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Clinical Trial
. 2018 Jun;46(6):819-830.
doi: 10.1007/s10439-018-1999-5. Epub 2018 Feb 22.

Estimated Brain Tissue Response Following Impacts Associated With and Without Diagnosed Concussion

Jonathan G Beckwith  1 , Wei Zhao  2 , Songbai Ji  2   3 , Amaris G Ajamil  4 , Richard P Bolander  4 , Jeffrey J Chu  4 , Thomas W McAllister  5 , Joseph J Crisco  6 , Stefan M Duma  7 , Steven Rowson  7 , Steven P Broglio  8 , Kevin M Guskiewicz  9 , Jason P Mihalik  9 , Scott Anderson  10 , Brock Schnebel  11 , P Gunnar Brolinson  12 , Michael W Collins  13 , Richard M Greenwald  4   3
Affiliations
Clinical Trial

Estimated Brain Tissue Response Following Impacts Associated With and Without Diagnosed Concussion

Jonathan G Beckwith et al. Ann Biomed Eng. 2018 Jun.

Abstract

Kinematic measurements of head impacts are sensitive to sports concussion, but not highly specific. One potential reason is these measures reflect input conditions only and may have varying degrees of correlation to regional brain tissue deformation. In this study, previously reported head impact data recorded in the field from high school and collegiate football players were analyzed using two finite element head models (FEHM). Forty-five impacts associated with immediately diagnosed concussion were simulated along with 532 control impacts without identified concussion obtained from the same players. For each simulation, intracranial response measures (max principal strain, strain rate, von Mises stress, and pressure) were obtained for the whole brain and within four regions of interest (ROI; cerebrum, cerebellum, brain stem, corpus callosum). All response measures were sensitive to diagnosed concussion; however, large inter-athlete variability was observed and sensitivity strength depended on measure, ROI, and FEHM. Interestingly, peak linear acceleration was more sensitive to diagnosed concussion than all intracranial response measures except pressure. These findings suggest FEHM may provide unique and potentially important information on brain injury mechanisms, but estimations of concussion risk based on individual intracranial response measures evaluated in this study did not improve upon those derived from input kinematics alone.

Keywords: Brain tissue response; Finite element model; HIT System; Head impact; Mild traumatic brain injury; Sports concussion.

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Conflict of interest statement

Conflict of Interest

Authors Crisco, Greenwald, Chu, and Beckwith and Simbex have a financial interest in the instruments (HIT System; Sideline Response System (Riddell, Inc)) that were used to collect the data reported in this study. The remaining authors have no financial interests associated with this study.

Figures

Figure 1
Figure 1
Four primary impact sites were (A, B, C, and D) were identified as points of contact that most frequently result in mTBI for NFL athletes. Each site was impacted at four target speeds: 4.4, 7.4, 9.3, and 11.2 m/s.
Figure 1
Figure 1
The WHIM (a, b) and SIMon (c, d) FEHM employed in this study with color-coded regions of interest (ROIs; cerebrum, cerebellum, and brainstem). The x-, y- and z-axis of the model coordinate system corresponds to the posterior-anterior, right-left, and inferior-superior direction, respectively.
Figure 2
Figure 2
FEHM estimated intracranial response (whole brain) for head impacts sustained prior to immediately diagnosed concussion.
Figure 3
Figure 3
Correlation between peak impact kinematics (Top – Linear Acceleration; Bottom – Rotational Acceleration) and FEHM estimated intracranial response for head impacts sustained prior to diagnosed concussion.
Figure 3
Figure 3
Correlation between peak impact kinematics (Top – Linear Acceleration; Bottom – Rotational Acceleration) and FEHM estimated intracranial response for head impacts sustained prior to diagnosed concussion.
Figure 4
Figure 4
Receiver Operating Characteristic (ROC) curves indicating the sensitivity and specificity of peak kinematic measures and intracranial response estimated from two FEHM. A 50% probability line is included to indicate the level of guessing (50 – 50 chance). Peak linear acceleration, coup pressure, and SIMon estimated contrecoup pressure are the most sensitive measures to immediately diagnosed concussion.
Figure 5
Figure 5
Average peak maximum principal strain (a and c) along with standard deviation (b and d) on a representative resampled coronal plane for 45 head impacts classified as immediately diagnosed concussion using the WHIM and SIMon (top and bottom rows, respectively)
Figure 6
Figure 6
Kinematic measures for head impacts associated with and without diagnosed concussion sustained by 45 collegiate and high school football players.
See this image and copyright information in PMC

References

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