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Bloengincering Center, Wayne State University418 Health Science Building NR 064-524/12-10-75Detroit, Michigan 48202 _____________
CONTROL6INGO PPICt 14AMI AND ADON96S 12, *O04 DATE
Department of the Navy, Office of Naval Research March 9. 1981Structural Mechanics Program (Code 474) 115 01a.1109 OF P {1"%42 tor- VA 22 217 ____5 _______v___
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biodynamic, response, -Gx acceleration, injury tolerance levels,mathematical neck model
P0 A*STPAC? (CenAuwe0 on, roer". side of noeeow .,O Idenify bor sch Rm"b.)The purpose of this
investigation has been three folds 1) to review the literature for experi-mental results which either contribute quantative tolerancht data or date sup-porting mechanisms or criteria of injury; 2) develop new wi.thods of inves-tigating neck response 'to Indirect loading; 3) further refine a mathematicalneck models
It has been found that retinal hem~orrhage or mild concussion ware thethreshold injuries produced In forward facing harnessed individuals subjected,
DD ~ 1473 EDIION OF I NOV O6 1110169T9PS N 0 102- LP. Old.A 6601 59CURSTY C&.ASSIPICATION OF TNII PAD Woff re.eDAI.N AIev,
1gCUmIY CL.ASSIFICATION OF THIS PA9 ("On DO cee Enle,.
to 39-45 g sled acceleration impulses lasting on the order of 0.270 ms depen-ding on head-neck orientation, On the other hand, field collision data indi-,caes insignificant head-neck injuries of belted passengers from purely iner-tial loading of the head due to collisions at highway automotive speeds, iiow-ever, in abrupt neck stretch experiments with cats it has been found that neckstretch and possible odontoid process - cord interaction are related to uncon-sciousness in this species, Tetanizing the cervical muscles reduced the inci-dence of "concussion" symptons produced in this animal, Collars on monkeyssubjected to flexion producing occipital impacts, were reported to provideconcussion protection...
. -Vollow#hgi-o?1with a freshly dead, hemisactioned monkey head model taggedto measure shear strain, it has been postulated that highest shear strainin a pure rotational setup was found in the brainstem. This was caused by thebrainstem pulling on the cervical cord restrained by dentate ligaments as thebrain attempted to rotate inside the skull. Another group using anesthetizedmonkeys accelerated on a Hyge translational sled, stopped the body lens abrup-tly than the head, producing a range of symptons in the monkey from short con-cussion to death. Pathological examinations showed that they produced manyneck injuries and large amounts of brainstem damage. Recent high speed workwith hemisectioned cadaver necks shows that abrupt arrest of the body at only3.9 m/s (11 ft/sec) causes inertial head loading to flex and stretch the car-vical spine up to 2.54 cm (1 in).
- -?,>While no clear picture of tolerable levels or even criteria of Injury conbe pulled out of this array of evidence, it is clear that until the problemcan be better defined, relative motion between head ind neck and a ponitionwhich will minimize stretch in the retinal attachments should be part of pro-tective systems, where feasible, when abrupt -C) can be anticipated.
4 N 010P , .0 ,6
1gCUiRI Y CLASSIFICATION OF TNI PAGEMM De InlfeeE)
TOLERANCE OF THE HEAD AND NECK TO -G INERTIAL LOADING OF THE HEADx
V. R. HodgsonWayne State UniversityBioengineering CenterDetroit, MI 48202
U.S.A.
Summary
The purpose of this investigation has been three fold: 1) toreview the literature for experimental results which either contri-bute quantative tolerance data or data supporting mechanisms orcriteria of injury; 2) develop new methods of investigating neckresponse to indirect loading; 3) further refine a mathematicalneck model.
It has been found that retinal hemmorrhage or mild concussionwere the threshold injuries produced in forward facing harnessedindividuals subjected to 39-45 g sled acceleration impulses Lastingon the order of 0.270 ms depending on head-neck orientation. Onthe other hand, field collision data indicates insignificant head--neck injuries of belted passengers from purely inertial loading ofthe head due to collisions at highway automotive speeds. However,in abrupt neck stretch experiments with cats it has been found thatneck stretch and possible odontoid process - cord interaction arerelated to unconsciousness in this species. Tetanizing the cervicalmuscles reduced the incidence of "concussion" symptoms produced inthis animal. Collars on monkeys subjected to flexion producingoccipital impacts, were reported to provide concussion protection.
Following work with a freshly dead, hemisectioned monkey headmodel tagged to measure shear strain, it has been postulated thathighest shear strain in a pure rotational setup was found in thebrainstem. This was caused by the brainstem pulling on the cer-vical cord restrained by dentate ligaments as the brain attemptedto rotate inside the skull. Another group using anesthetizedmonkeys accelerated on a Hyge translational sled, stopped the bodyless abruptly than the head, producing a range of symptoms in themonkey from short concussion to death. Pathologicol examinationsshowed that they produced many neck injuries and large amounts ofbrainstem damage. Recent high speed work wiLh hemisectioned cadavernecks shows that abrupt arrest of the body at only 3.9 m/s (11 ft/sec)causes inertial head loading to flex and stretch the cervical spine !A .03 p.. _up to 2.54 cm (1 in). O
While no clear picture of tolerable levels or even criteria of , F) '!.injury can be pulled out of this array of evidence, it is clear that/ . o.,until the problem can be better defined, relative motion between j
head and neck and a position which will minimize stretch in the /--- t 1 c . d
retinal attachments should be part of protective systems, wherefeasible, when abrupt -G can be anticipated./
A /
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A. INTRODUCTION
1. Human Volunteer Exposure
Col. John P. Stapp was one of the pioneers of voluntary
submission to forward facing linear deceleration (eyeballs
out) head loading. In his studies, twelve healthy male sub-
jects were exposed to acceleration at right angles to the
long axis of the body during high speed braking of a rocket
sled on which they were riding. Using an inverted V leg
strap added to the shoulder straps and lap belt assembly,
they sustained exposure to 45.5 g at 493 g/sec rate of onset
of deceleration, and up to 38.6 g at 1370 g/sec. Stapp
suffered mild retinal hemorrhage on a run in which the peak
mouth accelerometer registered about 42 g, total duration
around 270 ms. 1 He noted that much higher levels can be sur-
vived, although reversible injurious effects may intervene
(1). Stapp noted that in one test (Run 133) the "Subject
failed to follow instructions to keep his head down," (head
and neck flexed forward as nearly horizontal as possible to
minimize neck injury and chest impact) his helmet flew off
during deceleration and he lapsed into brief unconsciousness
on the sled. He revived and relapsed into unconsciousness
lasting about half a minute, responding to being slapped on
the back of the neck with head held down to knee level.
IVerbal communication with the New York State Boxing Commission Chairmanindicated that retinal detachments are a growing concern in that sport.Although gloves have been redesigned in recent years to prevent thumbs
from being used to gouge the eye of an opponent, it is conjectured bythe author that these injuries are due to fromtal blows causing relatively
high -G impulses. Preliminary work on dummies has indicated thatblows of 40 g, 8-10 ma duration are easily produced by an amateur wearingregulation 8 oz gloves.
4
In a repeat run to determine what caused the losA of un-
consciousness in Run 133, Stapp, with head held down to aviod
amplification of head loading, did not suffer uncon3ciousness
but did sustain comminuted fractures or radius and ulna of
the right arm. Gadd (2) has done an analysis of some of the
more severe runs by the Stapp group and estimated from the
unixial head acceleration oscillographs that considerably
higher biaxial accelerations were experienced with Severity
Indices to 1500.
The impact enviornment of Stapp and his co-workers was
evidently in excess of what is generally experienced in motor
vehicles. With regard to the applicability of head injury
(concussion) criteria (HIC) to seat belt system compliance
with U.S. Government motor vehicle safety standard tests, auto
manufacturers petitioned successfully for removal of the
criteria partly on grounds that field collision data does not
indicate that head movement (without striking an object)
by shoulder-belted vehicle occupants is a serious injury pro-
ducing factor (3). Part of the reason for rescinding the HIC
was also artifactual head waving response by existing dummies.
2. Anesthetized Animal Exposure
Hollister, et al (4) clamped the heads of anesthetized
cats in a stock with the body unsupported below and allowed
them to drop in guided free-fall. The stock was arrested
abruptly, causing the neck to be stretched by the inertial
loading of the body producing symptoms of experimental con-
concussion interpreted by loss of corneal reflex. They also
:- , • • • • • • • • • • • • • • • • • • • • • •5
performed the experiment with the body supported, and required
higher energy to produce "concussion." The symptoms were
also produced by a blow and by static neck stretch. They
found that the location and amount of histological damage
were not discernible between cats which were dropped and those
which received a blow. Brain neuronal damage was found
similar to those reported previously in experimental animal
head impact tests. However the neck stretch experiments
produced more pronounced damage around C1-C2 on the medio-
ventral surface of the cervical spinal cord. They attributed
the mechanism to a sharp flexion of the cord around the
odontoid process. It was conjectured that a subluxation of
the odontoid process during a forced position change might
contribute to aggravate the effect. Tentanizing the cervical
muscle reduced the incidence of "concussion."
These researchers confronted the same problem others
have experienced in head injury work, that of separating
the effects of variables. In addition to neck stretch,
when the stock is arrested, a blow is delivered to the bottom
of the skull due to the inertia of the head. Modification
of the apparatus failed to produce reproduceable, reliable
test results.
Ommaya and Rockoff (5) have produced concussion i i
experimental monkeys with and without a cervical collar,
the latter associated with the most severe concussive effect
and brain damage. It is not certain whether the increased
effect was caused by more neck stretch without the collar
6
or because of higher head acceleration without the mass of
the collar.
Interesting results were obtained by two Japanese teams
using a HygeR translational sled in anesthetized monkey
experiments (6, 7). They accelerated the whole body of the
primates and stopped the head first, followed by a more
gradual deceleration of the body, producing a range of neural
response from short duration concussion to death. No re-
lation was found between brain injur, and intracranial
pressure but many cervical cord and brainstem injuries were
produced.
3. Fresh Tissue Animal Brain Model
Hodgson and Thomas (8) devised a model in which shear
strain could be measured using a freshly dead monkey brain -
cervical cord hemisection. It was subjected to pure trans-
lation, pure rotation and a mixed motion mode. Rotation
produced the highest shear strains, which were 3-4 times
higher than had been predicted by mathematical models, and
were measured in the brainstem rather than as predicted in
the peripheral cortex. It was postulated that rotational
motion permits the brain to rotate within the cranial cavity
to the degree to which the tethering action of vessels and
spinal cord will allow. This action pulls on the cord
through the brainstem, stretching both, due to the reaction
of the dentate ligaments connected on either side of the
cervical cord pia mater to dura. Kahn (9) and later
Schneider (10) discussed the possible role of strong dentate
7
ligaments on the exertion of stress on the cord during
accidents.
4. Observation of Cervical Spine Ktion
4.1 Human Cadaver Neck Models
Recent work with hemisectioned cadaver necks by Wayne
State University researchers has helped to visualize the
motions of the cervical spine when subjected to experimental
-G impact. In this configuration the neck stretches due to in-x
ertial loading of the head as it attempts to continue moving for-
ward when the body stops. Excerpts taken from film exposed at
500 fps following arrest of the body at only 3.9 m/s (11 ft/sec)
are shown in Figure 1. The cervical spine is seen on film
to begin in the normal convex forward (lordotic) curvature;
straighten as the head moves linearly and with approximately
13 mm (0.5 in) elevation during the first 30 ms, and,
gradually curve into flexion. The spine, which began at
114 mm (4.5 in) length, stretches to a maximum of approxi-
mately 140 mm (5.5 in) when the chin contacts the chest at
90 ms, after a 60 degree rotation of the head. Figure 2
is a blow-up of the cervical spine near maximum flexion.
It is not known how much the cord stretches during this
maneuver.
4.2 Spine Displacement Transducers
Another approach to the measurement of cervical spine
motion during impact to the almost intact cadaver or
anesthetized animal spine, is by means of a vertebral
displacement transducer. It utilizes a Hall effect cell
8
which can measure magnetic field strength. The sensor
provides a linear single-ended output which is a
function of magnetic field intensity. In this applica-
tion it is desirable to vary the strength of a magnetic
field around the Hall sensor in a manner that is pro-
portional to the relative vertebral deflection so that
the output of the Hall effect sensor is proportional
to relative deflection.
The Hall effect sensor has the advantages of small
size, simple circuitry and being relatively impervious
to fluids. The difficulty is in obtaining enough linear
output for a limited range of displacement. It is
necessary therefore to condition the output with a
logarithmic amplifier to get a linear output. This
arrangement has been tried and appears to be linear within
4Z over a limited range of 3.0 m (0.12 in). It is now
being set up on a simulated cervical spine and tested for
cross-talk, as shown in Figure 3.
4.3 Cineradiography
A cineradiographic technique is also being examined
for the visualization of neck motion during impact. The
x-ray image is projected onto a television screen which
records the resultant motion of the cervical vertebrae due
to a quasi-static load. This method has the advantage
of observing spine movements in the intact neck to
witness such things as process fracture due to bone inter-
ference or ligament tension under extreme motion. It
9
has the current disadvantages of: relatively small field
(just encompasses the cervical spine); shoulder super-
imposition in the cadaver is difficult to overcome; and
slow rate of phosphor decay in the image intensifier
limits the upper framing rate to about 200 fps. Informa-
tion on neck stretch and motion of the dens from any or all
of the above techniques is for refinement of a mathematical
spinal model under development in this study.
5. Tolerance Criteria and the Effect of Head Protection on the Neck
Patrick and Hertz (11) have investigated the effects
of the added mass of helmets on neck reactions of volunteers
and cadavers subjected to an acceleration environment producing
hyperflexion of the head and neck. They found that both
magnitude and the location of the mass on the head contribute
to an increase in the neck reaction. The effective moment
at the occipital condyles was determined to be the critical
injury criterion, Maximum voluntary static moment at the
occipital condyles was 35 N.m (25.9 ft-lb), while under
dynamic conditions the same volunteer reached 88 N.m
(65 ft-lb). In general, it was found that the equivalent
moment at the occipital condyles was higher for the
cadavers than for the human voluuteer under the same con-
ditions. The restraint of the neck musculature of
the volunteer reduced the peak reaction at the occipital
condyles.
Ewing, et al, have done extensive work in the area
of head-neck hyperflexion movements from -Gx accelerations
10
(12, 13). He estimates that Stapp's -Gx sled acceleration
run (1) may have caused acceleration measured at his mouth
of 200 g. Ewing also has reported a complete disarticulation
of the atlanto-occipital junction on an 89 N (20 lb) rhesus
monkey subjected to a 160 -G sled acceleration.
6. SUMMARY
The work of many researchers with anesthetized animals,
brain models, human cadavers and volunteers indicates that:
1. The amount of relative movements at the cranio-
spinal junction may be vital to whether or not
consciousness is lost in high acceleration environ-
ments which produce hyperflexion of the head and
neck. Such motion should be minimized.
2. The odontoid process (dens) may be intimately involved
in the injury process to the cord as It bends over
the dens in this maneuver. Subluxation of the dens
may aggravate the injury to the cord.
3. Wearing a helmet will aggravate the problem by virtue
of added bending and axial and shear loads at the
atlanto-occipital junction due to higher mass and CG
of the head. A helmet presents an advantage, however,
in providing an attachment point on the head with which
to fasten a belt strapI inertia cable or collar lim4ting
head-neck motion to impact.
'Such as used by U.S Navy football players to prevent excessivebending of the neck.
11
nmmm m =nmm nmmm nmI.
4. A flexed head and neck with chin on sternum has been
found helpful to avoid losing consciousness and possible
retinal damage from -Gx impact but should be considered
with respect to possible increased hazard from -G .
REFERENCES
1. Stapp, J. P.: "Human Exposures to Linear Deceleration, Part 2.The Forward-Facing Position and the Development of a CrashHarness, AF Technical Report No. 5915, February 1952.
2. Gadd, C.W.: "Tolerance Severity Index in Whole-Head Non-mechanicalImpact." Proceedings of the Fifteenth Stapp Car Crash Conference,Coronado, California, November 1971, p. 809-816.
3. Department of Transportation National Highway Traffic SafetyAdministration (49 CFR Part 571), Docket No. 67-7, "OccupantCrash Protection Head Injury Criterion."
4. Hollister, N.R., Holley, W.R., Horne, R.G. and Friede, R.:"Biophysics and Concussion." WADC Technical Report 58-193and ASTIA Document No. AD 2033885, September 1958.
5. Omnmaya, A.K., Rockoff, S.D. and Baldwin, M.: "Experimental Con-cussion - A First Report." Journal of Neurosurgery, 21:249-265,1964.
6. Tsubokaga, T., Nakamura, S., Hayashi, N., Miyagami, M., Taguma,N., Yamada, J., Kurisaka, M., Sugawara, T., Shinozaki, H., Goto,T., Takeuchi, T., and Noriyasu, T.: "Experimental PrimaryFatal Head Injury Causes by Linear Acceleration-Biomechanicsand Pathogenesis." Tokyo, Japan.
7. Komaki, U., Kikuchi, A., Horii, M., Ono, K., Kitagawa, N., andMatsuno, M.: "The Research on the Fatal Level of the PrimatesHead Impact Tolerance." The Japan Automotive Research Institue,inc., (JARI) October 11, 1978.
8. Hodgson, V.R. and Thomas, L.M.: "Acceleration Induced Shear Strainin a Monkey Brain Hemisection" (719023) Twenty-Third Stapp CarCrash Conference, San Diego, California, p. 589-611, October 1979.
9. Schneider, R.C.: "A Syndrome in Acute Cervical Spine Injuriesfor Which Early Operation is Indicated." Journal of Neurosurgery,8:360-367, 1951.
10. Mertz H.J., and Patrick, L.M.: "The Effect of Added Weight onthe Dynamics of the Human Head," U.S. Army Natick Laboratories,Report on Contract No. DDAG-17-67-C-0202, Natick, Mass., 1971.
12
References (Continued)
11. Ewing, C.L.: "Injury Criteria and Human Tolerance for the Neck."Aircraft Crashworthiness, University Press of Virginia, p. 141-151,1975.
12. Ewing, C.L., Thomas, D.J., Belier, G.W.J., Patrick, L.M., andGillis, D.B., "Dynamic Responses of the Head and Neck of theLiving Human to -G Impact Acceleration, "Proceedings of theTwelfth Stapp Car trash Conference, Society of AutomotiveEngineers, p. 424-439, New York, 1968.
13
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