The authors would like to acknowledge the Center for Advanced Vehicular Systems (CAVS) at Mississippi State University for providing testing facilities and Rush Sports Medical of Meridian, Mississippi for their monetary support.

Note: The protocol for the presented test method refers to the following NOCSAE documents (available at http://nocsae.org/): NOCSAE DOC.002-13m13: "STANDARD PERFORMANCE SPECIFICATION FOR NEWLY MANUFACTURED FOOTBALL HELMETS"18. NOCSAE DOC.011-13m14d: " MANUFACTURERS PROCEDURAL GUIDE FOR PRODUCT SAMPLE SELECTION FOR TESTING TO NOCSAE STANDARDS"24. NOCSAE DOC.087-12m14: " STANDARD METHOD OF IMPACT TEST AND PERFORMANCE REQUIREMENT FOR FOOTBALL FACEGUARDS"25. NOCSAE DOC.100-96m14: "TROUBLESHOOTING GUIDE FOR TEST EQUIPMENT AND IMPACT TESTING"26. NOCSAE DOC.101-00m14a: "EQUIPMENT CALIBRATION PROCEDURES"27
1. Test Setup
<ol>
	<li>Construct NOCSAE twin-wire drop carriage assembly as defined in Section 15.1 of NOCSAE DOC. 001,18 as depicted in Figure 5. Verify that all components of the assembly are securely attached.</li>
	<li>Attach the size "large" NOCSAE headform to the drop carriage assembly by aligning the headform collar with the desired position on the headform rotator adjuster and by tightening the headform threaded lock ring. 
	Note: If the headform is new or repaired, refer to Section 5 of NOCSAE DOC. 100.26</li>
	<li>Securely attach the triaxial accelerometer to the accelerometer plate located at the center of gravity of the headform. Place the accelerometer in the center of the accelerometer plate lining up both holes in the accelerometer with the holes in the accelerometer plate. Using an Allen head screwdriver insert both screws and tighten them in a clockwise direction until the accelerometer is securely mounted to the accelerometer plate.</li>
	<li>Configure the data acquisition system according to manufacturer's specifications.28
	<ol>
		<li>Connect the cables for the data acquisition assembly.
		<ol>
			<li>Connect accelerometer cable to the three-way coaxial splitter, then connect a coaxial cable to each output of the coaxial splitter.</li>
			<li>Connect the free end of each coaxial cable from the three-way coaxial splitter to a sensor input port for channels 1, 2, and 3 located on the rear of the amplifier module.</li>
			<li>Connect a coaxial cables from the output ports of the amplifier module (channels 1, 2, and 3) to input connections on the front of the data acquisition system (channels 1, 2, and 3, respectively).</li>
			<li>Connect the split end of the RS-232 cable to the rear connector of the data acquisition system.</li>
			<li>Connect the remaining RS-232 cable to Com Port 1 of the Personal Computer (PC).</li>
		</ol>
		</li>
		<li>Power on the Personal Computer (PC) and login.</li>
		<li>Download and install the data acquisition system software onto the computer.</li>
		<li>Power on the data acquisition assembly: Plug in each components 120 volt outlet into a power source, then flip the amplifier toggle switch to the "on" position.</li>
		<li>Double-click the data acquisition program icon located on the desktop to open the software.</li>
		<li>Observe a prompt asking to check module status, click "yes".</li>
		<li>Load the Test Setup File. Click the "Setup" tab, scroll down to "Open" and then select "Test Setup".
		<ol>
			<li>Browse the computer directory, locate and select the test setup file labeled "NOCSAE1.TSF". Click "Load".</li>
		</ol>
		</li>
		<li>Enter sensor information for the accelerometers.
		<ol>
			<li>Click the yellow Sensor Input icon for channel 3 in the active Module.</li>
			<li>Insert the calibration value (mV/G) for the z-axis accelerometer into the "CAL Value" text box.</li>
			<li>Click the "PREV" button.</li>
			<li>Repeat Steps 1.4.8.1 - 1.4.8.3 for the y-axis accelerometer (channel 2) and for the x-axis accelerometer (channel 1).</li>
			<li>Click the green "Return" icon to exit sensor.</li>
		</ol>
		</li>
		<li>Click the green "Save" icon and then name the Test Setup as "NOCSAE-JoVE".</li>
		<li>Click "save".</li>
	</ol>
	</li>
</ol>
2. Helmet Preparation
<ol>
	<li>Select the helmet model for impact testing. For helmet certification, select samples for testing according to NOCSAE DOC.011.24 Test the sample according to Table 1 and as depicted in Figures 1 and 2.</li>
	<li>Select corresponding faceguards for each selected helmet model. Differing from the NOCSAE standard, conduct base helmet impact tests with the baseline faceguard for such helmet.</li>
	<li>Using a Philips head screwdriver, securely attach the correct faceguard and all faceguard specific hardware to each helmet selected for testing. In contrast to the NOCSAE standard test method, test all helmets with faceguards attached.</li>
	<li>Condition helmets in the temperatures according to Table 1, NOCSAE DOC. 0027, and NOCSAE DOC.08725 by exposing them to a laboratory environment or environmental chamber. Conduct initial helmet drop tests at ambient temperature.
	<ol>
		<li>Move selected helmets to a laboratory environment, 72 °F, ± 5 °F (22 °C, ± 2 °C), at least 4 hr prior to testing.</li>
		<li>If all ambient temperature impacts have been conducted, expose the helmet to the conditioned temperature, according to Table 1, for 4 but no longer than 24 hr.7 
		Note: At least two but no more than four impact locations that result in the highest recorded SI values for ambient temperature drops will be tested at high temperature.</li>
	</ol>
	</li>
</ol>
3. Calibration
<ol>
	<li>Perform Headform Calibration: Each headform must be calibrated prior to testing using the triaxial accelerometer, 3" calibration MEP pad and drop locations/velocities as identified by the annual NOCSAE Calibration Pad Qualification Report for that specific calibration MEP pad.
	<ol>
		<li>Securely attach 3" Calibration MEP pad to the anvil using an Allen wrench.</li>
		<li>Using the annual NOCSAE Calibration Pad Qualification Report, select an impact location and the corresponding impact velocity.</li>
		<li>Using the headform rotator assembly and anvil guide rail, adjust headform and anvil to the desired impact orientation (front, side, or top). Refer to Table 1, Appendix 2 of NOCSAE DOC. 001,18 and NOCSAE DOC. 100.26
		<ol>
			<li>Remove the taper-loc bolt from the headform rotator assembly and orient the headform adjuster to align bolt-holes to the desired position. Insert and securely fasten the taper-loc bolt.</li>
			<li>Loosen the headform threaded lock ring and rotate the headform nose position to the required orientation. Securely tighten the headform threaded lock ring.</li>
			<li>Loosen the two base plate-anvil bolts and slide anvil until desired impact location is achieved. Tighten base plate- anvil bolts and ensure all connections are securely fastened.</li>
		</ol>
		</li>
		<li>Attach release system to drop carriage assembly. Lift the drop carriage assembly to the height of the release system. Center the release system to its attachment point on the drop carriage assembly then flip the toggle switch for the electromagnetic release system to the "On" position.</li>
		<li>Raise drop carriage assembly to the specific height determined to achieve the desired impact velocity. Note: Specific heights may vary for each system due to frictional variations. Additional impacts may need to be conducted varying height to ensure the correct inbound velocity is achieved.</li>
		<li>Ready the data acquisition system for recording an event (according to manufactures specifications28).
		<ol>
			<li>Load the Test Setup File. Click the "Test" tab, and then click "Collect Data".</li>
			<li>Browse the computer directory, locate and select the test setup file labeled "NOCSAE-JoVE.TSF". Click "Load".</li>
			<li>Click "OK".</li>
			<li>Type a test description "Description" dialog box and then press the "Tab" key.</li>
			<li>Provide a 5 character test ID, Type "JoVE1" and click "Continue".</li>
			<li>Click "Continue".</li>
			<li>Observe the instrumentation warming up. Once the counter has reached 15 s, click "Continue" .</li>
			<li>Observe the system automatically performing accelerometer calibration. Once all boxes are colored green, click "continue".</li>
		</ol>
		</li>
		<li>Using the release system, drop the carriage assembly and trigger the data acquisition system to record the event by simultaneously flipping both toggle switches located on the release system power control box.</li>
		<li>Calculate and record the resulting SI value. Ensure the result is 1,200 SI ±2%.</li>
		<li>Repeat steps 3.4.2-3.4.8 until results are obtained for each of the three required impact locations. 
		Note: Calibration pads should be requalified annually at the laboratory specified by NOCSAE.</li>
	</ol>
	</li>
	<li>Perform a system check and maintain results. (see Section 18, NOCSAE DOC.00118)</li>
</ol>
4. Testing Procedure 
<ol>
	<li>Perform a system check and maintain results.</li>
	<li>Exchange the MEP pad used for calibration for the MEP test pad.</li>
	<li>Select impact location and velocity for testing according to Table 1. 
	Note: Impacts must be conducted from lowest drop velocity to the highest. Ambient temperature impacts should be conducted before conditioned impacts.</li>
	<li>Properly adjust the headform orientation and anvil position to achieve the desired impact location, as depicted in Figures 1 and 2 and according to the steps in section 3.</li>
	<li>Select helmet for testing.</li>
	<li>Properly fit the selected helmet to the headform according to the helmet manufacturers fitting instructions and NOCSAE procedures. Adjust and securely attach the helmets chinstrap to the headform. 
	Note: Due to the additional constraints of the faceguard, a light application of talcum powder may aid in fitting of the helmet to the headform.</li>
	<li>Attach mechanical release system to drop carriage assembly.</li>
	<li>Raise drop carriage assembly to the specific height determined to achieve the desired impact velocity.</li>
	<li>Ready the data acquisition system for recording an event. Repeat steps 3.4.1 through 3.4.8.</li>
	<li>Using the mechanical release system drop the carriage assembly and simultaneously trigger the data acquisition system to record the event.</li>
	<li>Immediately after impact, record SI, HIC, and peak acceleration results.</li>
	<li>Compare the recorded results to pass/fail criteria. Differing from the NOCSAE Standard, set a pass/fail value of 700 SI for all 5.46, 4.88, and 4.23 m/sec impacts. Maintain the pass/fail criterion of 300 SI for all 3.46 m/sec impacts.</li>
	<li>Repeat steps 4.3-4.11 until results are obtained for all required impacts. 
	Note: It is acceptable to test all helmets for a given impact location before changing headform orientation and anvil position.</li>
	<li>Perform a system check upon completion of testing and maintain results.</li>
	<li>Data validation: Compare pre-test and post-test system checks and ensure that any variation is 7% or less.</li>
</ol>
<img alt="Helmet impact test data chart at varied temperatures; conditions: ambient, high, low, with notes." src="/files/ftp_upload/53929/53929table1.jpg" data-altupdatedat="1747911167000" data-alt="Figure 1"> 
Table 1: Football helmet drop test matrix showing required impacts by drop velocity (m/sec) and impact location. (Table modified from NOCSAE DOC. 002-13m13) <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53929/53929table1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

<ol>
	<li>Langlois, J. A., Rutland-Brown, W., Wald, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+and+impact+of+traumatic+brain+injury:+a+brief+overview.">The epidemiology and impact of traumatic brain injury: a brief overview.</a> J Head Trauma Rehabil. (5), 375-378 (2006).</li><li>Broglio, S. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Head+impacts+during+high+school+football:+a+biomechanical+assessment.">Head impacts during high school football: a biomechanical assessment.</a> J Athl Train. 44, 342-349 (2009).</li><li>Broglio, S. P., Martini, D., Kasper, L., Eckner, J. T., Kutcher, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimation+of+head+impact+exposure+in+high+school+football:+Implications+for+regulating+contact+practices.">Estimation of head impact exposure in high school football: Implications for regulating contact practices.</a> Am. J. Sports Med. 41, 2877-2884 (2013).</li><li>Costanza, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Review:+Contact+sport-related+chronic+traumatic+encephalopathy+in+the+elderly:+clinical+expression+and+structural+substrates.">Review: Contact sport-related chronic traumatic encephalopathy in the elderly: clinical expression and structural substrates.</a> Neuropathol Appl Neurobiol. 37, 570-584 (2011).</li><li>McKee, A. C., Cantu, R. C., Nowinski , C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., Santini, V. E., Lee, H. S., Kubilus , C. A., Stern, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+traumatic+encephalopathy+in+athletes:+progressive+tauopathy+after+repetitive+head+injury.">Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury.</a> J. Neuropathol Exp Neurol. , 709-735 (2003).</li><li>Bartsch, A., Benzel, E., Miele, V., Prakash, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+test+comparisons+of+20th+and+21st+century+American+football+helmets:+Laboratory+investigation.">Impact test comparisons of 20th and 21st century American football helmets: Laboratory investigation.</a> J Neurosurg. 116, 222-233 (2012).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Standard Performance Specification for Newly Manufactured Football Helmets. , (2013).</li><li>Greenwald, R. M., Gwin, J. T., Chu, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Head+Impact+Severity+Measures+for+Evaluating+Mild+Traumatic+Brain+Injury+Risk+Exposure.">Head Impact Severity Measures for Evaluating Mild Traumatic Brain Injury Risk Exposure.</a> Neurosurg. 62, 789-798 (2008).</li><li>Newman, J. A., Yoganandan, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Accidental Injury: Biomechanics and Prevention. , (2015).</li><li>Newman, J. A., Shewchenko, N., Welbourne, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+proposed+new+biomechanical+head+injury+assessment+function+-+the+maximum+power+index.">A proposed new biomechanical head injury assessment function - the maximum power index.</a> Stapp Car Crash J. 44, 215-247 (2000).</li><li>Gadd, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+weighted-impulse+criterion+for+estimating+injury+hazard.">Use of a weighted-impulse criterion for estimating injury hazard.</a> SAE Technical Papers. , (1966).</li><li>Lissner, H. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+Studies+on+the+Relation+Between+Acceleration+and+Intracranial+Pressure+Changes+in+Man.">Experimental Studies on the Relation Between Acceleration and Intracranial Pressure Changes in Man.</a> Surgery, Gynecology and Obsterics. III, 329-338 (1960).</li><li>Gurdjian, E. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concussion+-+Mechanism+and+Pathology.">Concussion - Mechanism and Pathology.</a> , (1963).</li><li>Patrick, L. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Survival+by+Design+-+Head+Protection.">Survival by Design - Head Protection.</a> , (1963).</li><li>Versace, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+the+Severity+Index.">A review of the Severity Index.</a> SAE Technical Papers. , (1971).</li><li>Newman, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+biomechanical+assessment+of+mild+traumatic+brain+injury.+Part+2.+Results+and+conclusions.">A new biomechanical assessment of mild traumatic brain injury. Part 2. Results and conclusions.</a> Proceedings of International Research Conference on the Biomechanics of Impacts. , 223-233 (2000).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Standard Performance Specification for Newly Manufactured Football Helmets. , (2011).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Standard Test Method and Equipment used in Evaluating the Performance Characteristics of Protective Headgear/Equipment. , (2015).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Standard Method of Impact Test and Performance Requirements for Football Faceguards. , (2011).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Standards and Process. , (2013).</li><li>Gwin, J. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+investigation+of+the+NOCSAE+linear+impactor+test+method+based+on+in+vivo+measures+of+head+impact+acceleration+in+American+football.">An investigation of the NOCSAE linear impactor test method based on in vivo measures of head impact acceleration in American football.</a> J Biomech Eng. 132, (2010).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Standard Performance Specification for Newly Manufactured Lacrosse Helmets with Faceguards. , (2013).</li><li>Hodgson, V. R., Thomas, L. M., Prasad, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Testing+the+validity+and+limitations+of+the+severity+index.">Testing the validity and limitations of the severity index.</a> SAE Technical Papers. , (1970).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Manufactureers Procedural Guide for Product Sample Selection for Testing to NOCSAE Standards. , (2014).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Standard Method of Impact Test and Performance Requirements for Football Faceguards. , (2014).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Troubleshooting Guide for Test Equipment and Impact Testing. , (2014).</li><li>NOCSAE. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Equipment Calibration Procedures. , (2014).</li></ol>

The authors have nothing to disclose.

The reported methodology that couples NOCSAE football helmet and faceguard drop impact tests offers a unique technique to assess better performance characteristics of modern football helmets. The most critical steps for evaluating this better performance characteristic of modern football helmets are the following: 1) correctly setting up the mechanical test device; 2) accurately conducting calibration procedures; and 3) properly attaching the helmet/faceguard to the headform.
This methodology requires proper test setup and calibration procedures. There is inherent variability between each NOCSAE headform due to limitations in the manufacturing process, which include porosity in the polymeric materials. NOCSAE combats this unique variability by a normalization process via headform calibration procedures using and annually recertified calibration MEP pad. Thus, it is ever more important that additional variation is not introduced by ensuring that the mechanical test assembly is properly and securely maintained. Before testing, it is important the threaded headform collar and headform rotator and drop carriage bolts are checked and securely tightened. Helmet-headform positioning and chinstrap fit should be checked prior to every drop test. During impact, the helmet may shift, which is acceptable but may need to be adjusted.
In addition to testing the setup and calibration procedures, impact testing requires proper helmet preparation. Faceguard selection and correct attachment of helmet/faceguard to the headform is a critical part of the test procedure. For general helmet testing, a baseline faceguard model should be selected and securely attached with all faceguard specific hardware. Typically a baseline faceguard is defined as one that offers the minimal amount of facial protection, not including kicker-style faceguards. Due to the variability in modern helmet design and the added constraints of the faceguard component, additional procedures may be required for proper helmet-headform attachment. Generally, faceguards should be securely attached to the helmet prior to insertion onto the headform. Some helmets may require partial attachment of the faceguard to the helmet that is then secured upon helmet-headform insertion. A light application of talcum powder to the headform may aid in helmet attachment. For other troubleshooting refer to the NOCSAE troubleshooting guide for test equipment and impact testing (ND.087-12m14).
The test procedure required modification of NOCSAE standard impact locations, in order to account for the addition of the faceguard during testing. The impact locations for the present drop tower tests include replacement of the NOCSAE standard Front and Front Boss with the Front Top and Front Top Boss impact locations and inclusion of Faceguard Front and Faceguard Bottom locations. Figure 3 shows the SI levels at different impact locations including the two new proposed ones. For example, the Riddell data, shown in Figure 3, illustrates the point that the two new locations incur the greatest SI levels, which otherwise would not have been known since these two new tests have not been required for the NOCSAE certification. Initial testing determined that the Front Top and Front Boss were better suited impact sites since they would impact the helmet shell rather than the faceguard. These sites would be more realistic by allowing direct shell-liner impacts while still including the constraints of the faceguard component. Direct faceguard impacts were achieved by including the Faceguard Front and Faceguard Bottom impacts, which were identical to the prescribed impact locations for NOCSAE football faceguard certification tests. The inclusion of these two impacts allowed for a unified football helmet and faceguard drop test procedure. These faceguard impacts required exchanging of the test MEP with the faceguard MEP and additional environmental conditioning procedures, as portrayed in Table 1.
Representative drop test results show that football helmets should have faceguards attached during testing. Comparative drop test results revealed that the faceguard adds a stiffening kinematic constraint to the shell that lessens total energy absorption. Figure 3 and Table 2 show differences in the SI levels across impact locations for helmets in the NOCSAE standard (without faceguard) and the modified with faceguard configurations. As compared to the current NOCSAE test method, football helmets tested with the faceguard attached shows unique responses that are dependent on helmet type, which may vary by impact location. The differences in these responses can be accredited to the shell- faceguard couplings, which are dependent on unique design features of the helmet being tested. The Rawlings Quantum Plus, Riddell 360, Schutt Ion 4D and Xenith X2 helmets were used for representative results, as these helmets characterize some of the newest innovations in helmet technology. Each of these helmets vary significantly by their unique design features including faceguards, faceguard attachment systems, chinstrap attachment systems and liner systems. As displayed in Table 2, these representative results show significant variations (p &#60; 0.05) in HIC, SI, and peak acceleration values that are dependent on helmet type, impact location and the faceguard configuration. Additionally, differences in acceleration-time history profile were also observed. An example of such a response can be seen in Figure 4, where the triaxial acceleration response (for X, Y and Z axes) of the Xenith X2 helmet at a 4.88 m/sec Top impact displayed a 40 G dip in the X axis acceleration when the faceguard was not attached. Due to the additional constraint that the faceguard brings to the helmet shell, the acceleration dip was nonexistent for the same impact when the faceguard was attached to the shell. More specifically, when the faceguard was not included, the polycarbonate shell near the impact point could flex more and thus absorb more energy. When the faceguard was included, the polycarbonate shell would not flex as much. The inclusion of the faceguard during impact testing is intended to more accurately mimic on-field loading conditions.
Our proposed test method uses a more stringent certification limit as compared to the current NOCSAE standard. In our proposed test method for all 5.46, 4.88, and 4.23 m/s impacts, we recommend that the NOCSAE committee create a new safe lower SI level based on Hodgson et al. (1970) work.
If any resulting SI value for any one impact is greater than these respective thresholds, then the test is determined to be a failure. Representative results (Figure 3) show that SI values for 5.46 m/s of all helmets tested in this study fall well below the current 1,200 SI NOCSAE pass/fail criterion for such impacts. Additional injury metrics of HIC and peak resultant acceleration are included in Table 2, yet no certification limits were given on these metrics. Future helmet certification limits should investigate employment of multiple injury metric pass/fail criteria.
The final factor for an improved helmet test standard would be to publish standard test results in a manner that would allow a player to make an informed decision on helmet selection. For many players, appearance is often the most important factor when selecting a football helmet/faceguard combination. Heavier grill-type faceguard are also becoming more dominant on the football field today presumably for this reason. These heavier faceguards shift the center of gravity of the athletes head and add an extra moment arm inducing a more deleterious torque during oblique helmet to helmet impacts. Thus, it is ever more important to understand the systematic response of helmets and for the player to know how these heavier faceguards affect helmet performance. Future helmet certification should require manufacturers to display size and faceguard-specific helmet test results.
These reported test procedures serve as an effective solution that allows the ability to assess better performance characteristics of current and future football helmet systems. The test method defined herein is intended to be a modification to the current NOCSAE twin-wire drop test procedure, which inherently limits performance testing of headgear to linear acceleration-based injury criteria. While currently in-use and readily available, this twin-wire test device cannot measure angular acceleration. As compared to the existing methods, this reported football helmet test method gives a more accurate representation of a helmet&#39;s performance and its ability to mitigate on-field impact.

Motivation 
The main goal of this modified drop tower test method is to more closely represent on-field impacts of the American football helmet system and promote enhanced safety standards. The entailed test method can provide knowledge of helmets systematic response needed to effectively develop enhanced headgear for concussion prevention. The occurrence of concussions has persistently plagued contact sports, such as American Football. In the United States alone, sports-related concussions have been estimated to occur 1.6 to 3.8 million times every year.1 A football player can have more than 1,500 head impacts each season.2,3 While the magnitude of most impacts may be sub-concussive, the accumulation of these impacts may lead to long-term brain damage due to an impact induced neurodegenerative ailment known as chronic traumatic encephalopathy (CTE).4 CTE is linked to a buildup of tau protein in the brain, leading to memory loss, behavior and personality change, Parkinson's syndrome, and speech and gait abnormalities that has sometimes led to suicide.5 Football helmets have made some technological advancements in the past 15 years, but even today's most advanced helmets do not completely mitigate all of the incident forces on the helmet and hence, athletes still incur concussions. A study conducted by Bartsch et al.6 showed that in many cases the head impact doses and head injury risks while wearing vintage leatherhead helmets were comparable to those wearing the widely used 21st century helmets, illustrating the need for improvement in the design and testing standards of football helmets. In particular, the NOCSAE certification7 does not require the faceguard to be included in the drop tests for the helmet. The added stiffness from the faceguard connected to the helmet would dramatically change the overall mechanical response. The present study entails a method to provide more robust helmet safety standards that would serve as a driving force to promote safer helmet designs.
Background 
Head Injury Metrics 
The exact biological mechanisms related to concussions remain unidentified. While much work has been done in attempting to quantify head injury tolerances by various injury metrics, disagreement has arisen in the biomedical community regarding these criteria. These injury mechanisms are supposed to relate to several entities: linear acceleration, rotational acceleration, impact duration, and impulse.8,9,10,11 Several Injury criteria have been used to define a concussion as a measure of linear acceleration. The Wayne State Tolerance Curve (WSTC)12,13,14 was developed to predict skull fracture for automotive crashes during a frontal impact by defining a threshold curve boundary for linear acceleration versus impact duration. WSTC has served as the bases for other injury criteria such as the Severity Index (SI)11 and the Head Injury Criterion (HIC),15 which are the two most commonly used criteria. The SI and HIC both measure impact severity based on weighted integrals of the linear acceleration-time profiles. While these criteria define thresholds for linear acceleration, other criteria have been proposed to account for rotational acceleration, such as the Head Impact Power index.8,10,16 Today's helmet testing standards often use an injury criterion based upon the Wayne State Tolerance Curve (namely HIC or SI) or the peak acceleration criterion or in some cases both. While some modifications are needed to add angular acceleration to the standard performance criteria, the linear acceleration-based criteria remain dominant.
In this study, the metrics used to assess the relative safety that each helmet provided were the peak resultant accelerations, SI, and HIC values. Of these metrics only the SI is used for evaluation in the current National Operating Committee on Standards for Athletic Equipment (NOCSAE) football helmet standards. The SI is based on the following equation,
<img alt="Static equilibrium formula ΣF=0; integral expression for SI=T∫₀A²^·⁵dt; mathematical concept." src="/files/ftp_upload/53929/53929eq1.jpg" width="100" data-altupdatedat="1747911167000" data-alt="Equation 1">     (1)
where A is the translational acceleration of the Center of Gravity (CG) of the head, and t is the acceleration duration.11,17SI was calculated according to NOCSAE standards18, where the calculation is limited by a 4 G threshold along the resultant acceleration curve. The HIC values were calculated by the following equation,
<img alt="Head Injury Criterion (HIC) formula; static equilibrium analysis; mathematical equation." src="/files/ftp_upload/53929/53929eq2.jpg" width="325" data-altupdatedat="1747911167000" data-alt="Equation 1">     (2)
where a is the translational acceleration of the CG of the head, and t1 and t2 are the initial and final times, respectively, of the interval at which HIC attains a maximum value. All HIC values calculated in this study were HIC36, where the duration of the time interval is limited to 36 ms.
NOCSAE Football Helmet Test Standards 
NOCSAE Overview 
In 1969 NOCSAE was formed to develop performance standards for American football helmets/faceguards and other sporting equipment with a goal of reducing sports-related injuries.17 The NOCSAE football helmet standards were developed by Dr. Voigt Hodgson9 of Wayne State University to reduce head injuries by establishing requirements for impact attenuation and structural integrity for football helmets/faceguards. These football helmet standards include a certification test and annual recertification procedures for helmets. In 2015, NOCSAE implemented a quality assurance program requiring the use of a specific American National Standards Institute (ANSI) accredited body for helmet certification.
NOCSAE Test Method 
The NOCSAE Football Helmet Standard does not include the testing of helmets with faceguards as it calls for their removal before helmet drops are conducted. The NOCSAE helmet testing standards17 utilize a twin-wire drop impactor that relies on gravity to accelerate the headform and helmet combination to the required impact speeds. The NOCSAE headform is instrumented with triaxial accelerometers at the center of gravity. The headform and helmet combination is then dropped at specific speeds onto a steel anvil covered with a 12.7 mm thick hard rubber Modular Elastomer Programmer (MEP) pad. Upon impact, the instantaneous acceleration is recorded and SI values are calculated. These SI values are compared against a pass/fail criterion over a variety of required impact locations and velocities and two temperatures, including ambient and high temperature impacts. If the resulting SI value for any impact breaches the threshold, then the helmet will not pass the test.
A separate standard test method is used for football faceguard certification. The NOCSAE football faceguard standard includes structural integrity analysis as well as assessing the impact attenuation performance of the faceguard, chinstrap, and their attachment systems. Each impact measurement must be below 1,200 SI to pass the test, with no facial contact and no mechanical failure of any component, as defined by the NOCSAE Standard.19
There is a proposed additional NOCSAE test (Linear Impactor (LI))20 that includes the helmet with the faceguard, but it is not appropriate for football helmet certification because it cannot admit a crown impact. The LI uses a pneumatic ram to impact a helmet positioned on a NOCSAE headform equipped with a hybrid III dummy neck mounted on a linear bearing table in order to induce angular acceleration. For this reason the LI test is an additional test to the current twin-wire NOCSAE drop test procedure and not a replacement.20,21 Instead of the LI tests, we propose to simply add two more scenarios to the current twin-wire drop test procedure.
The NOCSAE standard test method for certification of football helmets currently includes six prescribed impact locations and one random impact location. The prescribed impact locations include the following: Front (F), Front Boss (FB), Side (S), Rear (R), Rear Boss (RB), and Top (T). The random impact location test may select a region from any point within the defined acceptable impact area of the helmet. The impact locations for our modified NOCSAE drop tower tests include replacing the previously defined Front and Front Boss impact locations with what was named as the Front Top (FT) and Front Top Boss (FTB) impact locations. Our Front Top and Front Top Boss impact locations are identical to the Front and Right Front Boss impact locations of the NOCSAE standard for Lacrosse Helmets, which also include the faceguard for drop tests.22 The helmet shell impact locations, including the replaced Front and Front Boss locations, are depicted in Figure 1. Additionally, the modified helmet test method of our present study includes two faceguard impact locations that were named the FG Front and FG Bottom. The two faceguard impacts locations are identical to the required impact locations for the current NOCSAE faceguard certification procedures. The eight impact locations for the modified NOCSAE impact tests of the present study are shown in Figure 2.
<img alt="Head movement analysis diagram; shows planes, angles, and vectors for rotational dynamics study." src="/files/ftp_upload/53929/53929fig1.jpg" data-altupdatedat="1747911167000" data-alt="Figure 1"> 
Figure 1: Approximate impact locations for football helmets. The six currently required NOCSAE drop test helmet impact locations, Front (F), Front Boss (FB), Side (S), Top (T), Rear (R), and Rear Boss (RB), and the two proposed impact locations, Front Top (FT), and Front Top Boss (FTB). Note: the NOCSAE standard test method for protective headgear does not include Front Top and Front Top Boss impact locations (indicated in red text) and for this study they replace the Front and Front Boss impact locations. (Image modified from NOCSAE DOC. 001-13m15b) <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53929/53929fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Helmet impact testing diagram illustrating various impact positions and setups for safety assessment." src="/files/ftp_upload/53929/53929fig2.jpg" data-altupdatedat="1747911167000" data-alt="Figure 2"> 
Figure 2: Modified NOCSAE drop test setup showing eight impact locations. Front Top, Front Top Boss, Side, Faceguard (FG) Front, Rear, Rear Boss, Top, and Faceguard Bottom (FB). Note: the NOCSAE standard does not include faceguard attachment and here Front Top and Front Top Boss replace the standard Front and Front Boss impact locations. (Image modified from NOCSAE DOC. 002-11m12) <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53929/53929fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Helmet designs have progressively changed in the past decade, whereas the NOCSAE football helmet standards have never included the faceguard with the helmet in evaluating the football helmet performance specifications. While, recently an amendment has been made to include a pass/fail value of 300 SI for the lowest velocity impacts (3.46 m/s), the general pass/fail limit of 1,200 SI has not changed since 1997.17 Prior to 1997, the NOCSAE used a 1,500 SI pass/fail criterion. Hodgson et al. (1970) has shown that SI values of greater than 1,000 is a danger to life, while SI values of 540 have produced linear skull fractures in non-helmeted cadaveric impact tests.23 Most modern football helmets have shown to pass well below the 1,200 SI limit but not all below 540 SI.

<table><tbody><tr><td>PCB Triaxial Accelerometers</td><td>PCB</td><td>Model 353B17</td><td></td></tr><tr><td>TDAS2 Data Acqusition System</td><td>Diversified Technical Systems, Inc.&amp;nbsp;</td><td>TDAS2</td><td>Or an equivalent Data Acquisition System</td></tr><tr><td>Current Source (Amplifier)&amp;nbsp;</td><td>Dytran Instruments, Inc.</td><td>4114B1</td><td>Or equivalent</td></tr><tr><td>Velocity gate and flag</td><td>CADEX</td><td>SB203</td><td>Or an equivalent velocimeter</td></tr><tr><td>Selected Football Helmet(s)/faceguard assem.</td><td></td><td>including chinstrap and faceguard hardware</td><td></td></tr><tr><td>Height Gauge</td><td></td><td></td><td></td></tr><tr><td>Torque wrench</td><td>Snap-on</td><td>QD21000</td><td>range to 200 in/lb minimum, 5% accuracy</td></tr><tr><td>&lt;strong&gt;Twin-wire Guide Assembly&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Drop Carriage&amp;nbsp;</td><td>SIRC</td><td>1001</td><td></td></tr><tr><td>1/2&quot; MEP Testing Pad</td><td>SIRC</td><td>1006</td><td></td></tr><tr><td>1/8&quot; Faceguard Testing Pad</td><td>SIRC</td><td>1007</td><td></td></tr><tr><td>3&quot; MEP Calibration Pad</td><td>SIRC</td><td>1005</td><td>Including Annual NOCSAE Calibration Pad Qualification Report</td></tr><tr><td>3/8&quot; Hook-eye Turnbuckle</td><td>SIRC</td><td>1043</td><td>Forged Steel with a 6&quot; take-up</td></tr><tr><td>1/8&quot; Wire Rope Thimble&amp;nbsp;</td><td>SIRC</td><td>1044</td><td></td></tr><tr><td>1/8&quot; Spring Music Wire&amp;nbsp;</td><td>SIRC</td><td>1045</td><td></td></tr><tr><td>1/8&quot; Wire Rope, Tiller Rope Clamp, Bronze&amp;nbsp;</td><td>SIRC</td><td>1046</td><td></td></tr><tr><td>3/8&quot; 16 x 3&amp;ldquo; Eye Bolt&amp;nbsp;</td><td>SIRC</td><td>1041</td><td></td></tr><tr><td>3/8&quot; Forged Eye Bolt</td><td>SIRC</td><td>1040</td><td></td></tr><tr><td>Right Angle DC Hoist Motor&amp;nbsp;</td><td>SIRC</td><td>2000</td><td></td></tr><tr><td>Single Groove Sheave (Pulley), 3 &amp;frac34;&quot;&amp;nbsp;</td><td>SIRC</td><td>2002</td><td></td></tr><tr><td>Top Mount Plate</td><td>SIRC</td><td>2003</td><td></td></tr><tr><td>18&quot; Top Channel Bracket&amp;nbsp;</td><td>SIRC</td><td>2004</td><td></td></tr><tr><td>Wall Mount Channel Bracket, 4&#039; x 1 5/8&quot;&amp;nbsp;</td><td>SIRC</td><td>2005</td><td></td></tr><tr><td>Mechanical Release System&amp;nbsp;</td><td>SIRC</td><td>2006</td><td></td></tr><tr><td>Lift Cable, Wire Rope, 20&#039; Coil&amp;nbsp;</td><td>SIRC</td><td>2007</td><td></td></tr><tr><td>Anvil Base Plate&amp;nbsp;</td><td>SIRC</td><td>2010</td><td></td></tr><tr><td>Anvil&amp;nbsp;</td><td>SIRC</td><td>2011</td><td></td></tr><tr><td>Headform Adjuster&amp;nbsp;</td><td>SIRC</td><td>2012</td><td></td></tr><tr><td>Headform Rotator Stem</td><td>SIRC</td><td>2013</td><td></td></tr><tr><td>Headform Threaded Lock ring</td><td>SIRC</td><td>2016</td><td></td></tr><tr><td>&amp;nbsp;Headform Collar&amp;nbsp;</td><td>SIRC</td><td>2014</td><td></td></tr><tr><td>Nylon Bushing&amp;nbsp;</td><td>SIRC</td><td>1803</td><td></td></tr><tr><td>Small Headform&amp;nbsp;</td><td>SIRC</td><td>1100</td><td></td></tr><tr><td>Medium Headform&amp;nbsp;</td><td>SIRC</td><td>1101</td><td></td></tr><tr><td>Large Headform</td><td>SIRC</td><td>1102</td><td></td></tr><tr><td>Taper-Loc Bolt</td><td></td><td></td><td></td></tr><tr><td>DC Motor Speed Controller (Reversible)&amp;nbsp;</td><td>SIRC</td><td>2001</td><td></td></tr></tbody></table>

modified drop tower impact tests for american football helmets

A modified National Operating Committee on Standards for Athletic Equipment (NOCSAE) test method for American football helmet drop impact test standards is presented that would provide better assessment of a helmet's on-field impact performance by including a faceguard on the helmet. In this study, a merger of faceguard and helmet test standards is proposed. The need for a more robust systematic approach to football helmet testing procedures is emphasized by comparing representative results of the Head Injury Criterion (HIC), Severity Index (SI), and peak acceleration values for different helmets at different helmet locations under modified NOCSAE standard drop tower tests. Essentially, these comparative drop test results revealed that the faceguard adds a stiffening kinematic constraint to the shell that lessens total energy absorption. The current NOCSAE standard test methods can be improved to represent on-field helmet hits by attaching the faceguards to helmets and by including two new helmet impact locations (Front Top and Front Top Boss). The reported football helmet test method gives a more accurate representation of a helmet's performance and its ability to mitigate on-field impacts while promoting safer football helmets.

A detailed quantitative analysis of the results for this methodology was presented by Rush et al.(submitted) A synopsis of the results and the associated effectiveness of a coupled faceguard-shell helmet testing methodology is displayed in drop test results using Rawlings Quantum Plus, Riddell 360, Schutt Ion 4D, and Xenith X2 helmets as examples. Each of these helmets (of size "large") with faceguards displayed different results when compared to helmets without the faceguards. Figure 3 comparatively plots the SI values of each example helmet with and without the faceguard for the Front Top, Front Top Boss, Top, Side, Rear, and Rear Boss impact locations at an impact velocity of 5.46 m/s. While the mean SI value for each of these three consecutive impacts (90 ± 15 s) was well below the NOCSAE 1,200 SI threshold, each helmet displayed a unique location-dependent response when the faceguard was attached. Table 2 further illustrates the significance of these same impact tests by displaying Mean Differences (MD) with Root Squared Errors (RSE) for the Head Injury Criterion (HIC), Severity Index (SI), and peak resultant acceleration (G's) values for with and without faceguard configurations. Here, a least squares regression by Analysis of Variance was used for P-value calculations showing significant differences (p &lt;0.05) for helmets with and without faceguards attached during testing. In addition to changes in HIC, SI, and Peak G, differences in impulsive responses were observed when the faceguards were added to these helmet examples. Figure 4 displays drop test results of the Xenith X2 helmet with faceguard and without faceguard at 4.88 m/s, showing a difference in acceleration-time history profile for each measured axis (X, Y and Z). It was also observed that the results were strongly dependent on helmet type, impact location, and impact velocity.
<img alt="Helmet impact test results; line graphs comparing SI by impact location for different helmet models." src="/files/ftp_upload/53929/53929fig3.jpg" data-altupdatedat="1747911167000" data-alt="Figure 3"> 
Figure 3: Drop test. Representative drop test results of Rawlings Quantum Plus, Riddell 360, Schutt Ion 4D, and Xenith X2 helmets at 5.46 meters per second; showing Severity Index (SI) per impact location for without faceguard (NOCSAE Standard) and with faceguard (w/FG) helmet configurations with Standard Error. Note: FG Front and FG Bottom direct faceguard impacts are not shown. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53929/53929fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Acceleration vs. time graph comparing Xenith X2 impacts, with and without faceguard, in G's." src="/files/ftp_upload/53929/53929fig4.jpg" data-altupdatedat="1747911167000" data-alt="Figure 4"> 
Figure 4: NOCSAE drop test. Results of the Xenith X2 helmet (Top) with faceguard and without faceguard at 4.88 m/s, showing a difference in acceleration-time history profile for each measured axis (X, Y and Z). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53929/53929fig4large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Helmet impact force comparison table showing metrics like HIC, SI, G's, MD, RSE, and P-values." src="/files/ftp_upload/53929/53929table2.jpg" data-altupdatedat="1747911167000" data-alt="Figure 5"> 
Table 2: Representative drop test. Results of Rawlings Quantum Plus, Riddell 360, Schutt Ion 4D, and Xenith X2 helmets at 5.46 m/s. Showing Mean Difference (MD) in Head Injury Criterion (HIC), Severity Index (SI), and peak resultant acceleration (G's) values for with and without faceguard configurations across Front Top (FT), Front Top Boss (FTB), Top (T), Side (S), Rear (R), and Rear Boss (RB) impact locations. Note: Displayed values represent Mean Differences and Root Squared Errors (RSE) in respect to the without faceguard configuration for three consecutive impacts with intervals 90 ± 15 s. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53929/53929table2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Free-fall experiment setup diagram; helmet impact test apparatus schematic for safety analysis." src="/files/ftp_upload/53929/53929fig5.jpg" data-altupdatedat="1747911167000" data-alt="Figure 5"> 
Figure 5: Schematic of twin-wire drop test rig. The schematic shows each component of the mechanical assembly with instillation constraints. Each component is denoted with a number corresponding with a part description as identified in the list of Materials. Refer to the list of Materials. (Image from NOCSAE DOC. 001-13m15b) <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53929/53929fig5large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Watch this Scientific Journal Video about Modified Drop Tower Impact Tests for American Football Helmets at JoVE.com

Modified Drop Tower Impact Tests for American Football Helmets

This article provides a novel technique to assess the performance characteristics of American football helmets by inclusion of faceguards during NOCSAE Standard drop tests. Additionally, two more impact locations are proposed to be added to the NOCSAE certification.

A modified National Operating Committee on Standards for Athletic Equipment (NOCSAE) test method for American football helmet drop impact test standards ...

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10.8K Views.  Mississippi State University. This article provides a novel technique to assess the performance characteristics of American football helmets by inclusion of faceguards during NOCSAE Standard drop tests. Additionally, two more impact locations are proposed to be added to the NOCSAE certification. 

Video: Modified Drop Tower Impact Tests for American Football Helmets

An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth involved in organized sports such as competitive hockey are nearly six times more likely to suffer a severe concussion compared to children involved in other leisure physical activities2. While the most common cognitive sequelae of mTBI appear similar for children and adults, the recovery profile and breadth of consequences in children remains largely unknown2, as does the influence of pre-injury characteristics (e.g. gender) and injury details (e.g. magnitude and direction of impact) on long-term outcomes. Competitive sports, such as hockey, allow the rare opportunity to utilize a pre-post design to obtain pre-injury data before concussion occurs on youth characteristics and functioning and to relate this to outcome following injury. Our primary goals are to refine pediatric concussion diagnosis and management based on research evidence that is specific to children and youth. To do this we use new, multi-modal and integrative approaches that will:
 1.Evaluate the immediate effects of head trauma in youth 
2.Monitor the resolution of post-concussion symptoms (PCS) and cognitive performance during recovery 
3.Utilize new methods to verify brain injury and recovery
To achieve our goals, we have implemented the Head Impact Telemetry (HIT) System. (Simbex; Lebanon, NH, USA). This system equips commercially available Easton S9 hockey helmets (Easton-Bell Sports; Van Nuys, CA, USA) with single-axis accelerometers designed to measure real-time head accelerations during contact sport participation 3 - 5. By using telemetric technology, the magnitude of acceleration and location of all head impacts during sport participation can be objectively detected and recorded. We also use functional magnetic resonance imaging (fMRI) to localize and assess changes in neural activity specifically in the medial temporal and frontal lobes during the performance of cognitive tasks, since those are the cerebral regions most sensitive to concussive head injury 6. Finally, we are acquiring structural imaging data sensitive to damage in brain white matter.

This article provides an overview of a multi-modal approach to mild traumatic brain injury diagnosis and recovery in youth. This approach combines neuropsychological testing with functional magnetic resonance imaging and the Head Impact Telemetry System to monitor the relationship between head impacts and brain activity during cognitive testing.

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth ...

Medicine

Laboratory Drop Towers for the Experimental Simulation of Dust-aggregate Collisions in the Early Solar System

For the purpose of investigating the evolution of dust aggregates in the early Solar System, we developed two vacuum drop towers in which fragile dust aggregates with sizes up to ~10 cm and porosities up to 70% can be collided. One of the drop towers is primarily used for very low impact speeds down to below 0.01 m/sec and makes use of a double release mechanism. Collisions are recorded in stereo-view by two high-speed cameras, which fall along the glass vacuum tube in the center-of-mass frame of the two dust aggregates. The other free-fall tower makes use of an electromagnetic accelerator that is capable of gently accelerating dust aggregates to up to 5 m/sec. In combination with the release of another dust aggregate to free fall, collision speeds up to ~10 m/sec can be achieved. Here, two fixed high-speed cameras record the collision events. In both drop towers, the dust aggregates are in free fall during the collision so that they are weightless and match the conditions in the early Solar System.

We present a technique to achieve low-velocity to intermediate-velocity collisions between fragile dust aggregates in the laboratory. For this purpose, two vacuum drop-tower setups have been developed that allow collision velocities between &#60;0.01 and ~10 m/sec. The collision events are recorded by high-speed imaging.

For the purpose of investigating the evolution of dust aggregates in the early Solar System, we developed two vacuum drop towers in which fragile dust ...

Engineering

Vision Training Methods for Sports Concussion Mitigation and Management

There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool and potentially as a supportive component to concussion prevention strategies. This paper is focused on providing detailed methods for select vision training tools and reporting normative data for comparison when vision training is a part of a sports management program. The overall program includes standard vision training methods including tachistoscope, Brock&#8217;s string, and strobe glasses, as well as specialized light board training algorithms. Stereopsis is measured as a means to monitor vision training affects. In addition, quantitative results for vision training methods as well as baseline and post-testing *A and Reaction Test measures with progressive scores are reported. Collegiate athletes consistently improve after six weeks of training in their stereopsis, *A and Reaction Test scores. When vision training is initiated as a team wide exercise, the incidence of concussion decreases in players who participate in training compared to players who do not receive the vision training. Vision training produces functional and performance changes that, when monitored, can be used to assess the success of the vision training and can be initiated as part of a sports medical intervention for concussion prevention.

This paper describes a protocol to conduct, quantitatively monitor, and assess the success of vision training initiated as part of a sports medical management program including intervention for concussion prevention and performance enhancement.

There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool ...

Behavior

A Contusive Model of Unilateral Cervical Spinal Cord Injury Using the Infinite Horizon Impactor

While the majority of human spinal cord injuries occur in the cervical spinal cord, the vast majority of laboratory research employs animal models of spinal cord injury (SCI) in which the thoracic spinal cord is injured. Additionally, because most human cord injuries occur as the result of blunt, non-penetrating trauma (e.g. motor vehicle accident, sporting injury) where the spinal cord is violently struck by displaced bone or soft tissues, the majority of SCI researchers are of the opinion that the most clinically relevant injury models are those in which the spinal cord is rapidly contused.1 Therefore, an important step in the preclinical evaluation of novel treatments on their way to human translation is an assessment of their efficacy in a model of contusion SCI within the cervical spinal cord. Here, we describe the technical aspects and resultant anatomical and behavioral outcomes of an unilateral contusive model of cervical SCI that employs the Infinite Horizon spinal cord injury impactor.
Sprague Dawley rats underwent a left-sided unilateral laminectomy at C5. To optimize the reproducibility of the biomechanical, functional, and histological outcomes of the injury model, we contused the spinal cords using an impact force of 150 kdyn, an impact trajectory of 22.5&deg; (animals rotated at 22.5&deg;), and an impact location off of midline of 1.4 mm. Functional recovery was assessed using the cylinder rearing test, horizontal ladder test, grooming test and modified Montoya's staircase test for up to 6 weeks, after which the spinal cords were evaluated histologically for white and grey matter sparing.
The injury model presented here imparts consistent and reproducible biomechanical forces to the spinal cord, an important feature of any experimental SCI model. This results in discrete histological damage to the lateral half of the spinal cord which is largely contained to the ipsilateral side of injury. The injury is well tolerated by the animals, but does result in functional deficits of the forelimb that are significant and sustained in the weeks following injury. The cervical unilateral injury model presented here may be a resource to researchers who wish to evaluate potentially promising therapies prior to human translation.

A reliable and repeatable way to produce a cervical unilateral spinal cord injury using the Infinite Horizon impactor is described. The method takes advantage of a custom designed frame and clamp to stabilize the spine. The standardized procedure and biomechanical injury parameters result in sufficient and sustained injuries.

While the majority of human spinal cord injuries occur in the cervical spinal cord, the vast majority of laboratory research employs animal models of ...

Data Acquisition Protocol for Determining Embedded Sensitivity Functions

The effectiveness of many structural health monitoring techniques depends on the placement of sensors and the location of input forces. Algorithms for determining optimal sensor and forcing locations typically require data, either simulated or measured, from the damaged structure. Embedded sensitivity functions provide an approach for determining the best available sensor location to detect damage with only data from the healthy structure. In this video and manuscript, the data acquisition procedure and best practices for determining the embedded sensitivity functions of a structure is presented. The frequency response functions used in the calculation of the embedded sensitivity functions are acquired using modal impact testing. Data is acquired and representative results are shown for a residential scale wind turbine blade. Strategies for evaluating the quality of the data being acquired are provided during the demonstration of the data acquisition process.

The data acquisition procedure for determining embedded sensitivity functions is described. Data is acquired and representative results are shown for a residential scale wind turbine blade.

The effectiveness of many structural health monitoring techniques depends on the placement of sensors and the location of input forces. Algorithms for ...

In Vivo Protocol of Controlled Subconcussive Head Impacts for the Validation of Field Study Data

Subconcussive hits pose a threat to neuronal health as they have shown to induce neuronal structural damage and functional impairment without causing outward symptomology and appear to be a key contributor to an irreversible neurodegenerative disease, chronic traumatic encephalopathy (CTE). In addition, athletes can incur more than 1,000 of these hits per season. The subconcussive soccer heading model (SSHM) is a relevant, reproducible, and leading method of isolating and examining the effects of these subconcussive head impacts. By controlling variables such as ball traveling speed, the frequency of impacts, interval, ball placement to the head, as well as by measuring head impact magnitude, the SSHM provides the scientific community with a superior avenue of investigating the acute subconcussive effects on neuronal health. In this paper, we demonstrate the utility of SSHM in studying a time-course expression of neurofilament-light polypeptide (NF-L) in plasma in a repeated measures fashion. NF-L is an axonal injury marker that has previously been shown to be elevated in boxers and football players following subconcussive head trauma. Thirty-four adult aged soccer players were recruited and randomly assigned to either a soccer heading (n = 18) or kicking (n = 16) group. The heading group executed 10 headers with soccer balls projected at a velocity of 25 mph over 10 min. The kicking group followed the same protocol with 10 kicks. Plasma samples were obtained before and at 0 h, 2 h, and 24 h after heading/kicking and assessed for NF-L expressions. The heading group showed a gradual increase in plasma NF-L expression and peaked at 24 h after the heading protocol, whereas the kicking group remained consistent across the time points. These results confirmed the NF-L data from clinical field studies, encouraging the use of SSHM to validate clinical subconcussion data.

The subconcussive soccer heading model is a safe and concise methodological approach to isolate and measure the effects of subconcussive head impacts.

Subconcussive hits pose a threat to neuronal health as they have shown to induce neuronal structural damage and functional impairment without causing ...

Cutting Procedures, Tensile Testing, and Ageing of Flexible Unidirectional Composite Laminates

Many body armor designs incorporate unidirectional (UD) laminates. UD laminates are constructed of thin (&#60;0.05 mm) layers of high-performance yarns, where the yarns in each layer are oriented parallel to each other and held in place using binder resins and thin polymer films. The armor is constructed by stacking the unidirectional layers in different orientations. To date, only very preliminary work has been performed to characterize the ageing of the binder resins used in unidirectional laminates and the effects on their performance. For example, during the development of the conditioning protocol used in the National Institute of Justice Standard-0101.06, UD laminates showed visual signs of delamination and reductions in V50, which is the velocity at which half of the projectiles are expected to perforate the armor, after ageing. A better understanding of the material property changes in UD laminates is necessary to comprehend the long-term performance of armors constructed from these materials. There are no current standards recommended for mechanically interrogating unidirectional (UD) laminate materials. This study explores methods and best practices for accurately testing the mechanical properties of these materials and proposes a new test methodology for these materials. Best practices for ageing these materials are also described.

The goal of the study was to develop protocols to prepare consistent specimens for accurate mechanical testing of high-strength aramid or ultra-high-molar-mass polyethylene-based flexible unidirectional composite laminate materials and to describe protocols for performing artificial ageing on these materials.

Many body armor designs incorporate unidirectional (UD) laminates. UD laminates are constructed of thin (&#60;0.05 mm) layers of high-performance yarns, ...

Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position

Mechanical testing of femora brings valuable insights into understanding the contribution of clinically-measureable variables such as bone mineral density distribution and geometry on the femoral mechanical properties. Currently, there is no standard protocol for mechanical testing of such geometrically complex bones to measure strength, and stiffness. To address this gap we have developed a protocol to test cadaveric femora to fracture and to measure their biomechanical parameters. This protocol describes a set of adaptable fixtures to accommodate the various load magnitudes and directions accounting for possible bone orientations in a fall on the hip configuration, test speed, bone size, and left leg-right leg variations. The femora were prepared for testing by cleaning, cutting, scanning, and potting the distal end and greater trochanter contact surfaces in poly(methyl methacrylate) (PMMA) as presented in a different protocol. The prepared specimens were placed in the testing fixture in a position mimicking a sideways fall on the hip and loaded to fracture. During testing, two load cells measured vertical forces applied to the femoral head and greater trochanter, a six-axis load cell measured forces and moments at the distal femoral shaft, and a displacement sensor measured differential displacement between the femoral head and trochanter contact supports. High speed video cameras were used to synchronously record the sequence of fracture events during testing. The reduction of this data allowed us to characterize the strength, stiffness, and fracture energy for nearly 200 osteoporotic, osteopenic, and normal cadaveric femora for further development of engineering-based diagnostic tools for osteoporosis research.

In this manuscript, we present a protocol to fracture test cadaveric proximal femora in a sideways fall on the hip configuration using instrumented fixtures mounted on a standard servo hydraulic frame. Nine digitized signals comprising forces, moments, and displacement along with two high speed video streams are acquired during testing.

Mechanical testing of femora brings valuable insights into understanding the contribution of clinically-measureable variables such as bone mineral density ...

A Test Bed to Examine Helmet Fit and Retention and Biomechanical Measures of Head and Neck Injury in Simulated Impact

Conventional wisdom and the language in international helmet testing and certification standards suggest that appropriate helmet fit and retention during an impact are important factors in protecting the helmet wearer from impact-induced injury. This manuscript aims to investigate impact-induced injury mechanisms in different helmet fit scenarios through analysis of simulated helmeted impacts with an anthropometric test device (ATD), an array of headform acceleration transducers and neck force/moment transducers, a dual high speed camera system, and helmet-fit force sensors developed in our research group based on Bragg gratings in optical fiber. To simulate impacts, an instrumented headform and flexible neck fall along a linear guide rail onto an anvil. The test bed allows simulation of head impact at speeds up to 8.3 m/s, onto impact surfaces that are both flat and angled. The headform is fit with a crash helmet and several fit scenarios can be simulated by making context specific adjustments to the helmet position index and/or helmet size. To quantify helmet retention, the movement of the helmet on the head is quantified using post-hoc image analysis. To quantify head and neck injury potential, biomechanical measures based on headform acceleration and neck force/moment are measured. These biomechanical measures, through comparison with established human tolerance curves, can estimate the risk of severe life threatening and/or mild diffuse brain injury and osteoligamentous neck injury. To our knowledge, the presented test-bed is the first developed specifically to assess biomechanical effects on head and neck injury relative to helmet fit and retention.

Using an anthropometric head and neck, optical fiber-based fit force transducers, an array of head acceleration and neck force/moment transducers, and a dual high speed camera system, we present a test bed to study helmet retention and effects on biomechanical measures of head and neck injury secondary to head impact.

Conventional wisdom and the language in international helmet testing and certification standards suggest that appropriate helmet fit and retention during ...

Development of an Uncomplicated Mild Traumatic Brain Injury Model Modified by Weight-Drop Method and Evidenced by Magnetic Resonance Imaging

Mild traumatic brain injury (mTBI), known as concussion, accounts for more than 85% of brain injuries globally. Specifically, uncomplicated mTBI showing negative findings in routine clinical imaging in the acute phase hinders early and appropriate care in these patients. It has been acknowledged that different impact parameters may affect and even accelerate the progress of subsequent neuropsychological symptoms following mTBI. However, the association of impact parameters during concussion to the outcome has not been extensively examined. In the current study, an animal model with closed-head injury (CHI) modified from the weight-drop injury paradigm was described and demonstrated in detail. Adult male Sprague-Dawley rats (n = 20) were randomly assigned to CHI groups with different impact parameters (n = 4 per group). Longitudinal MR imaging studies, including T2-weighted imaging and diffusion tensor imaging, and sequential behavioral assessments, such as modified neurological severity score (mNSS) and the beam walk test, were conducted over a 50-day study period. Immunohistochemical staining for astrogliosis was performed on day 50 post-injury. Worse behavioral performance was observed in animals following repetitive CHI compared to the single injury and sham group. By using longitudinal magnetic resonance imaging (MRI), no significant brain contusion was observed at 24 h post-injury. Nevertheless, cortical atrophy and alteration of cortical fractional anisotropy (FA) were demonstrated on day 50 post-injury, suggesting the successful replication of clinical uncomplicated mTBI. Most importantly, changes in neurobehavioral outcomes and image features observed after mTBI were dependent on impact number, inter-injury intervals, and the selected impact site in the animals. This in vivo mTBI model combined with preclinical MRI provides a means to explore brain injury on a whole-brain scale. It also allows the investigation of imaging biomarkers sensitive to mTBI across varying impact parameters and severity levels.

Here, we present a protocol to establish a closed-head injury animal model replicating the neuroimage outcome of uncomplicated mild traumatic brain injury with the preserved brain structure in the acute phase and long-term brain atrophy. Longitudinal magnetic resonance imaging is the primary method used for evidence.

Mild traumatic brain injury (mTBI), known as concussion, accounts for more than 85% of brain injuries globally. Specifically, uncomplicated mTBI showing ...

Modified Drop Tower Impact Tests for American Football Helmets

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