HEAD AND SPINAL INJURY TOLERANCE WITH NO DIRECT HEAD IMPACT

By

A. K . Ommaya, M . D . , F . R . C . S . and L. Thibault

This paper reviews the s ta t e o f the a r t concerning to lerance for

injury to the central nervous s y s tem when the head i s no t directly s truc k .

Progress i n this area of the biokine t i c s o f impact h a s been hampered by

the d i ff iculty of s u s tained c o l labor a t ive work in the three f ie l d s which

must be coordinated in order to achieve adequate r e l ia b i l i t y o f data ;

name l y , mathemat ical mode l s , experimental work with phys i c a l and animal

mod e l s and pred i c t ive va l idat ion from human accident data .

After reviewing the four ana l y t i c mod e l s currently avai l ab l e , this

paper wil l summar i z e the current knowledge concerning the o ther two areas

mentioned with special reference t o experimental work conducted by the

author a t the Na t ional Ins t i t u t e s of Hea l t h .

M a thema t i c a l Mod e l s

1. ADVANI . This mod e l i s o f an e l a s t i c spherical she l l with a low

modulus e l a s t ic/visco-ela s t i c core , subj ected to three types of loading :

1. axisymmetric translat ional impact

2. symmetric t o r s ional impact

3. whiplash type loading

The model drives numerical s o lut ions for limiting de splacement s , shear ,

and normal s tr e s s e s .

2. HAYASHI . This i s a two dimensional mode l , con s i s t ing of e l a s t ic-

a l l y connected concentric r igid body cylind er s . The loading i s in the

sag i t t a l p lane symmetry with angular acceleracion v s . t ime for the real

3 11
 eMAX
,,

S i tuat ion replaced by p u l s e wave for equivalent time duration t .

D
The model derives resul tant shear Stress vs . eMAX t
D
and uses the
,

con s t i tut ive r e l a t ions to determine the crit ical leve l s for inj ury . The

data derived from this model was compared to our experimental data with

reasonab l e correspondenc e .

3. JOSEPH AND CRI SP . This model i s o f a spheroidal brain-skull

2
body having the mathema tical relat ionship x +
7

The loading used in this model was a cons tant angular velocity i . e . , a

s t eady rotational motion about any of 3 mutually orthogonal axe s . The

model derives exp r e s s ions for mechanical s tress e s , s t rains and disp lace -

ments o f the brain and uses the cons titutive r e l a t ions developed by

the data from the work of Galford and McElhaney.

4. BYCROFT . This model i s of the skull as a rigid spherical she l l

and o f the brain a s a s imp l e e l a s t i c s o l id . The loading i s a f u l l sine

and ha l f - s ine angular accelerat ion in the axisymme tric plane and it

derives expres s ions for shear s tr e s s as a comp lex function o f t ime and

radial posi tion in the mod e l . Holburn ' s sca l i ng law i s used and compared

to data o b ta ined from s ome of this authors experimenta l work

Experimental Work in the Rhesus Animal Mode l .

Two hypotheses which have s t imulated considerable research in the

field of head inj uries are a s sociated with the name of Holbourn and

Gurdj ian. Based on experimen t s with gelatin models o f the brain

Holbourn b e l ieved that rotat ional components of iner t ia l loading of

the head was the mo s t s ignificant cause of diffuse effects on the

brain ( e . g . cerebral concussion and contrecoup l e s ions ) . He dis­

counted trans l a t i onal component s of ine r t ia l loading c l a iming tha t the

resul tant compre s s ion or rarefaction of the brain would not be s igni­
(l,2)
f i cantly inj uriou s . Gurdj ian correctly pointed out that this

analysis neglected the effect o f the foramen magnum and the work of

this inve s t igator and his colleagues over the past 2 5 years a t Wayne

S tate University has formed the basis o f the current standard tolerance

curve for head injury used by des ign engineers the world ove r . ( 3 , 4 )

Because this curve i s expre s s ed i n terms o f translational acceleration

only it was impor tan t to determine exper imentally the precise individual

contribution of b o th translat ion and ro tat ion to the injury p o t ential of

iner t ia l loading of the brain. Both hypothes i s accept that the contact

phenomena of impac t are the main cause of focal l e s ions at or near the

s i t e of impact but di ffer on the r e l a t ive s igni f i cance of the transla tional

and rotat ional component of inertial load ing caused by impa ct . Our earlier

work had shown tha t pure iner t ia l loading produced by exper iment a l whip lash

could produce cerebral concussion and surface haemorrhages of the brain

<5,6)
(primarily subarachnoid and subdural b leeding ) . Al though the traumatic

unconsciousness thus produced by a combination o f head rotat ion and trans­

la tion without direct impact was identical to that seen a f t er head impac t ,

the l esions found in the brain dif fered in the two types o f inj ury . This

dif ference was primarily due to the presence of cerebral contusions , no t

explicable s o l e ly by the conta c t phenomena of impac t . ( 7 )

This par t o f the paper presents our current data obtained b y two new

technique s ; f i r s t l y the use of a special head holding device has a llowed us

to compare for the f i r s t t ime the inj urious effects of pure translat ional

3 1 3
acc elerat ion of the head with head rotation at equivalent level s o f input

accelerat ion and without the comp l icating effect of impact conta c t

phenomena . (See Figure 1 ) Secondly, we have developed the somato sensory

evoked response (SER) as an in -vivo index of the onset and duration of

traumat i c uncons c iousnes s and development of brain l e s ions . ( S ee Figure 2)

We have evidence that cerebral concussion and diffuse lesions in the brain

are caused primarily by the rotat ional component o f inertial loading while

cortical contus ions , intracerebral haematomas and s imilar focal les ions

are primar ily due to translat ion . (See Figure 3 ) At the levels of

acceleration tes ted , cerebral concussion was invariably produced by r o ta t ion

but no t by translation of the head . ( B , 9 ) The s e data w i l l b e presented and

d iscussed .

Impl icat ions o f these data .

1. The standard to lerance curve for head injury wil l have to be modified

to take into account the role of rotat ion .

2. With this model for clo sed head injury it i s pos s ible to test hyp o theses

for head inj ury mechanisms with precis ion and ease .

3. lt i s now possible to analyse the c l inical phenomena o f head inj ury ( c oma ,

amnesia and post -trauma t ic sequelae) in a reproducible primate mode l .

4 . Our work to date makes i t poss ible to re-define cerebral concuss ion in a

way such that the cl inical and experimental data are reconciled . This

hypo thes i s will be di scus sed .

5. The technique o f SER record ing i s direc t ly app l icable to man for the

development of an ' on-line ' in-vivo index of severity of head injury a s

well a s a research tool to unravel the mechanisms o f neural trauma in

the human .
R e s u l t s With A Phys ical Model Using The Technique Of Moire Analysi s O f Strain.

In collaboration with Dr . A. J . Dur e l l i o f Catholic Univer s i ty , we are

currently performing experiments on four hal f skul l s o f the squirrel monkey ,

rhesus monkey , chimpanzee and the human . The s e half s ku l l s are f illed with

a s ilicon material with physical proper t i e s approaching that of brain on

which a grating has been printed and the entire surface i s covered with a

lexan pla t e . These models are subj ected to linear and rotat ional acceler­

a t ions and the Moire pat terns of the re sulant deformation are analyized to

determine the rela t ive displacement o f points in the plane o f symme try of

the brain mode l . This wil l be the f ir s t s tep in the determina t ion o f

s t rains , velocities , and accelerations t o which each point i s subj ected in

the proc e s s of indirect impac t . Pre l iminary resul t s of these experiments

sha l l a l s o be reviewed in this paper . Finally the paper wi l l at tempt to

correlate the available human injury data in this type of injury s i tuation

with the current ava i lable data from the models and p o s s ible direc tions

for future work will be outlined .

3 15
 HEAD A C C EL E R AT I N G D E VI C E

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 Bibl iography

1 . Advani , S . H . , Owings , R . P . and Schuck, L . Z . : Response Evaluation

of Translat ional and Rotational Head Injury Models . Shock and
Vibration Dige s t . O c tober , 1 9 7 2

2. Hayashi , Tsuyoshi . Brain Shear Theory of Head Injury due to Rota ­

t ional Impac t . Journal o f the Faculty o f Engineer ing . U . Tokyo .
( B ) . Va l . 3 0 , No . 4 . 1 9 7 0 .

3 . Joseph, P . D . and Crisp , J . D . C . : On the evalua tion of Mechanical

S t r e s s e s in the Human Brain while in mo tion . Brain Resear ch .
Val . 26 15-3 5 , 1 9 7 2 .

4 . Bycrof t , G . N . : Mathematical Model o f a Head subj ected to Angular

Accelera t ion . In press (Journal o f Biomechanics) .

5 . Holbourn, A . H . S . : Mechanics o f Head Injur i e s . Lancet 2 : 4 3 8 . 1943 .

6 . Holbourn , A . H . S . : Mechanics o f Brain Inj ur ie s . B r i t i sh Medical

Bull e t in 3 : 1 4 7 , 1 945 .

7 . Gurdj ian , E . S . , L i s sner , H . R . , Hodgson, V . R . e t a l : Mechanisms

of Head Inj ury . Clinical Neurosurgery 12 : 1 1 2 , 1966 .

8 . Gurdj ian, E . S . , Rober t s , V . L . and Thoma s , L .M . : Tolerance curves

of accelerat ion and intracranial pressure and protec tive index
in experimental head inj ury . Journal Trauma 6 : 600 - 604 , 1966 .

9 . Ommaya , A . K . , Hirsch, A . E . and Martinez , J . : The role o f "whiplash"

in cerebral concussion. Proceedings of lOth S t app Car Crash Conf ­
erenc e , 197-203 , 1966 .

10. Ommaya , A . K . , Faas , F . and Yarne l l , P . : Whiplash injury and brain

damage : An experimental study . JAMA 204 : 285-2 8 9 , 1968 .

11 . Ommaya , A . K . , Brugg , R . L . and Naumann, R . A . : Coup and contre-coup

inJ ury : observations on the mechanics of v i s ib l e brain injuries
in the rhesus monkey . J . Neuro surgery 35 : 503 - 5 1 6 , 1 9 7 1 .

12 . Gennare l l i , T . , Thibaul t , L . and Ommaya , A . K . : Compar ison o f

translational and rotat ional head motions i n experimental cerebral
concus s ion . Proceedings o f 1 5 t h St app Car Crash Conference , 7 9 7 -
803, 1 9 71 .

13 . Genna r e ll i , T . , Thibaul t , L . and Ommaya , A . K . : Pathophysiologie

r e sponses to rotat ional and translational acceleration o f the head .
Proceedings of 1 6 th S t app Car Crash Conferenc e , 296-308 , 1 9 7 2 .

14 . Ommaya , A . K . e t al : Traumat i c unconsciou sne s s : Mechanisms of Brain

Injury in violent shaking o f the head . Proceedin gs American Assoc .
Neurological Surgeons . Paper No . 3 6 , 1 9 7 3 .

3 1 9