Download PDF
Semin Neurol 2015; 35(01): 005-011
DOI: 10.1055/s-0035-1544242
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biophysical Mechanisms of Traumatic Brain Injuries

Lee Ann Young
1   Physical Security and Applied Sciences Sector, Applied Research Associates Inc., Dallas, Texas
,
Gregory T. Rule
2   Physical Security and Applied Sciences Sector, Applied Research Associates, Inc., San Antonio, Texas
,
Robert T. Bocchieri
3   Silicon Valley Office, Applied Research Associates, Inc., Los Altos, California
,
Jennie M. Burns
2   Physical Security and Applied Sciences Sector, Applied Research Associates, Inc., San Antonio, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
25 February 2015 (online)

    Permissions and Reprints

Abstract

Despite years of effort to prevent traumatic brain injuries (TBIs), the occurrence of TBI in the United States alone has reached epidemic proportions. When an external force is applied to the head, it is converted into stresses that must be absorbed into the brain or redirected by a helmet or other protective equipment. Complex interactions of the head, neck, and jaw kinematics result in strains in the brain. Even relatively mild mechanical trauma to these tissues can initiate a neurochemical cascade that leads to TBI. Civilians and warfighters can experience head injuries in both combat and noncombat situations from a variety of threats, including ballistic and blunt impact, acceleration, and blast. It is critical to understand the physics created by these threats to develop meaningful improvements to clinical care, injury prevention, and mitigation. Here the authors review the current state of understanding of the complex loading conditions that lead to TBI and characterize how these loads are transmitted through soft tissue, the skull and into the brain, resulting in TBI. In addition, gaps in knowledge and injury thresholds are reviewed, as these must be addressed to better design strategies that reduce TBI incidence and severity.

Keywords

traumatic brain injury - blunt trauma - blast - ballistic - physics - acceleration - diffuse axonal injury
 

  • References

  • 1 Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States emergency department visits, hospitalizations, and deaths. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010
    Google Scholar
  • 2 Levine B, Schweizer TA, O'Connor C , et al. Rehabilitation of executive functioning in patients with frontal lobe brain damage with goal management training. Front Hum Neurosci 2011; 5: 9
    PubMedGoogle Scholar
  • 3 Theeler BJ, Flynn FG, Erickson JC. Headaches after concussion in US soldiers returning from Iraq or Afghanistan. Headache 2010; 50 (8) 1262-1272
    CrossrefPubMedGoogle Scholar
  • 4 Kraus JF, McArthur DL, Silberman TA. Epidemiology of mild brain injury. Semin Neurol 1994; 14 (1) 1-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Kraus JF, Nourjah P. The epidemiology of mild, uncomplicated brain injury. J Trauma 1988; 28 (12) 1637-1643
    CrossrefPubMedGoogle Scholar
  • 6 Post A, Hoshizaki TB. Mechanisms of brain impact injuries and their prediction: a review. J Trauma 2012; 14 (4) 327-349
    CrossrefPubMedGoogle Scholar
  • 7 Gurdjian ES. Re-evaluation of the biomechanics of blunt impact injury of the head. Surg Gynecol Obstet 1975; 140 (6) 845-850
    PubMedGoogle Scholar
  • 8 King AI. Fundamentals of impact biomechanics: Part I—biomechanics of the head, neck, and thorax. Annu Rev Biomed Eng 2000; 2: 55-81
    CrossrefPubMedGoogle Scholar
  • 9 Hardy WN, Khalil TB, King AI. Literature review of head injury biomechanics. Int J Impact 1994; 15 (4) 561-586
    PubMedGoogle Scholar
  • 10 Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain 1974; 97 (4) 633-654
    CrossrefPubMedGoogle Scholar
  • 11 Ommaya AK, Thibault L, Bandak FA. Mechanisms of impact head injury. Int J Impact 1994; 15 (4) 535-560
    PubMedGoogle Scholar
  • 12 Adams JH, Graham DI, Gennarelli TA. Acceleration induced head injury in the monkey. II. Neuropathology. Acta Neuropathol Suppl 1981; 7: 26-28
    PubMedGoogle Scholar
  • 13 Adams JH, Graham DI, Gennarelli TA. Head injury in man and experimental animals: neuropathology. Acta Neurochir Suppl (Wien) 1983; 32: 15-30
    PubMedGoogle Scholar
  • 14 Gennarelli TA, Abel JM, Adams H , et al. Differential tolerance of frontal and temporal lobes to contusion induced by angular acceleration. In: Proceedings of the 23rd Stapp Car Crash Conference. SAE paper 791022.Warrendale, PA; Society of Automotive Engineers; 1979
    PubMedGoogle Scholar
  • 15 Zhang L, Yang KH, Dwarampudi R , et al. Recent advances in brain injury research: a new human head model development and validation. Stapp Car Crash J 2001; 45: 369-394
    PubMedGoogle Scholar
  • 16 Gurdjian ES. Head injury from antiquity to the present with special reference to penetrating head wounds. Springfield, IL: Charles C. Thomas Publishing; 1973
    Google Scholar
  • 17 Zhou C, Khalil TB, King AI. A new model for comparing responses of the homogeneous and inhomogeneous human brain. In: Proceedings of the 39th Stapp Car Crash Conference. Warrendale, PA; Society of Automotive Engineers; 1995:121–136
    PubMedGoogle Scholar
  • 18 Gorske T. Traumatic brain injury basics and beyond. Paper presented at: Pennsylvania Psychological Association Annual Convention; June 18–21, 2014; Harrisburg, PA
    PubMedGoogle Scholar
  • 19 Raymond DE, Crawford GS, Van Ee C, Bir CA. Biomechanics of temporo-parietal skull fracture from blunt ballistic impact. Paper presented at: The ASME Summer Bioengineering Conference; June 25–29, 2008; Marco Island, FL
    PubMedGoogle Scholar
  • 20 Needham CE. Blast Waves (Shock Wave and High Pressure Phenomena). Heidelberg, Germany: Springer; 2010
    Google Scholar
  • 21 U.S. National Academies of Science Committee on Gulf War and Health: Brain Injury in Veterans and Long Term Health Outcomes. Military personnel with traumatic brain injury at risk for serious long-term health problems; more studies needed on health effects of blast injuries. December, 4 2008. Available at: http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12436 . Accessed May 15, 2010
    PubMedGoogle Scholar
  • 22 Cernak I, Savic J, Malicevic Z , et al. Involvement of the central nervous system in the general response to pulmonary blast injury. J Trauma 1996; 40 (3, Suppl): S100-S104
    CrossrefPubMedGoogle Scholar
  • 23 Lemonick D. Bombings and blast injuries: a primer for physicians. Am J Chin Med 2011; 8 (3) 134-140
    PubMedGoogle Scholar
  • 24 Courtney AC, Courtney MW. A thoracic mechanism of mild traumatic brain injury due to blast pressure waves. Med Hypotheses 2009; 72 (1) 76-83
    CrossrefPubMedGoogle Scholar
  • 25 Chen Y, Huang W. Non-impact, blast-induced mild TBI and PTSD: concepts and caveats. Brain Inj 2011; 25 (7-8) 641-650
    CrossrefPubMedGoogle Scholar
  • 26 Chafi MS, Karami G, Ziejewski M. Biomechanical assessment of brain dynamic responses due to blast pressure waves. Ann Biomed Eng 2010; 38 (2) 490-504
    CrossrefPubMedGoogle Scholar
  • 27 Moss WC, King MJ, Blackman EG. Skull flexure from blast waves: a mechanism for brain injury with implications for helmet design. Phys Rev Lett 2009; 103 (10) 108702
    CrossrefPubMedGoogle Scholar
  • 28 Goeller J, Wardlaw A, Treichler D, Weiss G. Cavitation as a possible damage mechanism for traumatic brain injury (TBI) from an improvised explosive device (IED) blast. DARPA SBIR Final Report. Arlington, VA: Defense Advanced Research Projects Agency (DARPA); 2013
    Google Scholar
  • 29 Taylor PA, Ford CC. Simulation of blast-induced early-time intracranial wave physics leading to traumatic brain injury. J Biomech Eng 2009; 131 (6) 061007
    CrossrefPubMedGoogle Scholar
  • 30 Taylor PA, Ludwigsen JS, Ford CC. Investigation of blast-induced traumatic brain injury. Brain Inj 2014; 28 (7) 879-895
    CrossrefPubMedGoogle Scholar
  • 31 Zhang L, Yang KH, King AI. A proposed injury threshold for mild traumatic brain injury. J Biomech Eng 2004; 126 (2) 226-236
    CrossrefPubMedGoogle Scholar
  • 32 Nyein M, Jerusalem A, Radovitzky R, Moore D, Noels L. Modeling blast related brain injury. Paper presented at: The 26th Army Science Conference; December 1–4, 2008; Orlando, FL. Available at: http://handle.dtic.mil/100.2/ADA504193 . Accessed June 12, 2010
    PubMedGoogle Scholar
  • 33 Elder GA, Mitsis EM, Ahlers ST, Cristian A. Blast-induced mild traumatic brain injury. Psychiatr Clin North Am 2010; 33 (4) 757-781
    CrossrefPubMedGoogle Scholar
  • 34 Department of Energy. Manual for the Prediction of Blast and Fragment Loadings on Structures. DOE/TIC-11268. Amarillo, TX: Department of Energy, Amarillo Energy Office; 1980
    Google Scholar
  • 35 Przekwas A, Tan X, Rule G, Iyer K, Ott K, Merkle A. Modeling articulated human body dynamics under a representative blast loading. Paper presented at: The ASME 2011 International Mechanical Engineering Congress & Exposition; November 11–17, 2011; Denver, CO
    PubMedGoogle Scholar
  • 36 Dagro A, McKee P, Kraft R, Zhang T, Satapathy S. A preliminary investigation of traumatically induced axonal injury in a three-dimensional (3-D) finite element model (FEM) of the human head during blast-loading. 2013. ARL-TR-6504 website. Available at: http://oai.dtic.mil/oai/oai?verb=getRecord&metadataPrefix=html&identifier=ADA588181 . Accessed January 3, 2015
    PubMedGoogle Scholar
  • 37 Panzer MB, Bass CR. Human results from animal models: scaling laws for blast neurotrauma. Paper presented at: National Neurotrauma Society Annual Meeting; July 22–25, 2012; Phoenix, AZ
    PubMedGoogle Scholar
  • 38 Yu AW, Wang H, Matthews KA, Bass CR. Mouse lethality risk and intracranial pressure during exposure to blast. Paper presented at: The Biomedical Engineering Society Annual Meeting; October 24–27, 2012; Atlanta, GA
    PubMedGoogle Scholar
  • 39 Rafaels K, Bass CR, Salzar RS , et al. Survival risk assessment for primary blast exposures to the head. J Neurotrauma 2011; 28 (11) 2319-2328
    CrossrefPubMedGoogle Scholar
  • 40 Rafaels KA, Bass CR, Panzer MB , et al. Brain injury risk from primary blast. J Trauma Acute Care Surg 2012; 73 (4) 895-901
    CrossrefPubMedGoogle Scholar
  • 41 Shridharani JK, Wood GW, Panzer MB , et al. Porcine head response to blast. Front Neurol 2012; 3: 70
    PubMedGoogle Scholar
  • 42 Zhu F, Skelton P, Chou CC, Mao H, Yang KH, King AI. Biomechanical responses of a pig head under blast loading: a computational simulation. Int J Numer Methods Biomed Eng 2013; 29 (3) 392-407
    CrossrefPubMedGoogle Scholar
  • 43 Versace J. A review of the severity index. In: Proceedings of the 15th Stapp Car Crash Conference. SAE Paper 710881. Warrendale, PA; Society of Automotive Engineers; 1971
    PubMedGoogle Scholar
  • 44 Lissner HR, Lebow M, Evans FG. Experimental studies on the relation between acceleration and intracranial pressure changes in man. Surg Gynecol Obstet 1960; 111: 329-338
    PubMedGoogle Scholar
  • 45 Prasad P, Mertz H. The position of the United States delegation to the ISO Working Group 6b on the use of HIC in the automotive environment. SAE Paper 821246. Warrendale, PA; Society of Automotive Engineers; 1982
    PubMedGoogle Scholar
  • 46 Hutchinson J, Kaiser MJ, Lankarani HM. The head injury criterion (HIC) functional. Appl Math Comput 1998; 96 (1) 1-16
    PubMedGoogle Scholar
  • 47 Slobonik BA. SPH-4 helmet damage and head injury correlation. USAARL-80–7. Fort Rucker, AL: US Army Aeromedical Research Laboratory; 1980
    Google Scholar
  • 48 McIntire BJ, Whitley P. Blunt impact performance characteristics of the advanced combat helmet and the paratrooper and infantry personnel armor system for ground troops helmet. USAARL Report No. 2005–12. Fort Rucker, AL: US Army Aeromedical Research Laboratory; 2005
    Google Scholar
  • 49 Yoganandan N, Pintar FA, Kumaresan S, Maiman DJ, Hargarten SW. Dynamic analysis of penetrating trauma. J Trauma 1997; 42 (2) 266-272
    CrossrefPubMedGoogle Scholar
  • 50 Yoganandan N, Pintar FA, Zhang J, Gennarilli TA, Biomechanical aspects of blunt and penetrating head injuries. In: Gilchrist MD. , ed. IUTAM Symposium on Impact Biomechanics: From Fundamental Insights to Applications. Heidelberg, Germany: Springer; 2005: 173-184
    PubMedGoogle Scholar
  • 51 MacPherson D. Bullet Penetration: Modeling the Dynamics and Incapacitation Resulting from Wound Trauma. El Segundo, CA: Ballistic Publications; 2005
    Google Scholar
  • 52 Committee on Review of Test Protocols Used by the DoD to Test Combat Helmets. Board on Army Science and Technology; Division on Engineering and Physical Sciences; National Research Council Review of Department of Defense Test Protocols for Combat Helmets. Test Protocols for Backface Deformation: Statistical Considerations and Assessment. Washington, DC: National Academies Press; 2014. Available at: http://www.nap.edu/openbook.php?record_id=18621&page=R1 . Accessed January 3, 2015
    PubMedGoogle Scholar
  • 53 Panzer MB, Wood GW, Bass CR. Scaling in neurotrauma: how do we apply animal experiments to people?. Exp Neurol 2014; 261: 120-126
    CrossrefPubMedGoogle Scholar
  • 54 Lockhart P, Cronin D, Williams K, Ouellet S. Investigation of head response to blast loading. J Trauma 2011; 70 (2) E29-E36
    CrossrefPubMedGoogle Scholar
  • 55 King AI, Yang KH, Zhang L , et al. Is head injury caused by linear or angular acceleration. Paper presented at: International Research Council on Biomechanics of Injury Conference; September 24–26, 2003; Lisbon, Portugal
    PubMedGoogle Scholar
  • 56 Duma SM, Manoogian SJ, Bussone WR , et al. Analysis of real-time head accelerations in collegiate football players. Clin J Sport Med 2005; 15 (1) 3-8
    CrossrefPubMedGoogle Scholar
  • 57 Pellman EJ, Viano DC, Tucker AM, Casson IR ; Committee on Mild Traumatic Brain Injury, National Football League. Concussion in professional football: location and direction of helmet impacts-Part 2. Neurosurgery 2003; 53 (6) 1328-1340 , discussion 1340–1341
    PubMedGoogle Scholar
  • 58 Greenwald RM, Gwin JT, Chu JJ, Crisco JJ. Head impact severity measures for evaluating mild traumatic brain injury risk exposure. Neurosurgery 2008; 62 (4) 789-798 , discussion 798
    CrossrefPubMedGoogle Scholar
  • 59 Guskiewicz KM, McCrea M, Marshall SW , et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003; 290 (19) 2549-2555
    CrossrefPubMedGoogle Scholar
  • 60 Long J. Combined effects of primary and tertiary blast on rat brain: characterization of a model of blast-induced mild traumatic brain injury. Contract No. W81XWH-11–2-0127. Tacoma, WA: Geneva Foundation; 2013
    Google Scholar
  • 61 Needham CE, Ritzel D. Bad science yields wrong conclusion: blast testing issues and TBI. Front Neurology, in press
    Google Scholar
  • 62 Bowen IG, Fletcher ER, Richmond DR. Estimate of man's tolerance to the direct effects of air blast. Albuquerque, NM: Lovelace Foundation for Medical Education and Research; 1968
    Google Scholar
  • 63 Wood G, Panzer M, Yu A, Rafaels K, Matthews K, Bass C. Scaling in blast neurotrauma. Paper presented at: International Research Council on Biomechanics of Injury Conference; September 11–13, 2013; Gothenburg, Sweden
    PubMedGoogle Scholar