall 33% reduction in impact response. The football headgear models tested did not provide benefit during ball impact. This is probably because of the large amount of ball deformation relative to headband thickness. However, the headgear provided measurable benefit during head to head impacts.
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To undertake a detailed, large scale epidemiological study of match injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. A two season prospective design was used to study match injuries associated with 546 rugby union players at 12 English Premiership clubs. Team clinicians reported all match injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Match exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. The overall incidence of injury was 91 injuries/1000 player-hours, and each injury resulted on average in 18 days lost time. Recurrences, which accounted for 18% of injuries, were significantly more severe (27 days) than new injuries (16 days). Thigh haematomas were the most common injury for forwards and backs, but anterior cruciate ligament injuries for forwards and hamstring injuries for backs caused the greatest number of days absence. Contact mechanisms accounted for 72% of injuries, but foul play was only implicated in 6% of injuries. The ruck and maul elements of the game caused most injuries to forwards, and being tackled caused most injuries to backs. The hooker and outside centre were the playing positions at greatest risk of injury. On average, a club will have 18% of their players unavailable for selection as a consequence of match injuries.
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To characterize the risk of injury associated with 10 popular high school sports by comparing the relative frequency of injury and selected injury rates among sports, as well as the participation conditions within each sport. A cohort observational study of high school athletes using a surveillance protocol whereby certified athletic trainers recorded data during the 1995-1997 academic years. Players listed on the school's varsity team rosters for football, wrestling, baseball, field hockey, softball, girls' volleyball, boys' or girls' basketball, and boys' or girls' soccer. Injuries and opportunities for injury (exposures) were recorded daily. The definition of reportable injury used in the study required that certified athletic trainers evaluate the injured players and subsequently restrict them from participation. Football had the highest injury rate per 1000 athlete- exposures at 8.1, and volleyball had the lowest rate at 1.7. Only boys' (59.3%) and girls' (57.0%) soccer showed a larger proportion of reported injuries for games than practices, while volleyball was the only sport to demonstrate a higher injury rate per 1000 athlete-exposures for practices than for games. More than 73% of the injuries restricted players for fewer than 8 days. The proportion of knee injuries was highest for girls' soccer (19.4%) and lowest for baseball (10.5%). Among the studied sports, sprains and strains accounted for more than 50% of the injuries, except in field hockey (45.7%). Of the injuries requiring surgery, 60.3% were to the knee. An inherent risk of injury is associated with participation in high school sports based on the nature of the game and the activities of the players. Therefore, injury prevention programs should be in place for both practices and games. Preventing reinjury through daily injury management is a critical component of an injury prevention program. Although sports injuries cannot be entirely eliminated, consistent and professional evaluation of yearly injury patterns can provide focus for the development and evaluation of injury prevention strategies.
Conference Paper
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Purpose: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. Methods: During one ski season (1998–99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. Results: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. Conclusion: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.
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Hintergrund Über Risiken und Verletzungen des Radsports ist in der Literatur wenig berichtet. Ziel vorliegender Studie war es, alle Verletzten der 182 Profi- und 18.788 Amateurradfahrer der Hamburger „Cyclassics“ 2006 zu erfassen. Patienten und Methode Die Verletzten wurden durch Daten des Rettungsdienstes, des Veranstalters und der Kliniken erfasst und in einem Fragebogen befragt. Ergebnisse 70 Verletzte mit 193 Verletzungen wurden verzeichnet, die Verletzungsrate betrug 0,37%. Das mittlere Alter lag bei 44 (19–72) Jahren. Die Extremitäten waren in 94,4% der Fälle betroffen, häufigste Lokalisation war in 54,7% der Schultergürtel (32 Frakturen wurden registriert). Der „mittlere Abbreviated Injury Score“ (MAIS) betrug 1,34±0,73 (Spanne 1–4), der „Injury Severity Score“ (ISS) 2,86±3,61 (Spanne 1–20). 10% der Teilnehmer erlitten ernste Verletzungen (AIS≥3), statistisch signifikant häufiger bei Frauen als bei Männern (p
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OBJECTIVE: To identify those risk factors that have the greatest impact on the incidence of head and neck injuries in international football. METHOD: A case-control study of players sustaining head and neck injuries during 20 FIFA tournaments (men and women) from 1998 to 2004. Video recordings of incidents were used to identify a range of parameters associated with the incidents. Team physicians provided medical reports describing the nature of each injury. chi2 tests (p< or =0.01) and 95% confidence intervals were used to assess differences in distribution and incidence of injury, respectively. RESULTS: In total, 248 head and neck injuries were recorded of which 163 were identified and analysed on video sequences. The commonest injuries were contusions (53%), lacerations (20%), and concussions (11%). The incidence of all head and neck injuries was 12.5/1000 player hours (men 12.8, women 11.5) and 3.7 for lost-time injuries (men 3.5, women 4.1). The commonest causes of injury involved aerial challenges (55%) and the use of the upper extremity (33%) or head (30%). The unfair use of the upper extremity was significantly more likely to cause an injury than any other player action. Only one injury (a neck muscle strain) occurred as a result of heading the ball throughout the 20 tournaments equivalent to 0.05 injuries/1000 player hours. CONCLUSIONS: Players' actions most likely to cause a head or neck injury were the use of the upper extremity or the head but in the majority of cases these challenges were deemed to be fair and within the laws of the game.
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Criticisms of bicycle helmet design are reviewed, and changes in the design since the 1990's explored. Finite Element Analysis is used to model the impact of a generic helmet on flat and kerbstone anvils. The performance of current helmets was investigated using oblique impacts, in which the liner and rotational acceleration of a headform, fitted with a compliant scalp and a wig, were measured. Most of the design criticisms are shown to be invalid. The peak values of rotational acceleration were of the order of 5 krad s-2. However the coverage of the side of the head is not optimal.
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The performance of bicycle helmets was investigated in oblique impacts with a simulated road surface. The linear and rotational accelerations of a headform, fitted with a compliant scalp and a wig, were measured. The peak rotational accelerations, the order of 5krads−2 when the tangential velocity component was 4ms−1, were only slightly greater than in comparable direct impact tests. Oblique impact tests were possible on the front lower edge of the helmet, a site commonly struck in crashes, without the headform striking the ‘road’. Data characterizing the frictional response at the road/shell and helmet/head interfaces, were generated for interpretation via FEA modelling.
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The dynamics of a Hybrid III dummy's head and neck in helmeted impacts using a novel oblique impact test were studied. Three impact conditions were investigated that simulated a range of motorcyclist head impacts and provided estimates of head and neck injury using published injury assessment reference values. The resultant linear and angular accelerations in the coronal plane were significantly higher for an impact to the side of the head when compared with frontal impacts. Neck axial forces were recorded, ranging from 2.1 to 3.4 kN. Linear regression analyses were conducted to determine the correlation coefficients that characterised the relationships between dummy responses and impact and sled velocities. Linear regression curves showed that increasing the impact and sled velocities resulted in an increase of the head angular accelerations. The neck axial force was found to positively correlate with the impact and sled velocities in the lateral impacts.
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To determine whether exposure to repetitive head impacts over a single season negatively affects cognitive performance in collegiate contact sport athletes. This is a prospective cohort study at 3 Division I National Collegiate Athletic Association athletic programs. Participants were 214 Division I college varsity football and ice hockey players who wore instrumented helmets that recorded the acceleration-time history of the head following impact, and 45 noncontact sport athletes. All athletes were assessed prior to and shortly after the season with a cognitive screening battery (ImPACT) and a subgroup of athletes also were assessed with 7 measures from a neuropsychological test battery. Few cognitive differences were found between the athlete groups at the preseason or postseason assessments. However, a higher percentage of the contact sport athletes performed more poorly than predicted postseason on a measure of new learning (California Verbal Learning Test) compared to the noncontact athletes (24% vs 3.6%; p < 0.006). On 2 postseason cognitive measures (ImPACT Reaction Time and Trails 4/B), poorer performance was significantly associated with higher scores on several head impact exposure metrics. Repetitive head impacts over the course of a single season may negatively impact learning in some collegiate athletes. Further work is needed to assess whether such effects are short term or persistent.