EXPERIMENTAL TRAUMA OF OCCIPITAL IMPACTS

Joseph W . Young , l Rob ert G . F i s her , 2

G . Town ley Pri c e 3 and Richard F . Chand ler 4

I. INTROilJ CTION
Head injury i s a c knowledged t o be one of the more ser ious s a fety and med i ­
c a l management prob lems in both a i r and ground vehi c l e acc ident s . A l though
certain phys iological phenomena and injuries are pre d i c t iv e ly observed in
a c c i dent s i tuat i ons , l i t t le i s known of the more ba s ic mechanisms producing
the se phenomena and even less of the r e l a t i onships between viab le res pons e s ,
trauma and impact characteris t i c s .
Early injury t o lerance s tandards were b a s ed on b e s t e s t imates f rom i s o lated
c l a s s i c a l phys iolog i c a l experiments and judgments of c l in i c a l observat ions . In
more recent years , revis ions in injury t o le rances have , unfortuna t e ly , been
def ined primar ily in terms of fracture charact e r is t ics of cranial and f a c i a l
bones w i t h l i t t l e empha s i s on o r ser ious acknowledgment o f more critical
phys iolog i c a l prob lems . Iron i c a l l y , the ph i lo sophy of this approach had been
gener a l ly d is cred ited more than 100 years ago when Abernathy ( 185 2 ) ,
Hutchinson ( 18 7 7) and Bergmann ( 1880) , among other s , supported the view that
trauma t i c d i s order of the b r a in can occur w ithout s t ructural damage . The fact
tha t more recent inve s t igat o rs , such as Haynes and L is s ner ( 1 9 6 1 ) , s pe c i f i c a l l y
conc lude tha t s erious and f a t a l brain injuries can o c c u r w i t hout fracture , has
not s igni f i cant ly changed the exis t ing injury t o lerance s t andards for a s imple
lack of proper informa t ion . Fortunately , fol lowing Holbourn ' s major work
( 1 94 3 ) , Ommaya ' s overview o f head injury ( 1 96 6 ) and s ub s equent work have empha­
s i zed again a more re a l i s t i c trend in experimental head injury to de f ine the
b a s ic mechanisms and corre late the events of impact re s ponse s with contro l led
impa c t characte r i s t ic s . Such d a ta are r e l a t iv e t o the re a l acc ident s i tuation
where phys iolog i c a l res pons e s are d i re c t cor r e l a t ing f a c tors of injury and
surv iva l s t atus .
This report documents the phys iolog i c a l re spons es , trauma patho logy and
dynamic events o f head impac t experiments that produced a c l in i c a l ly de f ined
s t a t e of cereb ral concus s ion . It was antic ipated that a better understand ing
o f the r e lat ionships of trauma me chanisms would r e s u l t in a more effect ive
e a rly c l ini c a l management of he ad in juries and more e f f icient methods to pre ­
vent or redu c e ser ious he a d injury w ith meaningful tole rance s t andards for
des ign . Prevent ion o r redu ct ion o f incapa c i t a t ing hea d injuries f or eff ect ive
evacuation procedures in survivab l e a c c idents is cons idered a priority s a fety
prob l em .

1
chie f , Anatomy , Protect ion and Survi v a l Laboratory , Civil Aerome d i c a l Ins t i ­
tu t e , Feder a l Avia tion Admin i s t ra t i on
2
chairma n , Department o f Neurosurgery , The Universi ty o f Okl ahoma Health
S c i ences Center
3
cons ulting Patholog i s t , Great Plains D i agnos t i c Laboratory
4
chie f , Pro t e c tion and Surviva l Laborator y , C iv i l Aeromedica l Ins t i tute ,
Feder a l Aviat ion Admi n i s t r a t i on

2 7 1
II . METHODS

Exper imental Phi los ophy

The pur pos e of this s tudy was t o produce head t rauma a t cerebral concus ­
s iv e leve l s w i t h a le r t primate t e s t sub j e c t s to measure and corre late
phys iolog i c a l res pons e s , histopatholog y , head kinema t i cs and the dynamic events
assoc i a t ed with impact forces . This study was the in i t i a l phase of a compr e ­
hens ive head injury program planned for a series o f head t rauma experiments .
W ithin, the scope of this pha s e , only the acute trauma condit ions were
con s i dered for a two-variable s t udy .
The inherent problems of account ing for a l l influenc ing f a c tors on tes t
r e s pons e s and s e l e c t ion o f t e s t controls in exper iment a l des ign were no l e s s
c r it i c a l t o this study . S ince s pe c i f i c neurolog i c a l res pon s e s would be
measured and a variety of re sponse phenomena wou ld be expected to occur as un­
known f act ors w i t h unknown inf luence s , c er t a in t e s t cond it ions were cons idered
e s sentia l . Cr i t i c a l to this exper imen t a l de s ign wa s a pre - impa ct condition of
normal neurolog i c a l res ponsivene s s . As the measure of any t e s t res ponse would
be ques t ionab le under the influence of res idual effects from ane sthe s ia or
medi c a t ions that a lter normal funct ions , the subj ect cou ld not be t e s t ed un t i l
the prolonged e ffects o f me d icat ion had dis appeared . Such d e l a y between sur­
g ica l pr eparation and impact t e s t would present sub j e c t maintenance prob l ems
for the awa ke subject and preclude documentat ion of pre - impact base l ine va lue s .
The use of a n itrous ox ide -oxygen mixture w ith ha lothane f or surgical ane s ­
thes ia and loca l ane s t he s ia b locks pe riphe ral t o the o c c i pi t a l impact s it e
was cons idered es sent i a l for experiment a l v a l i dity .

Exper iment a l D e s ign

The exper iment a l des ign for this study cons idered procedures and tech­
niques that had been used in other a pp l ica t ions and represent the b e s t
comb inations to achieve program ob j e c t iv e s .

T e s t Fac tors . An acute two-va r iab le t e s t s erie s was conduc te d with

Savannah baboons (Papio cynocepha lus ) as the ini t ia l pha s e of the comprehens ive
head injury s t udy . The t e s t var iables were ( 1 ) occ ipita l impacts to immob i ­
lized , f ixed pos it ion heads (immob i lized s e r i e s ) and (2) o c c i p i t a l impa cts t o
he ads f r e e t o move in a cont rolled l inea r , po s te r ior-anter ior d irect ion (moving
s e r i e s ) . These var iab les were s e le ct ed to control certain he ad-neck kinema t ics
that could b e potent i a l ly related to phys iolog i c a l re spons es and to ident ify
the r e l a t ionships , if any , of a s s o c ia ted injur ie s . The d i re c t i on of impact ,
relat ive t o head orient a t i on , was para l le l to the sub j e c t ' s hor i zontal
Frankfort plane . This orientat ion of head-to- impa ctor int erface in the mid­
s a g i t t a l plane was maintained for a l l impact t e sts . The o c c i p i t a l type impa c t
was se lected a s the opt imal cond i t ion t o as sure the gre a t es t pos s ib l e shock
input t o head s t ructures with least trauma of hard and s o f t t i s sue s . S imilar ­
ly , the impact pro f i le and impa ctor char a c t er is t ic s se lected to produce
trauma t i c phys iolog i c a l changes provided optima l factors of shape , mas s and
ve loci ty to create a re l a t iv e ly high shock input to the head w ith the least
amount of s t ructural damag e . B a s ed on previous occipital impa c t s that con­
s idered factors of cran i a l geometry and fracture pa tt erns , impa ctor ve loc i t i e s
averag ing 4 3 , 4 5 and 5 0 f ee t per second were se lected us ing s imi lar x-ray
analys e s for each t e s t subj ect ,
 Tes t sub j ect r e s pons e s and condit ions c l inically observed and evaluated
were pu p i l lary and corneal ref lexes , l id c losur e , gross trauma and histopatho l ­
ogy . Instrumented and measured t e s t re s ponses were e lect roencepha lographic
(E&;) and e l ectrocard iographic (Ecx;) patterns , pu l s e rates , arterial and
venous b lood pres s ur es , cerebra l b lood f low rates , b lood gas leve l s , head
accelerat ion and he ad kinemati c patterns .
lt was ant i c i pated that res is tance by the sub j e c t to body res t ra int would
indirec t ly influence both observed and measured r e s pons e s during s equent i a l
t e s t procedures . The entire body was enc l o s ed i n a res traint s ys t e m , except
for cer t a in hea d and neck a reas , to control this r e s i s t ance and reduce the
i some t r i c s t re s s . The head was enc losed s e parate ly in a rigid form- f i t t ing
cast and s ecured to a holding device that cont rolled head mot ion for each t e s t
cond i t ion and prevented gross deformation o f the cran i a l vault dur ing impact .
An erect s it t ing pos ition of the test subj e c t was considered a b e s t compromi se
for impactor-sub j e c t o r ientation and s ub j ect maintenance dur ing extended
periods .
Environment a l control of the test a rea was planned and maintained to
as sure du p l icat ion of cond i t i ons for each t e s t . Temperatur e , light , noi s e and
motion f actors that prov ided external s ensory cues to the subject were con­
trol led to reduce spontaneous excit ement res pons es during data me a surement .
Test sub j e c t s we re laboratory- condi t ione d , adult fema le baboons in a weight
range of 2 2 to 28 pounds . A l l sub j e c t s w e r e he ld in quarantine and c l in i c a l l y
moni tored for a t least s ix weeks before t e s t ing t o a s sure behav ioral and
phys iolog ica l s tab i l i t y .

B ioins trument ation . Convent ional and modif ied bio instrumentation tech­
niques and equipment were s e lected on the b a s i s of s tate-of-the -art
availab i l i t y to this laborat ory .
A s t andard array of three b i la t era l ly pa ired s ignal leads were posit ioned
parasag i t ta l ly w i thin the exposed f ront a l and parie t a l hone a reas via a s ingle
midl ine s c a l p inc is ion . Each lead , s h ie lded and insulated , was at tached t o a
gold-plate d e lectrode implanted through the c a lvarium to permit a d ir ect extra­
dura l f luid interface . A s ing l e ground lead was implanted midsagit t a l ly on
the superior a s pect of the exposed supraorb ita l ridge . A l l extracran i a l
tissues , including the per iost eum, were removed from the implant s i tes t o
reduce s igna l interferenc e . Two Konigsberg pre s sure transducers ( P mode l ) were
placed extradu r a l l y to measure intracran i a l pr essure . Each t ransducer was
cemented in place deep in the trephined hole but d i d not extend through the
inner tab l e of h one to contact the dura . S t e r i l e normal s a l ine s o lut ion was
p l aced extradura l l y in both preparations to maintain a f luid interface w ith
the transducer . The trans ducers were a l igned in an anter ior-pos terior plane
f iv e m i l l imeters parasagi tta l ly to the le f t . An array of two miniature ac­
ce lerometers (Endevco 2000 Series) were a l igned and mounted as a unit mid s a g i t ­
t a lly in t h e pos t -orb i t a l r idge area to measure ant erior-po s t erior a n d check
vert ica l acce lerat ions during the impact s equenc e .
A l t hough d if f icu lt t o accurat e l y measure w ithout more s o phis ticated gas
o r i s otope t e chnique s , attempts to measure cereb ral b lood flow were made with
B iotronex BL f low transduce r s . Flow rates were measured by plac ing a trans ­
ducer a t the d i s t a l part of each conunon carotid artery through a s ing l e ,
anterior m i d l ine inc i s ion on the neck. Both external carotid branches were
l igated but no attempt was made to occ lude the paired vertebral artery s ource .

2 7 3
EH; measurements were obtained with a s t anda r d array of three need le e le c trode s
and s tab i l ized by taping the lead s .
Arter ia l and venous b lood pressur es were measured with Konigsberg cathe t er
type (P mod e l ) pressure transducers po sit ioned in the thoracic portion of the
des cending aorta and inf e r ior vena cava re spec t ive ly . The s e implants were a c ­
complished b y pas s ing the catheter through the right femoral artery and vein
via acces sory branches . Entry through and s ub s equent l igation of the a c c e s s ory
vess e l s were made to avoid interruption of the primary l imb c ircula t ion . A
catheter tube was likew i s e placed via the left femoral artery for an exte rna l
Sta tham type pre ssure transducer a s a b a c ku p measurement o f arte r i a l b l ood pre s ­
sur e . The left femoral v e in was f itted with a cannula to draw internal b lood
s ampl es for analy s i s with a Radiomete r , Mode l BMS -3 a c id -b a s e analyzer . Dua l ,
s ma ll d iameter a i r tub e s were po s i t ioned on the head restraint to d irect a ir
f low into the eyes as a cont inuous s t imu l i for eye ref lexes .

Test Procedures

A l l t e s t procedures were arranged and executed in a s t andardized , chrono­

logi c a l sequence to as sure compa t ib i lity w ith t e s t control requirements of
c r i t i c a l procedural time limits . Two days prior to the t e s t , a set of head and
neck x - rays , shaving of the surgi c a l surface areas and preparat ions for
r e s t r a int s izing were comple ted . The interven ing day was required to permit
the sub j ect to complet e l y recover from the effect s of phencyc l idine hydro­
chloride and sodium pentabarb i t a l used in preparat ion procedures .
Surgical preparation of the t e s t sub j ect was a ccomplished a s the f i r s t
procedure the f o l low ing day . An ini t i a l 75 mg sod ium methohexi t a l solut ion
was admin is tered intramuscularly w ith atrophine prior to surgica l ane s t he s ia ,
then tracheal intubat ion was performed and anesthes ia was accomplished w ith a
n i t rous oxide -oxygen mixture with ha lothane , (per cent r at io of 6 : 4 : 2 ) . A
maintenance dosage rate wa s continued with decreased halothane vo lume of one­
half to one per cent . After completion of a l l implant procedure s , the s ub j e c t
w a s pos i t ioned and s e cured in the re straint system. Anesthe t i c agents were
imme d ia t e ly w ithdrawn and the sub j ect a l lowed to regain consciousness with
continued oxygen support . The s ub j ect was monitored unt i l a l l vital s igns and
r e s pons e s were cons idered norma l, then placed in the t e s t pos it ion • Fol l ow ing a
.

brief c l in i c a l eva luation , the endotrachea l tube was removed and b io instru­
mentat ion conne cted to s tart b a s e l ine mon itoring and record ing . Instrumenta­
t ion continuity che c ks were made with v ia b l e s igna ls for amplifying and re cord­
ing equipment ; then data s ampl ing at f ive-minute intervals b egan at 3 0 minutes
bef ore impact with a c t ivat ion of the automat ic switching timer for came r a ,
lights and impact countdown . At f ive minutes pre- impa ct , recorders we re set on
cont inuous run for data s ampling unt il 30 minutes pos t - impact . Euthanas ia s o lu­
t ion was admini s t ered f o l low ing this monitoring period through the venous
cathe t er to terminate the sub j ec t .
Within one hour a f t e r death , a comprehensive necropsy protocol was con­
ducted to identify and d e s c ribe gross trauma of a l l head and neck s tructure s .
A l l observat ions were recorded on tape and by color phot ography . Autopsy
procedures were completed w i th the remova l o f the intact b ra in and cerv i c a l
c o r d for histological preparat ion and s tudy . A standardized plan of b r a in and
cord s e c t ioning was f o l lowed to as sure comparison of s imi lar s e c t ions in a l l
t e s t sub j e c t s . Typi c a l f ixing procedures with buffered formalin s o lutions
were f o l l owed for routine s ta ining with hemot oxy l in - eos in and g a locynanin b lue
agents . Since autopsy procedures were in itiated w ithin the hour after d e ath ,
addit ional immediate f ixing of the b r a in and cord was not considered nece s s a ry
to inhibi t auto lys is .

III . RESULTS

A s ummary o f t e s t re�ults for both t e s t v a r i ab l e s of immob i le and moving

he a d s e r ies are out lined in Tab l e s 1 and 2 . D i f f icult ies in ach iev ing mechan i ­
c a l s t ab i l ity o f inst rumentat ion implants during impact resulted in cert a in
d a t a a r t ifacts and , in some instance s , d a t a los s . The continuity o f E&;
e le c t rode and carot id f low transducer interfaces were moment a r i ly d i s rupted in
a l l t e s t s w ith artifac ted or part i a l data loss . A lthough E H; signa ls d i d
recov e r in part s tab l e s ignals , b oth f l ow transducers f a i led t o s tab i l i z e for
meaningful data record s . S im i l a r ly , s igna l output from the t ransducers
measuring intracran i a l pressure appeared to be a r t i f acted and w i l l not be con­
s id ered for a na lys i s i n t h is pa per . The des ign l imit s o f the mu l t i - pos i t i one d
a c c e lerometers were exceeded by impa ct v e lo c i t i e s and were not used therea f t er .
B lood gas v a lues obta ine d were not c ons idered s ign i f i c ant for the purpo s e s of
this s tudy . Although pos t - impact mon itoring continued for a s long a s one hour
in i s o l a ted cases , data ana lys is for this paper w i l l cons ider only the f ir s t
3 0 -minute period f o l lowing impa c t ,

Immob i l ized Head Series

Subject CP 1 10 . Pupi l d i l a t ion occurred b i latera l ly and returned to

norma l in 14 seconds on on ly the r ight s ide . Convers e ly , only the l e f t corne­
a l ref lex was functiona l a f t er 35 s e conds fol lowing b i lateral loss . EEG pat ­
terns demons trated s lowed act ivi t y pos t - impa ct . No sign i f i cant changes in the
Ecx; pattern were observed but both pu l s e rate and arter i a l pressure leve l s
dropped a f ter impact and recovered t o base l ine va lues a t 4 0 and 3 0 s econds
res pect ive ly . G ross autopsy f indings were subcutaneous hemorrhage at the
impact s ite , a s imple non-depre s s e d line a r fra cture from the occiput pa r a ­
s ag itta l ly into the f oramen magnum and contused a r e a s intradura l ly in the
inf e r i or - f ront a l , temporal and o c c i p i t a l areas and the cerebe l lum . Subarach­
noid hemorrhages were his tologica l l y conf irmed in the s a me areas and a f ew
i s o l a t e d hemorrhages were found deep in the temporal and cereb e l l a r subs tance .
Degenerat ive nerve c e l l changes were observed among norma l , hea l thy c e l l s in
the f ront a l and occ ipita l a re a s . These c e l l changes were mani f ested a s
s hrunken and pykno t i c w it h l o s s of nuc l e a r d e t a i l .

Subject CP 1 1 1 . Both pu p i l d i la t ion and corne a l ref lex l oss were b i later­
al w i th return except for cont inuous d i l a t ion of the l e f t pupil . Cornea l
ref l exes were a c t iv e a f t e r 4 6 se cond s . EEG a c t iv i ty was b r ie f ly s l owed and
E<X; demons trate d a continuous b radycardia and los s of P wave . Both pu l s e rate
and arterial pressure lev e l s were depre ssed pos t - impact and did not return to
norma l b as e l ine v a lues . Coincident with a sma l l l a c eration and subcutaneous
hemorrhage , a complex , fragmented fracture pattern w a s centered around the
impa c t s ite w i th occ ipit a l and pos t - parietal involvement . Occas ional sub­
ara chnoid hemor rhages in the fronta l , occipital and cereb e l lar a r e a s were con­
f i rmed histolog ic a l l y , but d e e p micro hemorrhages were found only in the
o c c i p i t a l port ion of the c erebrum and the cereb e l lum . In the fronta l , tempo­
r a l and occipi t a l portions of the cerebrum, s ome of the large nerve c e l ls are
shrun�n aüd miss haped and present a ltered s t a ining reaction . The i r nuc l e i
are indis t inct w ith absence o f chromatin and nuc leol i . Ce l l s in the o c c i pi t a l

2 7 5
portion s how more intense degenerat ive changes w ith pyknot ic nuc l e i or ind i s ­
t inct s tructure and inc re ased number o f g l ia l e lements .

Subje c t C P 1 12 , Pupi ls d i lated b i la t er a l ly with norma l return in 60

s econds , Corneal ref lexes were extinguished and became funct i on a l after 12 and
20 s e conds pos t - impa c t , E&; a c t ivity s l owed intermit tent ly and the ECG pattern
changed s igni f ican t ly with d i s t inct bradycard ia and premature ventricular con­
tract ions . Pul s e rate and arteria l pressure incre ased brief ly , then decreased
to remain b e low base l ine levels , Patholog ic a l l y , a s c a l p lacera t i on w i t h s ub ­
cutaneous hemo rrhage and a multi- fr agmented fracture pattern w a s centered
around the tmpa c t s it e . Gross examinat ion reve a led isolated areas of contus ion
on the inf erior surfa ces o f the fron t a l lobes , tempora l , oc c i p i t a l and pos t e r i ­
or c e reb e l lum . Subarachnoid hemorrhages were observed in micros copic sect ions
from the f rontal and temporal areas and the cereb e l l um. The only interna l
hemo rrhages were loca ted throughout the ce reb e l lum , A ma j or ity of the large
nerve ce l ls present the same degenera t iv e changes as d e s c r ibed in the other
t e s t sub j ect s . A l t hough nerve c e l l s in the cerv i c a l cord s e c t ion we re largely
we l l formed with d i s t inct nuc l e i , Nis s l s ub s t ance appears to be absent .

Subjec t CP 12 1 . Pupi l d i lat ion was b i lateral w ith return on the right
s ide only at 35 s econds . B i lateral corneal re f lex los s was very brief for
four s e cond s , EF.G showed a delayed , but b r ie f , s lowed act ivity and bradycardia
with premature ventricular contract ions d i s a ppeared by the end of the mon itor­
ing perio d , Pul s e r a t e and arteria l pre s s u r e decreased and recovered a t 4 0 and
35 se conds respect ive l y , A drop in the caro t id f low rates was observed for a
f ew s e cond s , then became uns t ab le w i t h neck movement . Is o la t e d hemorrhages
were found s ubcutaneous ly at the impact s it e , s uperf i c i a l to the origin of a
s in g l e l inear fra cture that continued into the foramen magnum, Gross contu­
s ions were ob s e rved w it h in the dura over the t empora l , pons , c e reb e ll a r and
pos t - cerv i c a l areas . Subarachnoid hemorrhages were s c a t t ered a long the sur­
f aces of the temporal lobes , pos terior cereb e l lum , pons and the c e rv i c a l cord .
This i s the only t e s t s ub j e ct tha t d id not demons trate degener a t iv e nerve c e l l
change s .

Subje ct CP 12 2 , Pos t - impact pup i l d i l a t ion was b i lateral with one of the
greatest dur a t ions of 1 2 0 s e conds . Conver s e ly , the b i later a l los s of corne a l
ref lexes was only two s econd s . Both the E&; s lowing and ECG p a t t erns o f
bradycardia and premature ventricular cont ract ions lasted for only 4 5 s econds ,
The pu ls e rate s t ab i l i z e d a fter 55 s e conds and arterial pre s s ure and carot id
f low r a t es returned to base l ine a f t er 180 s e c onds from depre s s e d leve ls , A
s ma l l s ub cutaneous hemorrhage was conf irmed a t the impact s ite , but there was
no fracture in the cran i a l va�l t . This was the only sub j e c t without f ractur e .
Two s ma l l areas o f dura l contus ions were found over the inferior a s pe c t o f the
f ront a l lobes and pos ter ior surface of the occipital l ob e s , Subarachnoid
hemorrhages were conf ine d t o the o c c i p i t a l and pons areas and internal hemor­
rhage only in the s ub s tance of the cereb e l l um and s upe rior cerv i c a l cord , A
numb er of large nerve c e l l s in a l l cereb r a l are a s were typica l ly degenerat ive
in na t ure , mos t w ithout nuclear d e t a i l and Niss l subs tance . The purkinage
c e l l s in the cerebe l lum were not remarkab le b ut f ew gangl ion c e l ls in the cer­
vica l cord demons trated degenerative change s . None o f the c e l ls pos s e s s ed
N i s s l s ubs tanc e ,
 Subje ct CP 1 24 . B i la t e r a l pupil d i lat ion rema ine d f or 43 se conds pos t ­
impact and corneal ref lexes were funct ion a l w i thin 1 6 se conds . The EEG pat­
terns typica l ly demons tra ted s lowed a c t iv i t y . Premature vent ricular contrac­
t ions were cons is tent throughout the mon itor ing per iod , but only a brief
interva l of bradycardia appeared imme d iat e ly pos t - impa ct . Pu lse rate , arteri a l
pressure and carot id f low rate decre a s e d immediate l y after impact , then
recovered to normal va lue s a f t e r 20 s econds . A s ub cutaneous hemorrhage over­
lying a s ing le non -depres s e d occipi t a l fracture was c o inc ident with the impact
s i te . The entire ant er ior s ur f a ce areas of the f ront a l lobes were contused
un l ike a l l other subj e c t s . Subara chnoid hemorrhages were f ound in the sub­
f ronta l and inferior te mpor a l s urfaces and a long the pos t e r ior a s pects of the
occipi t a l lobes and cereb e l lum . Internal hemorrhages were located in the pons
and d e e p throughout the cereb e l l um and typic a l degenerat ive neural a l tera t i ons
were conf irmed in the tempora l and oc cipi t a l areas .

Moving Head Series

Subjec t C P 1 1 3 . B i la t e r a l pup i l d i l a t ion and los s of corne a l ref lex

o ccurred imme d i a t e ly pos t - impact w ith recovery w i thin 20 se conds . Slowed EF.G
a c t iv i t y occurred b r ief ly and the E(l; pa t t erns were not remar kab le . Arte r i a l
pressure inc reased f o r 2 0 s e conds w i th s imi lar carotid f low shifts , but pu l s e
rate d e pre s s e d 120 s e conds . Typi c a l s c a l p lacerat ion a n d subcut aneous hemor­
rhage was a s s o c i a ted w ith a s hort l inear fr acture of the occipita l bone at the
impact s ite . Contused areas were found on the inferior s urfaces of the fronta l
lobes , anter ior a s pe c t s of the tempora l lobes and pos ter ior occipital areas .
Dif fuse subarachnoid hemorrhages were confined t o corres ponding fron t a l and
tempora l a r e as and a s ingle a rea of internal hemorrhage was located in the
r ight o c c i p i t a l l obe . Among normal ce l l s , degenerative changes were found in
the front a l , t emporal and occipita l areas .

Subje ct CP 1 14 . Pupi l d i l a t ion and corne a l ref lex loss were b i la t era l
w ith short term recovery t ime a t 12 and 2 se conds respectiv e l y . As in Sub j e c t
CP 1 13 , the E(l; pa tterns were not remarkab le and on ly a b r ie f f ew-se cond
s lowed a c t iv ity was evident . Both pu l s e rate and arte ria l pres sure were de­
pre s s e d for 25 and 80 se conds res pe c t ive l y . Loca l subcutaneous hemorrhage was
coinc ident with the o c c i p i t a l impact s it e and the origin of a l inear fracture
pa s s ing pa r a s ag i t t a l ly into the f o ramen magnum. Areas of intradura l hemor­
rhage were found on the anterior a s pect of the tempora l lobes , pos t e rior
a s pe c t s of the o c c i p it a l poles and cereb e l lum. Subarachnoid hemorrhages were
conf irmed in the front a l and tempor a l areas and deep hemorrhages were revea led
in the subs tance of the pons and cereb e l lum . Ty pical degenerative nerve c e l l
changes are mani f e s t with some d i f f erence . Few we l l - f ormed c e l l s show ind i s ­
t inct nuc l e a r det a il w i t h s ome loss of chroma t in . Many more of the s everely
affected c e l l s present s a t e l l it o s i s and early karyoly s is . Most of thes e
changes are confined t o the cerebrum .

Subject CP 115 . B i la t e r a l pu p i l d i l a tion occurred and corne a l re f l exes

ex t ingu ished with recovery of e ither . EF.G waves were f la t tened and s lowed and
pul s e r a t e , arterial pre s sure and carot id f low a l l depres sed w ithout return t o
normal b as e l ine leve ls . A s ca l p lacera t i on and subcutaneous hemorrhage a t t end­
ed a complex , mu l t i - f r agmented f r a c ture pa t t ern of the o c c i p i t a l and par iet a l
bones . De pressed fragments was the cause of s a g i t t a l s inus lacerat ions and
subsequent loss of a large volume of b lood , This sub j ect was t erminated a f t e r
a 15 -minute monitoring period without rega ining consc iousness . Gross c ontusion

2 7 7
areas were observed over the anterior temporal lob e , occipit a l and cereb e l lum
area s . Subara chnoid hemorrhage was extens ive in the tempora l , o c c i p it a l , pons ,
cereb e l l um and cerv i c a l areas . Degene rat ive nerve c e l l changes we re conf ined
to the occ i pi t a l and cerebel lar a reas .

S ub j ect CP 1 16 . There was no pup i l d i l a t ion and b i la t er a l ly extinguished

corne a l ref lexes returned after two s e conds . There was a quest ionab le a r e a of
s lowed EEX:; a c t iv ity and pu lse rate and arteria l pressure d e pre s s e d for only 12
and 25 s econds respe c t iv e ly . A s ma l l subcutaneous hemorrha ge and short linear
f racture were found a t the impact s i te . A lthough dur a l conge s t ion was evident
on the anter ior s ur f a c e s o f the temporal lobes , occ ipita l and cerebe l l a r sur­
faces , subarachnoid and deep hemorrhages we re confined to the cereb e l lum .
Conver s e ly , degene rat ive nerve c e l l changes were found in a l l his to logica l
s ect ions w i t h the exception of the pons .

Sub je c t C P 1 1 7 . The b i l a teral pupil d i l a t ion d i d not fully return to

norma l ; however , b oth corne a l ref lexes were extingui s hed for only two se conds .
S lowed act ivity was s uggested in the EEI; pa t t ern s , but the ECG was not remark­
ab l e . Pu l s e rate was depressed for 3 9 seconds and arterial pres sure returned
to normal a f t e r incre a s ing for 25 s econds . The inferior front a l , o c c i pi t a l
and cereb e l l ar a re a s showed dural contusions ; howeve r , only the cerebe l l ar had
both subarachnoid and d e e p hemorrhages . An i s o la t ed tempor a l area of sub­
arachnoid hemorrhage was conf irme d . Degenerative nerve c e l l changes were
f ound in the fronta l , tempora l , occipital a nd cereb e l lum a reas . There a ppear
to be gradat ions of changes w i th s l ight ly m i s s haped and a l tered nuclear de t a i l
in many c e l l s .

Sub je c t C P 1 1 8 . A l though b i latera l pup i l d i lati on never recovered on the

right s i de , and the left remained d i l a ted for 1 1 3 s e conds , both corne a l
re f lexes wer e a c t iv e after only two s econd s . EEG a c t ivity s lowed and the P
wave in the E<X; w a s depres s e d . The pu l s e rate remained e levated for 2 2 0 s e c ­
onds and , conve r s e ly , t he arterial pressure de pre s sed f o r only 6 0 s e conds
before recovery to norma l b a s e l ine leve l . A s imple l inear f racture in the
occipi t a l hone was found with s uperf i c i a l s ubcutaneous hemorrhage and s c a l p
lacer a t i on . G r o s s l y obs e rved areas o f c ontus ion were located a long the anter i ­
o r tempora l , o c c i p i t a l and cereb e l l a r surf a ces . Degenerat ive nerve c e l l
changes were conf ined t o the tempora l , o c c i p i t a l and cereb e l la r sect ions with
c l ear zones s urrounding these misshaped c e l ls to suggest edema . Intense areas
of subarachnoid hemorrhages were f ound in the f ron t and tempora l portions and
deep micro hemorrhages only in the cerebe l lum .

Subject CP 120 . Similar to CP 1 1 7 , there was no recovery o f norma l pu p i l

di ameter b u t cornea l ref lexes returned b i l a t e ra l ly w ithin 13 s e conds . S lowed
EEX:; a ct iv i t y i s suggested and P wave remained depre s se d f or most of the moni­
toring period . A depre s s e d pu lse rate recovered after 25 se conds pos t - impact
and arterial pre s s ure decreased to b a s e l ine levels a f t e r 80 s e conds . A com­
plex , mu l t i p l e f r a cture pa tt ern in the o c c i p i t a l bone and par ie t a ls was not
depr e s s e d and a s s o c ia t ed with the typi c a l lacerated s c a l p and subcutaneous
hemorrha ge . Grass contusion a reas o f the dura were mo s t exten s iv e in this
group cover ing the s ub - f ron ta l , tempora l , oc c i pita l , cereb e l l a r area s . Sub­
arachnoid hemorrhage was extens ive in the fron t a l , tempora l , occ i p it a l , c e re ­
b e l l a r and cervica l surfaces w i th deep hemorrhage only in the oc c i pita l and
c e reb e l l a r s e c t i on s . Shrunken and mi s s ha ped c e l ls with pyknotic nuc l e i are
aga in found a mong normal c e l ls in the f ront a l , t empor a l , o c c i p i t a l and c e re-
b e l l ar areas .

IV . DISClJ SSION

The r e l a t ively sma l l numb e r of sub j e c t s in this i n i t i a l t e s t s eries pre­

c ludes a det a i le d s t a t i s t i c a l analys is o f data va lues ; however , trends of
certa in res ponse phenomenon are d i s t inct and appear t o be pre d ictab le . The
general nature of c l inic a l ly observed and me asured acute res ponses to dire c t
occ ipit a l impact was not un l i ke s ys t emic r e s ponses that have been observed and
documented by others . The results do suggest that certain funct iona l and s t ruc­
tura l changes are occurr ing under these part icular impact condit ions which may
not conform to the more popular explanat ions of injury mechanisms or have not
been exper iment a l l y produced by others . In genera l , the re lat ively higher
leve l s of shock input res u l t ing in the immob i le head s eries produced more
intense injury and more pronounced changes in sys temic re s ponse than found in
the t e s t with contro l led head mot ion . A l though there was an average d i f f erence
in impactor ve locity o f 4 f t . / s e c . f a s ter and relat iv e ly higher inputs t o the
heads of the moving head s e r ie s , the type and intensity of cranial vault f ra c ­
tur e was n o t s ignif icant ly d i f f e rent w i th two except ions . In Sub j e c t CP 122
there was no fracture in a predicted worse case condition and , ironica lly ,
mu l t i pl e depres s e d fra ctures oc curred in a moving head s ub j e c t (CP 1 15 ) tha t
a r t if ac ted mos t o f the phy s i o logica l res ponse da t a .
Los s o f cornea l ref lexes and pup i l d i l a t ion occurred as expe c t ed and
typic a l ly conf irmed by other res earchers such as Denny -Brown and Rus s e l l ( 1 94 1) ,
McCu l lough ( 1 9 7 1 ) and Tind a l l ( 1 9 72 ) . The duration o f the r e f lex loss was
longer in the immob i le head s e r ies and the pupil d i l a t ion wi thout recovery is
a t t r ibuted to the more s e vere shock input based on h i s t o logical evidence .
There a ls o a ppears t o b e a s ign ifi cant d i f f erence in the E cx; respons e s w ith
d i s t inct b radycardia and premature ventricular contract ions occurring in f ive
of the s ix immob i le head t e s t s and only a marked P wave depress ion occurr ing in
two subj e c t s of the moving head s e r ie s . Thi s phenomenon s eems cons istent with
the re l a t ive intens ity of a ltered phy s iolog i c a l re s pons es o ccurring with im­
mob i l ized heads . The s e leve l s a re a l so cons is tently higher than produced in
othe r re latab l e work and cannot be e f f e c t iv e l y compar ab le .
Of greater significanc e , examina t ion of patho logical findings reveal un­
usual comb ina t ions of trauma that s e em to contradict e s tab l ished conv en t ions o f
injury me chanisms . The conformat ion of such trauma b y h i s t o logica l ana lys is
was not comple te ly unexpected in some instances ; however , the d i s t inct and
intense hemorrhage in the f r onta l and tempora l areas of al l sub jects w ith im­
mob i li z e d heads a s we l l as thos e in the moving head series is not regarded a s
typical f indings under these exper imen t a l condit ions . B y c onventional de f ini­
t ion these t rauma areas a re def ined as contrecoup injuries and s hould have only
occurred in heads that were free t o move w i th _ the occipital b l ow . This def ini­
t ion of contrecoup was w e l l documented by LeCount and A pf e lbach ( 1 92 0 , Vance
( 1 92 7 ) and Munro ( 1 938) with conf irmed exper imen t a l and human dat a . The s e
same ob s e rv a tions were conf irmed experimen t a l l y b y Denny-Brown and Rus s e l l
L 9 14 1 ) , among others , who f a i led t o produce contrecoup injury with immob i l ized
he ads at impact , but at lower leve l s of shock input .
lt is int e r e s t ing t o note that while contrecoup injuries and loss of con­
s c iousnes s were produced in both moving and immob ile heads w ith trans lat ional
mo t ion-force orientation , the theory of Holbourn ( 1 94 3 ) and experimen t a l evi­
dence by Ommaya ( 1 966) , Hirs ch ( 1 970) and Gennare l li ( 1 9 7 2 ) demonstrates that
rota t iona l , not tran s l a tiona l , motion is the primary component a s s o c ia ted w ith

2 7 9
concuss ion and b r a in injury f or brie f shock input s . Whether or not contrecoup
trauma can b e expected to occur predictively under these and s im i lar conditions,
must await further exper imenta l evidenc e . S ince this study pha s e d id not con­
s ider the rotat ional component as an experimen t a l variab l e , the relat ive s ign i ­
f ic ance of the trans lat ional r o l e in producing unc ons c iousnes s under other
condit ions is not known ,
S i mi l a r l y , the extens ive h i s to log i c a l ana l y s i s has revea led a degenerative
neuro l og i c a l phenomenon a s s o c i a ted with impact events of both t e s t condit ions .
With on ly one exception , a l l traumat ized sub j e c t s in both t e s t s e ries demon­
s trated a lterat ions of the large nerve ce l l s and e lements a s s hrunken , mis ­
s haped w ith pyknotic nuc l e i and c l a s s i c los s o f nuc l e a r det a i l . l t i s usua l ly
agreed that such degenera t iv e changes require a number of hours to manife s t
f o l l ow ing ins ult . The s e ce l l changes occurred within 6 0 minutes o r less a f t e r
impa cts in this s tudy . Cons iderations of v i ra l prob lems and other pr edis pos ing
f actors were no t confi rmed a f t e r a lengthy and detailed analys is . Control s ub ­
j e c t s , both laboratory bred and fresh co lony impor ts o f d i f ferent origin , were
ana lyzed for pos s ib l e sources of artif acts with negative results and a re eva lu ­
at ion o f potent i a l t e s t cond it ions for s ources of anoxia had the s ame result ,
In a d e t a i led ana lys is of over 300 other h i s t o logi c a l surveys of traumat ized
baboons w i thout d irect head impact , no degenerat ive changes s imilar to the se
were f ound . Only two other s ources of exper imental wer k , by Snyder ( 1 97 2 ) and
Portnoy ( 1 970) , have conf irmed s imi lar f ind ings and a re , in f a c t , produced
under s im i l a r impact cond i t i ons .

V. CONCUJ SIONS

On the b as i s of the s e in i t i a l t e s ts , there appears to be certain combina­

tions o f phys iolog i c a l re s ponse s and a s s o c iated injury mechanisms that may be
e ither contradictory in part to current theories now held by a number of in­
ves t igators or actually ind icate add i t ional phenomena not previous ly document­
ed . Of grea tes t s igni f i c anc e , the contrecoup injury has been produced by
d irect occ ipita l impact to he ads immob il ized and not free to res pond kinema t i ­
c a l ly t o the impact f or c e . Furthe r , this type o f ind irect injury has been
produced by only trans lat ional forces in both the immob i l ized heads and heads
free to move in a controlled ante r ior-poster ior plane w it h r e l a t ively s im i l a r
f o r c e inputs . Degenerative nerve c e l l changes have a l s o b e en cons i s t ently pro­
duced under the conditions of acute head impact in less than one hour and ,
w ithout b ene f it of furthe r experimen t a l evidence , appear to b e trauma re la ted .
lt i s sugge s t ed that the experimen t a l evidence presented here is s u f f i c ient to
s e r ious ly que s t ion the absolute adequacy of current injury tolerance d a t a that
are be ing off ered and used to es t ab l is h tolerance s t andards . Addit ional ex­
perimenta l t e s t ing w i l l be necessary to s t a t is t ic a l ly evaluate the s e poten t i a l ­
ly conf l i c t ing theories and provide rea l i s t i c tolerance va lues f o r des ign
S tandards .

REFERENCES
ABERNATHY , J . "Surgi c a l Observat ions on Injuries o f the He ad , " London , 1825 .
B ERGMANN , E . VON. "Di e Lehre von dem Kopfver let zungen , " in B i l lroth and Lueke,
"Deuts che Chirurg i e , " Lief . , 3 0 , Stuttgar t , 1880 .
DENNY-BROWN , D . and RIJ S SELL , W . R . Exper imenta l Cerebra l Concus s ion , Bra in ,
64 : 93 - 164 , 1 94 1 .
G ENNARELLI , T . A . , THIBAULT , L . E . and OMMAYA , A . K . "Pathophy s io logie Re­
s pons e s to Rot a tiona1 and Trans lat iona l Acce lerat ions of the Head , "
Proceedings o f the 16th S tapp Car Crash Conferenc e , SAE , NY , 1 9 72 .
HAYNES , A . L . and LISSNER , H . R . "Experiment a l Head Impact Studie s , " Proceed­
ings of the F ifth Stapp Automotive Cr ash and F i e ld Demonstrat ion Confer­
ence , U nivers ity of Minnesota , 1 96 1 .
HIRSCH , A . E . and OMMAYA , A . K . "Pro tect ion from B r a in Injur y : The Re l a t iv e
Signif icance o f Trans lat ion a l a n d Rot a t iona l Motions o f the Head After
Impact , " Proceedings of the 14th S ta pp Car Crash Conference , SAE , NY , 1 9 70 .
HOLBOORN , A . H . s . "Me chanics o f Head Injury , " Lance t , Vo l . 2 4 5 : 4 3 8 -44 1 , 1 94 3 .
HJTCHINSON, J . " I l lu s t ra t ions o f Clinical Surgery , " 1 , London , 1 8 7 7 .
LE COONT , E . R . and APFELBACH, C . W . "Patho log ie Anat omy of Trauma t i c
Fracture s o t Cran ial Banes and Concomi tant B r a in Injuri e s , " J . Ame r . Med .
A s sn . , 74 : 50 1 -5 1 1 , 1 92 0 .
MC UJLLOUGH , D . , NELSON , K . and OMMAYA , A . K . "The Acute Effe c t s o f Experi­
men t a l Head Injury on the Vertebrob a s i lar Circu lat ion : Angiographic
Ob serva t ions . Jour . of Trauma , Vo l . 1 1 , No . 5 , 1 9 7 1 .
MJNRO , D . "Cranio -Cerebr a l Injuries , " London , 1 93 8 .
OMMAYA , A . K . , HIRS CH , A , E . and MARTINEZ , J . "The Ro l e of 1Whiplas h 1 in
Cereb r a l Concus s i on , " Proceedings of the lOth Stapp Car Crash Conference ,
SAE , NY , 1 966 .
PORTNOY , H . ; B ENJAMIN , D . ; BRIAN, M . ; MC COY , L , ; PINC E , B . ; EDGERTON , R , and
YOUNG , J . "Intracranial Pressure and Head Accelera tion During Whipla s h , "
Proceedings o f the 14th Stapp Car Crash Conference , SAE , NY , 1 9 7 0 .
SNYDER , R . G . Persona l c ommunicat ion , 1 9 7 2 .
TINDALL , G . T . Persona l commun i c a t ion , 1 972 .
VANCE , B . M . Arch. Sur g . 14 , 102 2 , Chicago , 1 92 7 .

A CKNOWLEDGMENTS
The authors gra t e f u l ly acknowledge the inva luab l e contributions of
D . E . Row l an , E . M . Trout , M. A . A l lgood , B . G . Nixon , Dr . G . D . Hanneman , and
Dr . A . M. Rev z in , a l l of the Aerome d ica l Research Branch, Civil Aerome d i c a l
Inst itute , a n d to Dr . S . Deuts ch , Chairman of the Department of Ane s the s io l ogy ,
the U n ivers ity of Okl ahoma Hea lth S c iences Cent er , in s upport of this study ,

2 8 1
 TABLE I . SUMMARY OF IMMOB ILE HEAD IMPACT RESFONSES

OP 1 1 0 OP 1 1 1 O P 112 OP 121 O P 122 O P 124

PUPIL
Both Both Both Both Bot h Both
DILATION
PU PILS R: 1 4 sec R: 90 sec Both at R: 35 eec Both at Bot h at
NORMAL L t None L t None 60 sec L : None 120 eec 43 eec
OORNSALS
Both Both Both Both Both Bot h
INAOTIVE
OORNBALS R t None Both at R s 20 eec Both at Both at R t 16 sec
AOTIVE L: �5 eec 46 eec L t 12 s e c 4 sec 2 seo L : B sec
EiG Slowed Slowed Slowed Slowed Slowed Slowed
BOG Bradycard Bradycard Bradycard Bradycard Bradycard
No P Yave wo wo PVC PVC
PULSE Down:Norm Down t No Up-Down t Down :Norm DownsNorm Down :Norm
RATE at 40 sec Return No Return at 40 eec at 55 eeo at 20 eec
ARTERIAL Down :Norm Down : No Up-Down s DownsNorm Up tNorm Down :Norm
PR!SSURE et 30 eec Return No Return at 35 eec et 180eeo et 20 eec
OAROTID
De creaee Increaee Decreaee
FLOW
GROSS: Sin g le : Mult iple : Mult iple : Sin g l e : None Sin g l e t
ORAN IAL Occipit a l Occ ipit a l Occ ipital Oc c ipital Occ ipital
FRACTUR!
GROSSt Front a l Occ ipital Frontal Temporal Front a l Fr ont a l
DURAL Temporal Oere b e l l Temporal Occ ipit a l Oc c ipit a l Temporal
HEMO Oc c i pi t e l Oc c ipi t e l Oere b e l l Oc c ipital
Cereb e l l Oereb e l l Cereb e l l
H ISTO : Fr ont a l Front a l Frontal Temporal Oc c ipit a l Fr ontal
SUB- Temporal Occ ipital Temporal Pons Pon e Te mporal
ARAOHN Occ ipit a l Oereb e l l Oereb e l l Oerebe l l Oo c ip it a l
HEMO Oereb e l l Oervical O ere b e l l
HISTOt
DEEP Temporal Ooc ipital Pone Pon e Oereb e l l Pon e
BRAIN Oere b e l l Oereb e l l Cer e b e l l Cereb e l l Cerv ical Oere b e l l
HßMO
H ISTO: Front a l Front a l Frontal None Front a l Temporal
NERV! Occ ip i t a l Tempor a l Temporal Temporal O c c i pit a l
CELL Occ ipit a l Oc c ipit a l Occ ipi t e l
CHANGE
IMPACTOR 43.7 43. 7 43.0 4 1 .9 43.5 42.0
VELOCITY ft/eec ft/eec f't/eec ft/eec ft/eec ft/eec
IMPACTOR 9 75 1025 9 30 750
LOAD lbe lb e lbs lb e
IMPAOTOR 1260 1200 1 100 9 00
PEAK g g g g g
 TABLE I I . SUMMARY OF MOV ING HEAD IMPACT RESPONSES

C P 11) C P 1 14 C P 115 C P 116 OP 117 OP 118 O P 120

PUPIL Both Bot h Both None Both Bot h Both

D ILATION
PU PILS Both at Bot h at None Bot h None R: None None
NORMAL 2 0 eec 12 eec L : l l3 sec
C ORNEALS Bot h Both Both Both Both Both Both
INACTIVE
CORNEALS Bot h e t Bot h e t None Both at B o t h at Bot h at R e l) sec
ACTIVE 20 eec 2 eec 2 sec 2 eec 2 sec L c 10 eec
EEG Slowed Slow e d Slowed Slowed Slowed Slow e d Slow e d
ECG P llTave P Wave
Depr e s eed Depre s sed
PULSE Down:Norm Down :Norm Down : No Down :Norm Down :Norm Up :Norm Down :Norm
RATE at 120sec at 25 eec Return at 1 2 sec at 39 sec at 220sec e.t 25 sec
ARTER IAL Up :Norm Down :Norm Up-Down : Down:Norm Up :Norm Down :Norm Up :Norm
PRESSURE at 20 eec at eo eec No Return e.t 25 sec e.t 25 sec e.t 60 s e c at eo sec
CAROTID
Incree.ee De c r e a ee De c r e e. s e In c r e a e e Dec r e a s e
FLOW
GROSS: Sin gl e : Sin g l e : Mult iple : Sin g le : Mult i p l e : Sin g le : Mult i pl e :
CRAN IAL Occ ipit a l Oc c i p it a l Oc c i pit a l Oc c ip i t a l Oc c i pit e. l Oc c i pi t e l Occ i p it a l
FRACTURE Par i et a l Par i e t a l Par i e t a l
GROS5 t Front a l Tempora l Temporal Temporal Fr ontal Tempor a l Front a l
DURAL Tem poral Occ i p i t a l Oc c i pit a l Oc c i p it a l Oc c i p i t a l Oc c i p it a l Temporal
HEMO Occ i p it a l Cereb e l l Cere b e l l Oerebell C e r ebe l l Oereb e l l Occ i p it a l
Cereb e l l
HISTO: Front a l F�ont a l Temporal C e r eb e l l Temporal Front a l Front a l
SUB- Tempora l Temporal Oc c i pital C e r eb e l l Tempora l Temporal
ARACHN Pon s Occ i p it e. l
HEMO Cereb e l l C e r eb e l l
Oerv ical Cervical
HISTO: Oc c i p it a l Pon s Front a l C e r eb e l l Oere b e l l Oerebe l l Occ i p it e. l
DEEP Cere b e l l Temporal Cerebell
BRAIN Occ i p it a l
HEMO Pone
Oereb e l l
Cerv i c e. l
HISTO t Front e. l Front a l Occ i p i t a l Fr ont a l Front a l Tempo r a l Fr ont a l
NERVE Tempora l Tempo r a l Cereb e l l Temporal Temporal Occ ipi ta l Tem poral
CELL Occ i p it a l Occ i p it a l Oc c i p it a l Oc c ipital Cereb e l l Occ i p it e. l
C HANGE Cerebe 1 1 Cereb e l l Cereb e l l
Cerv i c e. l

/
IMPACTOR 4;.6 45.; 50.2 43.7 45 . 7 48.8 51.6
VELOC ITY ft/sec ft/s e c f't sec ft/s e c ft/sec ft/e e c ft/sec
IMPAOTOR 700 925 400 1 125 800 e 15 e5o
LOAD lb e lbe lb B lb e lbe lbe lbe
I.MPAOTOR e4o 1 100 eoo 1)25 900 1050 1020
PBt\K g g g g g g g g

2 8 3