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  • Journal article
    Abayazid FF, Ghajari M, 2024,

    Viscoelastic circular cell honeycomb helmet liners for reducing head rotation and brain strain in oblique impacts

    , Materials and Design, Vol: 239, ISSN: 0264-1275

    Rotational head motion is one of the major contributors to brain tissue strain during head impacts, which damages axons and vessels and leads to traumatic brain injury. Helmet technologies have come to market promising enhanced protection against such rotational head motion. We recently introduced novel air-filled viscoelastic cell arrays and showed that their shear response under oblique impacts can be tailored through altering the cell wall curvature. We found that concave cells provide shear stiffness that is a few folds larger than that of convex cells. Here we test whether altering the cell curvature can reduce head rotational kinematics and brain strain and whether the viscoelastic cell arrays outperform the reference EPS foam-based liner. To test these hypotheses, we incorporate the viscoelastic cell arrays in a bicycle helmet liner. We use validated finite element models of the helmet and replace the liner with validated finite element models of the cellular cell arrays. We simulate oblique impacts at different locations to represent a wide range of real-world bicycle head impacts. In all cases, the head kinematics and brain deformation metrics indicate significant improvements with the novel cell arrays over the conventional EPS liner. We show that the shear-compliant cell arrays can reduce head rotational acceleration by as much as 64 % and brain strain by 69 %, but not in all impact locations. Cell arrays with similar axial stiffness yet lower shear stiffness often bottomed out, indicating that a considerable amount of energy is dissipated via cell shearing around the impact zone. Our results show that placement of cells with varying amounts of shear stiffness should be optimised, with the most shear-compliant cells near the crown and the least near the temples. This study shows the promising performance of viscoelastic cell arrays in protecting the head and brain under oblique impacts and provides avenues for optimising the distribution of their compress

  • Journal article
    Yu X, Singh G, Kaur A, Ghajari Met al., 2024,

    An assessment of Sikh turban's head protection in bicycle incident scenarios

    , Annals of Biomedical Engineering, ISSN: 0090-6964

    Due to religious tenets, Sikh population wear turbans and are exempted from wearing helmets in several countries. However, the extent of protection provided by turbans against head injuries during head impacts remains untested. One aim of this study was to provide the first-series data of turbans' protective performance under impact conditions that are representative of real-world bicycle incidents and compare it with the performance of bicycle helmets. Another aim was to suggest potential ways for improving turban's protective performance. We tested five different turbans, distinguished by two wrapping styles and two fabric materials with a size variation in one of the styles. A Hybrid III headform fitted with the turban was dropped onto a 45 degrees anvil at 6.3 m/s and head accelerations were measured. We found large difference in the performance of different turbans, with up to 59% difference in peak translational acceleration, 85% in peak rotational acceleration, and 45% in peak rotational velocity between the best and worst performing turbans. For the same turban, impact on the left and right sides of the head produced very different head kinematics, showing the effects of turban layering. Compared to unprotected head impacts, turbans considerably reduce head injury metrics. However, turbans produced higher values of peak linear and rotational accelerations in front and left impacts than bicycle helmets, except from one turban which produced lower peak head kinematics values in left impacts. In addition, turbans produced peak rotational velocities comparable with bicycle helmets, except from one turban which produced higher values. The impact locations tested here were covered with thick layers of turbans and they were impacted against flat anvils. Turbans may not provide much protection if impacts occur at regions covered with limited amount of fabric or if the impact is against non-flat anvils, which remain untested. Our analysis shows that turbans can

  • Journal article
    Psarras S, Munoz R, Ghajari M, 2023,

    Compression performance of composite plates after multi-site impacts: A combined experimental and finite element study

    , COMPOSITE STRUCTURES, Vol: 322, ISSN: 0263-8223
  • Journal article
    Jones CM, Austin K, Augustus SN, Nicholas KJ, Yu X, Baker C, Chan EYK, Loosemore M, Ghajari Met al., 2023,

    An instrumented mouthguard for real-time measurement of head kinematics under a large range of sport specific accelerations

    , Sensors, Vol: 23, Pages: 1-15, ISSN: 1424-8220

    BACKGROUND: Head impacts in sports can produce brain injuries. The accurate quantification of head kinematics through instrumented mouthguards (iMG) can help identify underlying brain motion during injurious impacts. The aim of the current study is to assess the validity of an iMG across a large range of linear and rotational accelerations to allow for on-field head impact monitoring. METHODS: Drop tests of an instrumented helmeted anthropometric testing device (ATD) were performed across a range of impact magnitudes and locations, with iMG measures collected concurrently. ATD and iMG kinematics were also fed forward to high-fidelity brain models to predict maximal principal strain. RESULTS: The impacts produced a wide range of head kinematics (16-171 g, 1330-10,164 rad/s2 and 11.3-41.5 rad/s) and durations (6-18 ms), representing impacts in rugby and boxing. Comparison of the peak values across ATD and iMG indicated high levels of agreement, with a total concordance correlation coefficient of 0.97 for peak impact kinematics and 0.97 for predicted brain strain. We also found good agreement between iMG and ATD measured time-series kinematic data, with the highest normalized root mean squared error for rotational velocity (5.47 ± 2.61%) and the lowest for rotational acceleration (1.24 ± 0.86%). Our results confirm that the iMG can reliably measure laboratory-based head kinematics under a large range of accelerations and is suitable for future on-field validity assessments.

  • Journal article
    MacManus DB, Khorshidi MA, Ghajari M, Sedighi HMet al., 2023,

    Micromechanics in biology and medicine

    , IET Nanobiotechnology, Vol: 17, Pages: 125-126, ISSN: 1751-8741
  • Journal article
    Baker CE, Yu X, Patel S, Ghajari Met al., 2023,

    A review of cyclist head injury, impact characteristics and the implications for helmet assessment methods

    , Annals of Biomedical Engineering, Vol: 51, Pages: 875-904, ISSN: 0090-6964

    Head injuries are common for cyclists involved in collisions. Such collision scenarios result in a range of injuries, with different head impact speeds, angles, locations, or surfaces. A clear understanding of these collision characteristics is vital to design high fidelity test methods for evaluating the performance of helmets. We review literature detailing real-world cyclist collision scenarios and report on these key characteristics. Our review shows that helmeted cyclists have a considerable reduction in skull fracture and focal brain pathologies compared to non-helmeted cyclists, as well as a reduction in all brain pathologies. The considerable reduction in focal head pathologies is likely to be due to helmet standards mandating thresholds of linear acceleration. The less considerable reduction in diffuse brain injuries is likely to be due to the lack of monitoring head rotation in test methods. We performed a novel meta-analysis of the location of 1809 head impacts from ten studies. Most studies showed that the side and front regions are frequently impacted, with one large, contemporary study highlighting a high proportion of occipital impacts. Helmets frequently had impact locations low down near the rim line. The face is not well protected by most conventional bicycle helmets. Several papers determine head impact speed and angle from in-depth reconstructions and computer simulations. They report head impact speeds from 5 to 16 m/s, with a concentration around 5 to 8 m/s and higher speeds when there was another vehicle involved in the collision. Reported angles range from 10° to 80° to the normal, and are concentrated around 30°-50°. Our review also shows that in nearly 80% of the cases, the head impact is reported to be against a flat surface. This review highlights current gaps in data, and calls for more research and data to better inform improvements in testing methods of standards and rating schemes and raise helmet s

  • Journal article
    Yu X, Baker C, Brown M, Ghajari Met al., 2023,

    In-depth bicycle collision reconstruction: from a crash helmet to brain injury evaluation

    , Bioengineering, Vol: 10, Pages: 1-16, ISSN: 2306-5354

    Traumatic brain injury (TBI) is a prevalent injury among cyclists experiencing head collisions. In legal cases, reliable brain injury evaluation can be difficult and controversial as mild injuries cannot be diagnosed with conventional brain imaging methods. In such cases, accident reconstruction may be used to predict the risk of TBI. However, lack of collision details can render accident reconstruction nearly impossible. Here, we introduce a reconstruction method to evaluate the brain injury in a bicycle–vehicle collision using the crash helmet alone. Following a thorough inspection of the cyclist’s helmet, we identified a severe impact, a moderate impact and several scrapes, which helped us to determine the impact conditions. We used our helmet test rig and intact helmets identical to the cyclist’s helmet to replicate the damage seen on the cyclist’s helmet involved in the real-world collision. We performed both linear and oblique impacts, measured the translational and rotational kinematics of the head and predicted the strain and the strain rate across the brain using a computational head model. Our results proved the hypothesis that the cyclist sustained a severe impact followed by a moderate impact on the road surface. The estimated head accelerations and velocity (167 g, 40.7 rad/s and 13.2 krad/s2) and the brain strain and strain rate (0.541 and 415/s) confirmed that the severe impact was large enough to produce mild to moderate TBI. The method introduced in this study can guide future accident reconstructions, allowing for the evaluation of TBI using the crash helmet only.

  • Journal article
    Yu X, Baker CE, Ghajari M, 2023,

    Head impact location, speed and angle from falls and trips in the workplace

    , Annals of Biomedical Engineering, Pages: 1-16, ISSN: 0090-6964

    Traumatic brain injury (TBI) is a common injury in the workplace. Trips and falls are the leading causes of TBI in the workplace. However, industrial safety helmets are not designed for protecting the head under these impact conditions. Instead, they are designed to pass the regulatory standards which test head protection against falling heavy and sharp objects. This is likely to be due to the limited understanding of head impact conditions from trips and falls in workplace. In this study, we used validated human multi-body models to predict the head impact location, speed and angle (measured from the ground) during trips, forward falls and backward falls. We studied the effects of worker size, initial posture, walking speed, width and height of the tripping barrier, bracing and falling height on the head impact conditions. Overall, we performed 1692 simulations. The head impact speed was over two folds larger in falls than trips, with backward falls producing highest impact speeds. However, the trips produced impacts with smaller impact angles to the ground. Increasing the walking speed increased the head impact speed but bracing reduced it. We found that 41% of backward falls and 19% of trips/forward falls produced head impacts located outside the region of helmet coverage. Next, we grouped all the data into three sub-groups based on the head impact angle: [0°, 30°], (30°, 60°] and (60°, 90°] and excluded groups with small number of cases. We found that most trips and forward falls lead to impact angles within the (30°, 60°] and (60°, 90°] groups while all backward falls produced impact angles within (60°, 90°] group. We therefore determined five representative head impact conditions from these groups by selecting the 75th percentile speed, mean value of angle intervals and median impact location (determined by elevation and azimuth angles) of each group. This led to two representative head impact conditions for trip

  • Journal article
    He L, Maiolino P, Leong F, Lalitharatne T, Lusignan SD, Ghajari M, Iida F, Nanayakkara Tet al., 2023,

    Robotic simulators for tissue examination training with multimodal sensory feedback

    , IEEE Reviews in Biomedical Engineering, Vol: 16, Pages: 514-529, ISSN: 1941-1189

    Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring involuntary facial and vocal expressions in response to palpation, and using pain expressions both as a source of information and as a constraint on physical examination. Patient simulators can provide a safe learning platform to novice physicians before trying real patients. This paper reviews state-of-the-art medical simulators for the training for the first time with a consideration of providing multimodal feedback to learn as many manual examination techniques as possible. The study summarizes current advances in tissue examination training devices simulating different medical conditions and providing different types of feedback modalities. Opportunities with the development of pain expression, tissue modeling, actuation, and sensing are also analyzed to support the future design of effective tissue examination simulators.

  • Journal article
    Zimmerman K, 2023,

    The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries

    , Brain: a journal of neurology, ISSN: 0006-8950
  • Journal article
    Leong F, Chow Yin L, Siamak Farajzadeh K, He L, Simon DL, Thrishantha N, mazdak Get al., 2022,

    A surrogate model based on a finite element model of abdomen for real-time visualisation of tissue stress during physical examination training

    , Bioengineering, Vol: 9, ISSN: 2306-5354

    Robotic patients show great potential to improve medical palpation training as they can provide feedback that cannot be obtained in a real patient. Providing information about internal organs deformation can significantly enhance palpation training by giving medical trainees visual insight based on their finger behaviours. This can be achieved by using computational models of abdomen mechanics. However, such models are computationally expensive, thus able to provide real-time predictions. In this work, we proposed an innovative surrogate model of abdomen mechanics using machine learning (ML) and finite element (FE) modelling to virtually render internal tissue deformation in real-time. We first developed a new high-fidelity FE model of the abdomen mechanics from computerized tomography (CT) images. We performed palpation simulations to produce a large database of stress distribution on the liver edge, an area of interest in most examinations. We then used artificial neural networks (ANN) to develop the surrogate model and demonstrated its application in an experimental palpation platform. Our FE simulations took 1.5 hrs to predict stress distribution for each palpation while this only took a fraction of a second for the surrogate model. Our results show that the ANN has a 92.6% accuracy. We also show that the surrogate model is able to use the experimental input of palpation location and force to provide real-time projections onto the robotics platform. This enhanced robotics platform has potential to be used as a training simulator for trainees to hone their palpation skills.

  • Journal article
    Yu X, Logan I, Sarasola IDP, Dasaratha A, Ghajari Met al., 2022,

    The protective performance of modern motorcycle helmets under oblique impacts

    , Annals of Biomedical Engineering, Vol: 50, Pages: 1674-1688, ISSN: 0090-6964

    Motorcyclists are at high risk of head injuries, including skull fractures, focal brain injuries, intracranial bleeding and diffuse brain injuries. New helmet technologies have been developed to mitigate head injuries in motorcycle collisions, but there is limited information on their performance under commonly occurring oblique impacts. We used an oblique impact method to assess the performance of seven modern motorcycle helmets at five impact locations. Four helmets were fitted with rotational management technologies: a low friction layer (MIPS), three-layer liner system (Flex) and dampers-connected liner system (ODS). Helmets were dropped onto a 45° anvil at 8 m/s at five locations. We determined peak translational and rotational accelerations (PTA and PRA), peak rotational velocity (PRV) and brain injury criteria (BrIC). In addition, we used a human head finite element model to predict strain distribution across the brain and in corpus callosum and sulci. We found that the impact location affected the injury metrics and brain strain, but this effect was not consistent. The rear impact produced lowest PTAs but highest PRAs. This impact produced highest strain in corpus callosum. The front impact produced the highest PRV and BrIC. The side impact produced the lowest PRV, BrIC and strain across the brain, sulci and corpus callosum. Among helmet technologies, MIPS reduced all injury metrics and brain strain compared with conventional helmets. Flex however was effective in reducing PRA only and ODS was not effective in reducing any injury metrics in comparison with conventional helmets. This study shows the importance of using different impact locations and injury metrics when assessing head protection effects of helmets. It also provides new data on the performance of modern motorcycle helmets. These results can help with improving helmet design and standard and rating test methods.

  • Conference paper
    Baker CE, Montemiglio A, Li R, Martin PS, Wilson MH, Sharp DJ, Ghajari Met al., 2022,

    Assessing the influence of parameter variation on kinematic head injury metric uncertainty in multibody reconstructions of real-world pedestrian vehicle and ground impacts

    , 2022 IRCOBI Conference, Pages: 393-394, ISSN: 2235-3151
  • Journal article
    Yu X, Halldin P, Ghajari M, 2022,

    Oblique impact responses of Hybrid III and a new headform with more biofidelic coefficient of friction and moments of inertia

    , Frontiers in Bioengineering and Biotechnology, Vol: 10, Pages: 1-14, ISSN: 2296-4185

    New oblique impact methods for evaluating head injury mitigation effects of helmets are emerging, which mandate measuring both translational and rotational kinematics of the headform. These methods need headforms with biofidelic mass, moments of inertia (MoIs) and coefficient of friction (CoF). To fulfil this need, the working group 11 of the European standardization head protection committee (CEN/TC158) has been working on the development of a new headform with realistic MoIs and CoF, based on recent biomechanics research on the human head. In this study, we used a version of this headform (Cellbond) to test a motorcycle helmet under oblique impacts at 8m/s at five different locations. We also used the Hybrid III headform, which is commonly used in helmet oblique impacts. We tested whether there is a difference between the predictions of the headforms in terms of injury metrics based on head kinematics, including peak translational and rotational acceleration, peak rotational velocity and BrIC (Brain Injury Criterion). We also used Imperial College finite element model of human head to predict strain and strain rate across the brain and tested whether there is a difference between the headforms in terms of predicted strain and strain rate. We found that the Cellbond headform produced similar or higher peak translational accelerations depending on the impact location (-3.2% in front-side impact to 24.3% in rear impact). The Cellbond headform however produced significantly lower peak rotational acceleration (-41.8% in rear impact to -62.7% in side impact), peak rotational velocity (-29.5% in side impact to -47.6% in rear impact) and BrIC (-29% in rear-side impact to -45.3% in rear impact). The 90th percentile value of the maximum brain strain and strain rate were also significantly lower using this headform. Our results suggest that MoIs and CoF have significant effects on headform rotational kinematics, and consequently brain deformation, during helmeted oblique imp

  • Journal article
    Ji S, Ghajari M, Mao H, Kraft RH, Hajiaghamemar M, Panzer MB, Willinger R, Gilchrist MD, Kleiven S, Stitzel JDet al., 2022,

    Use of brain biochemical models for monitoring impact exposure in contact sports

    , Annals of Biomedical Engineering, Vol: 50, Pages: 1389-1408, ISSN: 0090-6964

    Head acceleration measurement sensors are now widely deployed in the field to monitor head kinematic exposure in contact sports. The wealth of impact kinematics data provides valuable, yet challenging, opportunities to study the biomechanical basis of mild traumatic brain injury (mTBI) and subconcussive kinematic exposure. Head impact kinematics are translated into brain mechanical responses through physics-based computational simulations using validated brain models to study the mechanisms of injury. First, this article reviews representative legacy and contemporary brain biomechanical models primarily used for blunt impact simulation. Then, it summarizes perspectives regarding the development and validation of these models, and discusses how simulation results can be interpreted to facilitate injury risk assessment and head acceleration exposure monitoring in the context of contact sports. Recommendations and consensus statements are presented on the use of validated brain models in conjunction with kinematic sensor data to understand the biomechanics of mTBI and subconcussion. Mainly, there is general consensus that validated brain models have strong potential to improve injury prediction and interpretation of subconcussive kinematic exposure over global head kinematics alone. Nevertheless, a major roadblock to this capability is the lack of sufficient data encompassing different sports, sex, age and other factors. The authors recommend further integration of sensor data and simulations with modern data science techniques to generate large datasets of exposures and predicted brain responses along with associated clinical findings. These efforts are anticipated to help better understand the biomechanical basis of mTBI and improve the effectiveness in monitoring kinematic exposure in contact sports for risk and injury mitigation purposes.

  • Journal article
    Yu X, Nguyen T, Wu T, Ghajari Met al., 2022,

    Non-lethal blasts can generate cavitation in cerebrospinal fluid while severe helmeted impacts cannot: a novel mechanism for blast brain injury

    , Frontiers in Bioengineering and Biotechnology, Vol: 10, ISSN: 2296-4185

    Cerebrospinal fluid (CSF) cavitation is a likely physical mechanism for producing traumatic brain injury (TBI) under mechanical loading. In this study, we investigated CSF cavitation under blasts and helmeted impacts which represented loadings in battlefield and road traffic/sports collisions. We first predicted the human head response under the blasts and impacts using computational modelling and found that the blasts can produce much lower negative pressure at the contrecoup CSF region than the impacts. Further analysis showed that the pressure waves transmitting through the skull and soft tissue are responsible for producing the negative pressure at the contrecoup region. Based on this mechanism, we hypothesised that blast, and not impact, can produce CSF cavitation. To test this hypothesis, we developed a one-dimensional simplified surrogate model of the head and exposed it to both blasts and impacts. The test results confirmed the hypothesis and computational modelling of the tests validated the proposed mechanism. These findings have important implications for prevention and diagnosis of blast TBI.

  • Journal article
    Abayazid FF, Carpanen D, Ghajari M, 2022,

    New viscoelastic circular cell honeycombs for controlling shear and compressive responses in oblique impacts

    , INTERNATIONAL JOURNAL OF MECHANICAL SCIENCES, Vol: 222, ISSN: 0020-7403
  • Journal article
    Duckworth H, Azor A, Wischmann N, Zimmerman KA, Tanini I, Ghajari Met al., 2022,

    A finite element model of cerebral vascular injury for predicting microbleeds location

    , Frontiers in Bioengineering and Biotechnology, Vol: 10, ISSN: 2296-4185

    Finite Element (FE) models of brain mechanics have improved our understanding of the brain response to rapid mechanical loads that produce traumatic brain injuries. However, these models have rarely incorporated vasculature, which limits their ability to predict the response of vessels to head impacts. To address this shortcoming, here we used high-resolution MRI scans to map the venous system anatomy at a submillimetre resolution. We then used this map to develop an FE model of veins and incorporated it in an anatomically detailed FE model of the brain. The model prediction of brain displacement at different locations was compared to controlled experiments on post-mortem human subject heads, yielding over 3,100 displacement curve comparisons, which showed fair to excellent correlation between them. We then used the model to predict the distribution of axial strains and strain rates in the veins of a rugby player who had small blood deposits in his white matter, known as microbleeds, after sustaining a head collision. We hypothesised that the distribution of axial strain and strain rate in veins can predict the pattern of microbleeds. We reconstructed the head collision using video footage and multi-body dynamics modelling and used the predicted head accelerations to load the FE model of vascular injury. The model predicted large axial strains in veins where microbleeds were detected. A region of interest analysis using white matter tracts showed that the tract group with microbleeds had 95th percentile peak axial strain and strain rate of 0.197 and 64.9 s−1 respectively, which were significantly larger than those of the group of tracts without microbleeds (0.163 and 57.0 s−1). This study does not derive a threshold for the onset of microbleeds as it investigated a single case, but it provides evidence for a link between strain and strain rate applied to veins during head impacts and structural damage and allows for future work to generate threshold valu

  • Journal article
    Yu X, Wu T, Nguyen T-TN, Ghajari Met al., 2022,

    Investigation of blast-induced cerebrospinal fluid cavitation: Insights from a simplified head surrogate

    , International Journal of Impact Engineering, Vol: 162, Pages: 1-9, ISSN: 0734-743X

    Blast induced traumatic brain injury (bTBI) has been a prevalent injury in recent conflicts. Post-mortem studies have shown damage in the brain tissue close to the cerebrospinal fluid (CSF) in bTBI cases compared to non-blast TBI cases. CSF cavitation is a potential mechanism for this brain/CSF interface injury. In this study, our aim was to explore the possibility and mechanism of blast induced CSF cavitation. We first developed a one-dimensional simplified human head surrogate and exposed it to nonlethal blast waves using a shock tube. High-speed videography and pressure sensors data showed the formation and collapse of cavitation in the CSF simulant. Then, we explored the mechanism of the cavitation using a finite element model of the head surrogate. We found that the pressure waves transmitting through the skull (outer wave) and tissue simulants (inner wave) are responsible for the generation and collapse of the cavitation bubbles, respectively. Next, we used this insight to explore the possibility of CSF cavitation in the human head using a detailed finite element model. The simulations verified the role of the inner and outer waves in the generation and collapse of cavitation. Our results suggested that CSF cavitation is likely to happen in the human head under blast loading. Finally, we studied the CSF cavitation in head surrogate models with different lengths. The results showed that the head length significantly affected the CSF cavitation, indicating the potential drawback of using small animals to study bTBI in human head. Our findings can improve our understanding of the brain/CSF interface injury after blast exposure and inform the design of protection systems and animal tests.

  • Journal article
    Yu X, Ghajari M, 2022,

    Protective performance of helmets and goggles in mitigating brain biomechanical response to primary blast exposure

    , Annals of Biomedical Engineering, Vol: 50, Pages: 1579-1595, ISSN: 0090-6964

    The current combat helmets are primarily designed to mitigate blunt impacts and ballistic loadings. Their protection against primary blast wave is not well studied. In this paper, we comprehensively assessed the protective capabilities of the advanced combat helmet and goggles against blast waves with different intensity and directions. Using a high-fidelity human head model, we compared the intracranial pressure (ICP), cerebrospinal fluid (CSF) cavitation, and brain strain and strain rate predicted from bare head, helmet-head and helmet-goggles-head simulations. The helmet was found to be effective in mitigating the positive ICP (24-57%) and strain rate (5-34%) in all blast scenarios. Goggles were found to be effective in mitigating the positive ICP in frontal (6-16%) and lateral (5-7%) blast exposures. However, the helmet and goggles had minimal effects on mitigating CSF cavitation and even increased brain strain. Further investigation showed that wearing a helmet leads to higher risk of cavitation. In addition, their presence increased the head kinetic energy, leading to larger strains in the brain. Our findings can improve our understanding of the protective effects of helmets and goggles and guide the design of helmet pads to mitigate brain responses to blast.

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