Stefan M. Duma

Background: Individuals with ADHD may perform poorly on tasks targeting executive functioning skills such as the ImPACT, which requires the test-taker to employ judgement in non-routine situations Objective: To determine whether ADHD serves as a mediating variable for increasing the likelihood of an invalid score. Materials and Methods: A total of 39,140 collegiate athletes and United States military cadets consented to the Concussion Assessment, Research, and Education (CARE) Consortium study. Participants completed the CARE Baseline Packet which included various sections through which study participants provide self-report data, including demographic, personal, and family history sections. The personal history portion of the CARE Baseline Packet addressed the participant’s neurological history, including self-reported diagnosis of ADHD and history of traumatic brain injury. Variables utilized for the current study included age, gender, race, ethnicity, the participant’s primary college sport, use of mouthguards for athletes competing in sports requiring them, and the presence of an ADHD diagnosis. Participants responded to a question, inquiring if they had ever been diagnosed by a medical professional with ADHD, ultimately producing a dichotomous yes/no response. Results: We found that participants with ADHD were more likely to produce invalid baseline scores (ß = −0.884; p < 0.001). Similar results were found when controlling for sex, race, age, sport played, mouthguard use, and number of previous concussions (ß = −0.786; p < 0.001). Sex, race, sport played, and mouthguard use each played a significant role in determining profile validity, independent of ADHD diagnosis. With ADHD removed from the model, age negatively affected the likelihood of a valid score (ß = −0.052; p = 0.048). Conclusions: Our study suggests that the relationship between age and ImPACT validity is explained by the presence of ADHD. Results support adjusting ImPACT’s validity thresholds for individuals with ADHD.

Drones have been increasing in popularity and are able to cause skin injuries ranging from minor abrasions to severe lacerations. The objective of this study was to determine the aspects of drone blades that cause injuries, and to help manufacturers design safer drones by suggesting an injury threshold. The blade tip thickness, blade length, angular velocity, and blade tip speed of a variety of popular drones were measured. The injury caused by each drone blade contacting a fetal bovine skin surrogate at different speeds was recorded. Blade tip speed had the highest correlation to injury severity, while blade tip thickness, blade length, and rpm had little to no correlation with the resulting injury. Blade tip speeds above 25 m/s resulted in minor abrasions, and speeds above 60 m/s resulted in minor lacerations. To prevent severe injuries, drone manufacturers should design drones with blade tip speeds below the threshold of 60 m/s.

Objective: The purpose of this study was to obtain non-censored rib fracture data due to three-point belt loading during dynamic frontal post-mortem human surrogate (PMHS) sled tests. The PMHS responses were then compared to matched tests performed using the Hybrid-III 50^th percentile male ATD. Methods: Matched dynamic frontal sled tests were performed on two male PMHSs, which were approximately 50^th percentile height and weight, and the Hybrid-III 50^th percentile male ATD. The sled pulse was designed to match the vehicle acceleration of a standard sedan during a FMVSS-208 40 kph test. Each subject was restrained with a 4 kN load limiting, driver-side, three-point seatbelt. A 59-channel chestband, aligned at the nipple line, was used to quantify the chest contour, anterior-posterior sternum deflection, and maximum anterior-posterior chest deflection for all test subjects. The internal sternum deflection of the ATD was quantified with the sternum potentiometer. For the PMHS tests, a total of 23 single-axis strain gages were attached to the bony structures of the thorax, including the ribs, sternum, and clavicle. In order to create a non-censored data set, the time history of each strain gage was analyzed to determine the timing of each rib fracture and corresponding timing of each AIS level (AIS = 1, 2, 3, etc.) with respect to chest deflection. Results: Peak sternum deflection for PMHS 1 and PMHS 2 were 48.7 mm (19.0%) and 36.7 mm (12.2%), respectively. The peak sternum deflection for the ATD was 20.8 mm when measured by the chest potentiometer and 34.4 mm (12.0%) when measured by the chestband. Although the measured ATD sternum deflections were found to be well below the current thoracic injury criterion (63 mm) specified for the ATD in FMVSS-208, both PMHSs sustained AIS 3+ thoracic injuries. For all subjects, the maximum chest deflection measured by the chestband occurred to the right of the sternum and was found to be 83.0 mm (36.0%) for PMHS 1, 60.6 mm (23.9%) for PMHS 2, and 56.3 mm (20.0%) for the ATD. The non-censored rib fracture data in the current study (n = 2 PMHS) in conjunction with the non-censored rib fracture data from two previous table-top studies (n = 4 PMHS) show that AIS 3+ injury timing occurs prior to peak sternum compression, prior to peak maximum chest compression, and at lower compressions than might be suggested by current PMHS thoracic injury criteria developed using censored rib fracture data. In addition, the maximum chest deflection results showed a more reasonable correlation between deflection, rib fracture timing, and injury severity than sternum deflection. Conclusions: Overall, these data provide compelling empirical evidence that suggests a more conservative thoracic injury criterion could potentially be developed based on non-censored rib fracture data with additional testing performed over a wider range of subjects and loading conditions.

Computerized neuropsychological testing has become an important tool in the identification and management of sports-related concussions; however, the psychometric effect of repeat testing has not been studied extensively beyond test–retest statistics. The current study analyzed data from Division I collegiate athletes who completed Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baseline assessments at four sequential time points that varied over the course of their athletic careers. Administrations were part of a larger National Institutes of Health (NIH) study. Growth curve modeling showed that the two memory composite scores increased significantly with successive administrations: Change in Verbal Memory was best represented with a quadratic model, while a linear model best fit Visual Memory. Visual Motor Speed and Reaction Time composites showed no significant linear or quadratic growth. The results demonstrate the effect of repeated test administrations for memory composite scores, while speed composites were not significantly impacted by repeat testing. Acceptable test–retest reliability was demonstrated for all four composites as well.

When access to live-fire test facilities is limited, experimental studies of blast-related injuries necessitate the use of a shock tube or Advanced Blast Simulator (ABS) to mimic free-field blast overpressure. However, modeling blast overpressure in a laboratory setting potentially introduces experimental artifacts in measured responses. Due to the high sampling rates required to capture a blast overpressure event, proximity to alternating current (AC-powered electronics) and poorly strain-relieved or unshielded wires can result in artifacts in the recorded overpressure trace. Data in this study were collected for tests conducted on an empty ABS (“Empty Tube”) using high frequency pressure sensors specifically designed for blast loading rates (n=5). Additionally, intraocular overpressure data (“IOP”) were collected for porcine eyes potted inside synthetic orbits located inside the ABS using an unshielded miniature pressure sensor (n=3). All tests were conducted at a 30 psi static overpressure level. A 4th order phaseless low pass Butterworth software filter was applied to the data. Various cutoff frequencies were examined to determine if the raw shock wave parameters values could be preserved while eliminating noise and artifacts. A Fast Fourier Transform (FFT) was applied to each test to examine the frequency spectra of the raw and filtered signals. Shock wave parameters (time of arrival, peak overpressure, positive duration, and positive impulse) were quantified using a custom MATLAB® script. Lower cutoff frequencies attenuated the raw signal, effectively decreasing the peak overpressure and increasing the positive duration. Rise time was not preserved the filtered data. A CFC 6000 filter preserved the remaining shock wave parameters within ±2.5% of the average raw values for the Empty Tube test data. A CFC 7000 filter removed experimental high-frequency artifacts and preserved the remaining shock wave parameters within ±2.5% of the average raw values for test IOP test data. Though the region of interest of the signals examined in the current study did not contain extremely high frequency content, it is possible that live-fire testing may produce shock waves with higher frequency content. While post-processing filtering can remove experimental artifacts, special care should be taken to minimize or eliminate the possibility of recording these artifacts in the first place.

The head impact exposure experienced by football players at the college and high school levels has been well documented; however, there are limited data regarding youth football despite its dramatically larger population. The objective of this study was to investigate head impact exposure in middle school football. Impacts were monitored using a commercially available accelerometer array installed inside the helmets of 17 players aged 12–14 years. A total of 4678 impacts were measured, with an average (±standard deviation) of 275 ± 190 impacts per player. The average of impact distributions for each player had a median impact of 22 ± 2 g and 954 ± 122 rad/s², and a 95th percentile impact of 54 ± 9 g and 2525 ± 450 rad/s². Similar to the head impact exposure experienced by high school and collegiate players, these data show that middle school football players experience a greater number of head impacts during games than practices. There were no significant differences between median and 95th percentile head acceleration magnitudes experienced during games and practices; however, a larger number of impacts greater than 80 g occurred during games than during practices. Impacts to the front and back of the helmet were most common. Overall, these data are similar to high school and college data that have been collected using similar methods. These data have applications toward youth football helmet design, the development of strategies designed to limit head impact exposure, and child-specific brain injury criteria.