Computational modeling of blast-induced traumatic brain injury

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 2010.Cataloged from PDF version of thesis.Includes bibliographical references (p. 105-113).Blast-induced TBI has gained prominence in recent years due to the conflicts in Iraq and Afghanistan, yet little is known about the mechanical effects of blasts on the human head; no injury thresholds have been established for blast effects on the head, and even direct transmission of the shock wave to the intracranial cavity is disputed. Still less is known about how personal protective equipment such as the Advanced Combat Helmet (ACH) affect the brain's response to blasts. The goal of this thesis is to investigate the mechanical response of the human brain to blasts and to study the effect of the ACH on the blast response of the head. To that end, a biofidelic computational model of the human head consisting of 11 distinct structures was developed from high-resolution medical imaging data. The model, known as the DVBIC/MIT Full Head Model (FHM), was subjected to blasts with incident overpressures of 6 atm and 30 atm and to a 5 m/s lateral impact. Results from the simulations demonstrate that blasts can penetrate the intracranial cavity and generate intracranial pressures that exceed the pressures produced during impact; the results suggest that blasts can plausibly directly cause traumatic brain injury. Subsequent investigation of the effect of the ACH on the blast response of the head found that the ACH provided minimal mitigation of blast effects. Results from the simulations conducted with the FHM extended to include the ACH suggest that the ACH can slightly reduce peak pressure magnitudes and delay peak pressure arrival times, but the benefits are minimal because the ACH does not protect the main pathways of load transmission from the blast to brain tissue. A more effective blast mitigation strategy might involve altering the helmet design to more completely surround the head in order to protect it from direct exposure to blast waves.by Michelle K. Nyein.S.M

Computational modeling of primary blast effects on the human brain

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 2013.This electronic version was submitted and approved by the author's academic department as part of an electronic thesis pilot project. The certified thesis is available in the Institute Archives and Special Collections.Cataloged from department-submitted PDF version of thesis.Includes bibliographical references (p. 155-167).Since the beginning of the military conflicts in Iraq and Afghanistan, there have been over 250,000 diagnoses of traumatic brain injury (TBI) in the U.S. military, with the majority of incidents caused by improvised explosive devices (IEDs). Despite the urgent need to understand blast-induced TBI in order to devise strategies for protection and treatment, much remains unknown about the mechanism of injury, the effects of personal protective equipment (PPE) such as helmets, and injury metrics and thresholds. In order to help address these gaps, this thesis has four objectives: 1) to present a comprehensive computational framework for investigating the mechanical response of the human head to blasts that includes blast-structure interaction codes, a detailed, three-dimensional model of a human head generated from high-resolution medical imaging data, and an experimentally-validated constitutive model for brain tissue; 2) to validate the framework against a broad range of experiments, including free-field blast tests involving physical human head surrogates and laboratory-scale shock tube tests involving animals and human cadavers; 3) to use the computational framework to investigate the effect of PPE on the propagation of stress waves within the brain following blast events and evaluate their blast protection performance; and 4) to develop interspecies scaling laws for the blast response of the brain that would allow translation of injury metrics from animals to humans.by Michelle K. Nyein.Ph.D

Porcine Head Response to Blast

Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposes porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110 to 740 kPa peak incident overpressure with scaled durations from 1.3 to 6.9 ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. Instrumentation was placed on the porcine head to measure bulk acceleration, pressure at the surface of the head, and pressure inside the cranial cavity. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within 30 s and the remaining two recovered within 8 min following respiratory assistance and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80 to 390 kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300–2830 kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385 to 3845 G’s and were well correlated with peak incident overpressure (R2 = 0.90). One SD corridors for the surface pressure, intracranial pressure (ICP), and head acceleration are presented to provide experimental data for computer model validation

An animal-to-human scaling law for blast-induced traumatic brain injury risk assessment

Despite recent efforts to understand blast effects on the human brain, there are still no widely accepted injury criteria for humans. Recent animal studies have resulted in important advances in the understanding of brain injury due to intense dynamic loads. However, the applicability of animal brain injury results to humans remains uncertain. Here, we use advanced computational models to derive a scaling law relating blast wave intensity to the mechanical response of brain tissue across species. Detailed simulations of blast effects on the brain are conducted for different mammals using image-based biofidelic models. The intensity of the stress waves computed for different external blast conditions is compared across species. It is found that mass scaling, which successfully estimates blast tolerance of the thorax, fails to capture the brain mechanical response to blast across mammals. Instead, we show that an appropriate scaling variable must account for the mass of protective tissues relative to the brain, as well as their acoustic impedance. Peak stresses transmitted to the brain tissue by the blast are then shown to be a power function of the scaling parameter for a range of blast conditions relevant to TBI. In particular, it is found that human brain vulnerability to blast is higher than for any other mammalian species, which is in distinct contrast to previously proposed scaling laws based on body or brain mass. An application of the scaling law to recent experiments on rabbits furnishes the first physics-based injury estimate for blast-induced TBI in humans.United States. Army Research Office. Institute for Soldier Nanotechnologies (Contract DAAD-19-02-D-0002

In Silico Investigation of Intracranial Blast Mitigation with Relevance to Military Traumatic Brain Injury

Blast-induced traumatic brain injury is the most prevalent military injury in Iraq and Afghanistan, yet little is known about the mechanical effects of blasts on the human head, and still less is known about how personal protective equipment affects the brain’s response to blasts. In this study we investigated the effect of the Advanced Combat Helmet (ACH) and a conceptual face shield on the propagation of stress waves within the brain tissue following blast events. We used a sophisticated computational framework for simulating coupled fluid–solid dynamic interactions and a three-dimensional biofidelic finite element model of the human head and intracranial contents combined with a detailed model of the ACH and a conceptual face shield. Simulations were conducted in which the unhelmeted head, head with helmet, and head with helmet and face shield were exposed to a frontal blast wave with incident overpressure of 10 atm. Direct transmission of stress waves into the intracranial cavity was observed in the unprotected head and head with helmet simulations. Compared to the unhelmeted head, the head with helmet experienced slight mitigation of intracranial stresses. This suggests that the existing ACH does not significantly contribute to mitigating blast effects, but does not worsen them either. By contrast, the helmet and face shield combination impeded direct transmission of stress waves to the face, resulting in a delay in the transmission of stresses to the intracranial cavity and lower intracranial stresses. This suggests a possible strategy for mitigating blast waves often associated with military concussion.Joint Improvised Explosive Device Defeat Organization (U.S.)United States. Army Research OfficeMassachusetts Institute of Technology. Institute for Soldier Nanotechnologie

Reply to Moss et al.: Military and medically relevant models of blast-induced traumatic brain injury vs. ellipsoidal heads and helmets

Moss et al. (1) acknowledge the second main conclusion of Nyein et al. (2): that a face shield may significantly mitigate blast-induced traumatic brain injury (TBI). However, they obviate the first and most important finding: that the advanced combat helmet (ACH) does not amplify the overpressure experienced by the head, as suggested by Moss et al. in the letter in ref. 3; therefore, it is safe for blast exposure. As has been shown repeatedly in theater, the ACH provides significant protection against shrapnel and ballistic threats

Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study

Introduction: Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARSCoV-2 in neurological syndromes, which risks under- or over-reporting. Methods: We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (kappa <= 0.4), "moderate" or "good" (kappa > 0.6). Results: 1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barre ' syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed