Current and future concepts in helmet and sports injury prevention.

Since the introduction of head protection, a decrease in sports-related traumatic brain injuries has been reported. The incidence of concussive injury, however, has remained the same or on the rise. These trends suggest that current helmets and helmet standards are not effective in protecting against concussive injuries. This article presents a literature review that describes the discrepancy between how helmets are designed and tested and how concussions occur. Most helmet standards typically use a linear drop system and measure criterion such as head Injury criteria, Gadd Severity Index, and peak linear acceleration based on research involving severe traumatic brain injuries. Concussions in sports occur in a number of different ways that can be categorized into collision, falls, punches, and projectiles. Concussive injuries are linked to strains induced by rotational acceleration. Because helmet standards use a linear drop system simulating fall-type injury events, the majority of injury mechanisms are neglected. In response to the need for protection against concussion, helmet manufacturers have begun to innovate and design helmets using other injury criteria such as rotational acceleration and brain tissue distortion measures via finite-element analysis. In addition to these initiatives, research has been conducted to develop impact protocols that more closely reflect how concussions occur in sports. Future research involves a better understanding of how sports-related concussions occur and identifying variables that best describe them. These variables can be used to guide helmet innovation and helmet standards to improve the quality of helmet protection for concussive injury.

[1]  A. Ommaya,et al.  Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. , 1974, Brain : a journal of neurology.

[2]  R A Wennberg,et al.  National Hockey League Reported Concussions, 1986-87 to 2001-02 , 2003, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[3]  T Blaine Hoshizaki,et al.  The Science and Design of Head Protection in Sport , 2004, Neurosurgery.

[4]  Koshiro Ono,et al.  Human Head Tolerance to Sagittal Impact Reliable Estimation Deduced from Experimental Head Injury Using Subhuman Primates and Human Cadaver Skulls , 1980 .

[5]  Blaine Hoshizaki,et al.  A centric/non-centric impact protocol and finite element model methodology for the evaluation of American football helmets to evaluate risk of concussion , 2014, Computer methods in biomechanics and biomedical engineering.

[6]  D. Viano,et al.  Concussion in Professional Football: Reconstruction of Game Impacts and Injuries , 2003, Neurosurgery.

[7]  D. Jones,et al.  Research and Development of Hockey Protective Equipment—A Historical Perspective , 1989 .

[8]  S. Kleiven.  Predictors for traumatic brain injuries evaluated through accident reconstructions. , 2007, Stapp car crash journal.

[9]  Alan M. Nahum,et al.  Experimental studies of side impact to the human head , 1980 .

[10]  Andrew S McIntosh,et al.  Numerical reconstruction of real-life concussive football impacts. , 2009, Medicine and science in sports and exercise.

[11]  Thomas Blaine Hoshizaki,et al.  Impact Attenuation Characteristics of Thin Walled Collapsible Air Chambers for Use in Protective Helmets , 2009 .

[12]  J. Adams,et al.  Diffuse axonal injury and traumatic coma in the primate , 1982, Annals of neurology.

[13]  R. Cantu.  Neurologic Athletic Head and Spine Injuries , 2000 .

[14]  C. W. Gadd.  Use of a weighted-impulse criterion for estimating injury hazard , 1966 .

[15]  King H. Yang,et al.  A proposed injury threshold for mild traumatic brain injury. , 2004, Journal of biomechanical engineering.

[16]  Marshall Kendall,et al.  Dynamic impact response characteristics of a helmeted Hybrid III headform using a centric and non-centric impact protocol , 2012 .

[17]  A. Post.  The Influence of Dynamic Response Characteristics on Traumatic Brain Injury , 2013 .

[18]  D. C. Schneider,et al.  Impact Studies of Facial Bones and Skull , 1972 .

[19]  V L Roberts,et al.  Experimental intracranial pressure gradients in the human skull. , 1966, Journal of neurology, neurosurgery, and psychiatry.

[20]  V. R. Hodgson,et al.  Tolerance of the facial bones to impact , 1967 .

[21]  V L Roberts,et al.  Tolerance curves of acceleration and intracranial pressure and protective index in experimental head injury. , 1966, The Journal of trauma.

[22]  James A. Newman,et al.  HEAD INJURY CRITERIA IN AUTOMOTIVE CRASH TESTING , 1980 .

[23]  T. Walilko,et al.  Biomechanics of the head for Olympic boxer punches to the face , 2005, British Journal of Sports Medicine.

[24]  W Goldsmith,et al.  Current controversies in the stipulation of head injury criteria. , 1981, Journal of biomechanics.

[25]  J. Versace.  A Review of the Severity Index , 1971 .

[26]  Earl F. Hoerner,et al.  Safety in Ice Hockey , 1989 .

[27]  M A Forero Rueda,et al.  Finite element modelling of equestrian helmet impacts exposes the need to address rotational kinematics in future helmet designs , 2011, Computer methods in biomechanics and biomedical engineering.

[28]  M D Gilchrist,et al.  The use of accident reconstruction for the analysis of traumatic brain injury due to head impacts arising from falls , 2006, Computer methods in biomechanics and biomedical engineering.

[29]  Michael D. Gilchrist,et al.  Examination of the relationship between peak linear and angular accelerations to brain deformation metrics in hockey helmet impacts , 2013, Computer methods in biomechanics and biomedical engineering.

[30]  T A Gennarelli,et al.  Acceleration induced head injury in the monkey.I. The model, its mechanical and physiological correlates. , 1981, Acta neuropathologica. Supplementum.

[31]  A. Post,et al.  Head Injuries, Measurement Criteria and Helmet Design , 2013 .

[32]  William Roper.  Football, today and tomorrow , 1927 .

[33]  Luke M Gessel,et al.  Concussions among United States high school and collegiate athletes. , 2007, Journal of athletic training.

[34]  Andrew Post,et al.  Mechanisms of brain impact injuries and their prediction: A review , 2012 .

[35]  A K Ommaya,et al.  Mechanical properties of tissues of the nervous system. , 1968, Journal of biomechanics.

[36]  H. R. Lissner,et al.  Observations on the mechanism of brain concussion, contusion, and laceration. , 1955, Surgery, gynecology & obstetrics.

[37]  L. Lamb,et al.  Deformation mechanisms and impact attenuation characteristics of thin-walled collapsible air chambers used in head protection , 2009, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[38]  J Sandover,et al.  The damaging punch. , 1985, British medical journal.

[39]  King H. Yang,et al.  Is head injury caused by linear or angular acceleration , 2003 .

[40]  T A Gennarelli,et al.  Acceleration induced head injury in the monkey. II. Neuropathology. , 1981, Acta neuropathologica. Supplementum.

[41]  M. Gilchrist,et al.  Mechanical characterization of brain tissue in compression at dynamic strain rates. , 2012, Journal of the mechanical behavior of biomedical materials.

[42]  Rémy Willinger,et al.  Human head tolerance limits to specific injury mechanisms , 2003 .

[43]  Thomas Blaine Hoshizaki,et al.  Compressive properties of helmet materials subjected to dynamic impact loading of various energies , 2008 .

[44]  Peter Halldin,et al.  A New Laboratory Rig for Evaluating Helmets Subject to Oblique Impacts , 2003, Traffic injury prevention.

[45]  E. Benzel,et al.  Boxing and mixed martial arts: preliminary traumatic neuromechanical injury risk analyses from laboratory impact dosage data. , 2012, Journal of neurosurgery.

[46]  John W. Melvin,et al.  Head Impact Response , 1977 .

[47]  A. G. Demusyak.  International Standards Organization (ISO) , 1967 .

[48]  D. J. Thomas,et al.  Biomechanics of skull fracture. , 1995, Journal of neurotrauma.

[49]  Michael D. Gilchrist,et al.  The creation of three-dimensional finite element models for simulating head impact biomechanics , 2003 .

[50]  A E Hirsch,et al.  Tolerances for cerebral concussion from head impact and whiplash in primates. , 1971, Journal of biomechanics.

[51]  M. Hutchison,et al.  Concussions in the National Hockey League (NHL): The Video Analysis Project , 2012 .

[52]  Thomas Blaine Hoshizaki,et al.  The influence of impact location and angle on the dynamic impact response of a Hybrid III headform , 2011 .

[53]  V. Silva,et al.  Mechanics and Strength of Materials , 2005 .

[54]  D. Meaney,et al.  Tissue-level thresholds for axonal damage in an experimental model of central nervous system white matter injury. , 2000, Journal of biomechanical engineering.

[55]  Blaine Hoshizaki,et al.  An examination of American football helmets using brain deformation metrics associated with concussion , 2013 .

[56]  Michael D. Gilchrist,et al.  Identifying injury characteristics for three player positions in American football using physical and finite element modeling reconstructions , 2013 .

[57]  David C. Viano,et al.  Twelve Years of National Football League Concussion Data , 2010, Sports health.

[58]  Marshall Kendall,et al.  Comparison between Hybrid III and Hodgson–WSU headforms by linear and angular dynamic impact response , 2012 .

[59]  Mark Schickendantz,et al.  Analysis of Baseball-to-Helmet Impacts in Major League Baseball , 2012, The American journal of sports medicine.

[60]  A K Ommaya,et al.  Trauma to the nervous system. , 1966, Annals of the Royal College of Surgeons of England.

[61]  K O'Riordain,et al.  Reconstruction of real world head injury accidents resulting from falls using multibody dynamics. , 2003, Clinical biomechanics.

[62]  Svein Kleiven,et al.  Evaluation of head injury criteria using a finite element model validated against experiments on localized brain motion, intracerebral acceleration, and intracranial pressure , 2006 .

[63]  Michael D. Gilchrist,et al.  The application of brain tissue deformation values in assessing the safety performance of ice hockey helmets , 2012 .

[64]  Blaine Hoshizaki,et al.  Finite element analysis of the effect of loading curve shape on brain injury predictors. , 2012, Journal of biomechanics.

[65]  D F Meaney,et al.  Defining brain mechanical properties: effects of region, direction, and species. , 2000, Stapp car crash journal.

[66]  A. McKee,et al.  The epidemiology of sport-related concussion. , 2011, Clinics in sports medicine.

[67]  H. R. Lissner,et al.  Experimental Concussion , 1955, Neurology.