{"id":212,"date":"2014-05-13T16:42:38","date_gmt":"2014-05-13T20:42:38","guid":{"rendered":"http:\/\/jhumag.dev.173.166.187.154.xip.io\/?p=212"},"modified":"2014-06-04T12:25:51","modified_gmt":"2014-06-04T16:25:51","slug":"conquering-concussion","status":"publish","type":"post","link":"https:\/\/engineering.jhu.edu\/magazine-archive\/2014\/05\/conquering-concussion\/","title":{"rendered":"Conquering Concussion"},"content":{"rendered":"

With their \u201cdigital head\u201d<\/strong> a team of mechanical engineers is perfecting a computer model that could have profound implications\u2014from the battlefield<\/strong>\u00a0to the playing field<\/strong>.<\/em><\/p>\n\"conquering-concussion_lead\"\n

Knocked Out.\u00a0Bell Rung.\u00a0Punch Drunk.\u00a0Shell Shocked.\u00a0Seeing Stars.\u00a0The lexicon of concussion is<\/strong>\u00a0long and colorful, but creative as these twists of phrase are, they mask a much darker truth: Head trauma is no laughing matter.<\/p>\n

In the best cases, a short wait, a few smelling salts, and things are back to normal. In more serious cases, the resulting dizziness, moodiness, headaches, and confusion can haunt the victim for life. In the most extreme cases, repeated concussion can be fatal.<\/p>\n

Deciphering the difference between these extremes has been a challenge for medical science. Concussion cannot be photographed or measured by conventional medical imaging\u2014MRI, CT, PET scans, and the like\u2014and so it remains a largely invisible menace. Doctors are left with an arcane series of cognitive tests to determine whether an injury has occurred and, if so, how bad the damage is. It is a problem that has become, quite literally, a matter of life and death.<\/p>\n

Into this void have stepped K.T. Ramesh, the Alonzo G. Decker Jr. Professor in Science and Engineering, and a team of mechanical engineers who have begun to apply their specialized knowledge of extreme materials to better understand traumatic brain injury. Ramesh, a professor of mechanical engineering and director of the Hopkins Extreme Materials Institute (HEMI), has developed an advanced computer model that uses real-world data to recreate the physiological and biomechanical dynamics of brain injuries. His goal is to combine real-time, in-game data from sensors mounted in helmets and mouth guards to help assess brain injuries as they happen.<\/p>\n

\u201cWe call our model the digital head, and believe it will address some of the big challenges of studying brain injury. The biggest is ethical in nature because you can\u2019t do injury-causing experiments on living people, so the digital head gives us insights that just aren\u2019t available in other ways,\u201d explains Nitin Daphalapurkar, an assistant research professor at HEMI, collaborating with Ramesh on the project.<\/p>\n

Though computer models to study brain injury are not new, Ramesh and Daphalapurkar have incorporated several novel factors in their model that help them not only understand what is happening to the cellular and subcellular structures of the brain but also pinpoint where damage has occurred and what sort of cognitive impairments\u2014blurred vision, memory loss, dizziness, and so forth\u2014might result from any specific injury.<\/p>\n

Jell-o With a Twist<\/h2>\n

Ramesh has approached the matter as a true engineer, as a study of a complex biomechanical material. The brain is hyperelastic. In texture, it is not unlike Jell-O. Tap it, shake it, push it, pull it, the brain will move about, stretching, straining, and deforming but eventually returning to its resting state.<\/p>\n

When the head is subjected to a rapid and powerful force or change of direction, like that from an aggressive hit in football, a car accident, or the explosion of a bomb, the brain quite literally sloshes around within the rigid confines of the skull, compressing and stretching, twisting and turning until the energy of the blow dissipates. These motions are at the core of traumatic brain injury. <\/p>\n

\"conquering-concussion_body1\"
Nitin Daphalapurkar (left) with K.T. Ramesh<\/figcaption><\/figure>\n

\u201cWe\u2019re dealing with a very soft material inside a very hard structure. A hit to the head causes pressure waves and shear waves to move through the brain, like a rap on a bowl of Jell-O,\u201d Ramesh says.<\/p>\n

\u201cThese stresses and strains can cause injuries that cascade through the tissues and create larger damage and cognitive problems,\u201d Daphalapurkar adds.<\/p>\n

Here the analogy with Jell-O ends. The brain is not a monolithic structure in which all the physical features and tissues behave identically. It is instead a complex mesh of different structures\u2014neurons and axons, meninges and synapses, dendrites and glia\u2014each responding in its own way to physical forces. In technical terms, the brain is anisotropic. Like a piece of wood, it is stronger and more resilient in certain directions than in others. The engineer\u2019s job is to anticipate and account for these varying behaviors in the computer models. This is no easy task.<\/p>\n

The team has focused its attention on the axons, the long, thin threads of cells that carry electrical impulses from neuron to nearby neuron. Filled with fatty lipids, axons appear white to the naked eye and make up the majority of the brain\u2019s inner structure, known appropriately as the white matter.<\/p>\n

Surprisingly, however, while strain on the axons has been shown to cause functional damage to neurons, it has never been used to calculate injury in computational models of traumatic brain injury.<\/p>\n

The sloshing of the brain due to head trauma stretches the axons, causing damage and brain malfunction,\u201d Ramesh says. \u201cWe\u2019re the first to incorporate axonal damage in computer models of head trauma.\u201d<\/p>\n

The team is trying to decipher why some physical movements in the brain cause severe damage and others do not. More specifically, they are trying to determine where the fine line between minor and serious injury is drawn.<\/p>\n

\u201cIn earlier computer models, brain tissue was often treated as this homogeneous material, ignoring the various internal structures that behave very differently from one another,\u201d Ramesh says.<\/p>\n

In addition to treating the brain as an anisotropic material, Ramesh has gone deeper still by adding rotational acceleration to his algorithms. There are two types of acceleration: linear, which moves in a straight line, and rotational, which spins around an axis like a figure skater. The automobile industry uses a set of metrics known as the head injury criterion to predict brain injury, but it ignores rotational acceleration and therefore falls short of the nuance Ramesh is after.<\/p>\n

\u201cIn traumatic brain injury, anatomy really matters. Our models allow us to see in real time how brain deformations vary from one person to another, and from force to force,\u201d Daphalapurkar explains. The final piece of the computational puzzle was incorporating the orientation of the axons into the models. In this regard, modern brain imaging tools proved critical.<\/p>\n

Diffusion tensor imaging, a form of MRI, is able to measure the direction of the flow of water through tracts in the white matter of the brain. Though it doesn\u2019t help to illuminate damage necessarily, it can tell the researchers important information about the alignment of the fibers of the brain.<\/p>\n

\u201cIt can tell us where the wires go,\u201d says Ramesh. Like the grain in wood, the alignment of the axons\u2014the wires in Ramesh\u2019s analogy\u2014 makes the tissue stronger in some directions and weaker in others.<\/p>\n

Combining all three factors in his calculations\u2014anisotropy, rotational acceleration, and axonal orientation\u2014Ramesh paints a remarkably detailed picture of traumatic brain injury in his model and has revealed some surprising findings about brain trauma.<\/p>\n

The first is that the human brain is actually quite good at sustaining head-on motions and, to a lesser degree, side-on, lateral movements. This is likely due to the fact that humans have evolved as bilaterally symmetric organisms, and the majority of axons have naturally followed suit, aligning to better endure forces in certain directions.<\/p>\n

Just as the model shows where the brain is most resilient, however, it also demonstrates where it is most vulnerable. Ramesh and team have found that the greatest damage to axons occurs from rotational motion, as if the brain were being wrung like a washcloth. In mechanical science, this stress is known as shear.<\/p>\n

Boxing fans might imagine the classic knockout punch to the jaw that can drop a heavyweight in an instant. It is believed that this shearing motion stretches the axons to the point that normal biochemical processes are disrupted, leading to impairment or even cell death. The degree of injury is related to how much and how fast the axons get stretched. Ramesh\u2019s team uses an experimentally characterized threshold at the point where the axons stretch more than 18 percent beyond their normal length.<\/p>\n\"\"\n

Increasing Scrutiny<\/h2>\n

Concussion is a subset of a broader continuum of brain injuries known as mild traumatic brain injury, but even the experts diverge on exact classifications and the terms often are used interchangeably. For many experts, however, there is a distinction.<\/p>\n

\u201cA concussion is temporary,\u201d says Daphalapurkar. \u201cIt\u2019s when the brain has been rattled due to traumatic accelerations disrupting normal function. Mild traumatic brain injury, on the other hand, is a physical change in the brain in which the cells have been deformed to an extreme level.\u201d<\/p>\n

While terminology of brain injury is a matter of debate, the threat posed by such injuries is not. Concussion has come under increasing scrutiny in recent years fueled largely by concerns for the long-term mental and physical health of soldiers and million-dollar athletes who have sustained head trauma. Numerous former athletes have shown signs of a once rare but increasingly common condition known as chronic traumatic encephalopathy (CTE). CTE is a serious degenerative brain disease caused by repeated concussions, like those suffered over a lengthy football career. The lifelong and often debilitating symptoms include irritability, memory loss, and confusion, among many others.<\/p>\n

CTE can only be diagnosed posthumously, but it is turning up in an alarming number of autopsies performed on retired players from virtually every professional sport today, from football, baseball, and soccer to horse racing.<\/p>\n

In an effort to address the growing concerns for the safety of the athletes, the National Football League, General Electric, and Under Armour have sponsored the Head Health Initiative, a $20 million effort to advance the development of technologies that can detect early stage concussions and improve brain protection.<\/p>\n

The first of two challenges set out by the Head Health Initiative is focused on discovering imaging technologies and algorithms to better detect and analyze the changes in the brain from head trauma. The second challenge is to find new materials and technologies that protect the brain and track head impacts in real time.<\/p>\n

To help fulfill these goals, Ramesh and Daphalapurkar envision a biomechanics-based digital head that could help to better identify traumatic injuries in real-time and to design systems able to protect players from injury. Such models might someday be used for in-game evaluations of players involved in sports accidents.<\/p>\n

\u201cProfessional sports are being documented like never before, in high-definition and from multiple angles,\u201d Ramesh says. \u201cWe can use this footage to reconstruct the specific forces in a collision and determine, on the spot, what level and type of force a player has sustained.\u201d<\/p>\n

Down the road, Ramesh can foresee a day when football helmets, mouth guards, and other equipment are fitted with sensors that might feed real-time data into the digital head to determine the presence and extent of injury. This information might also be used to build better equipment. But the problem is larger than gear alone can solve.<\/p>\n

\u201cWe\u2019re hoping to use that information to provide guidance not only to the doctors and to the people who make equipment but also to those who make the rules of the game,\u201d says Ramesh.<\/p>\n

Yes, No, Maybe: The Basics of Brain Trauma<\/h2>\n\"conquering-concussion_body3\"\n

Using real-world acceleration data, Professor K.T. Ramesh has created a computer model that anticipates where axonal damage is likely to occur during concussion and to map those injuries to cognitive impairments that might result.<\/p>\n

His model tells him many things, but one of the most surprising is that the direction of a blow is often as important to injury as the amount of force applied. Determining which type of hits is the most risky is as easy as yes, no, and maybe.<\/p>\n

The forward-and-back motion of an affirmative nod (y) is the least likely to cause injury. The researchers describe this as a \u201cyes\u201d motion. The shoulder-to-shoulder motion (x) of indecision, known as \u201cmaybe,\u201d tends to cause more damage. The left-right twist (z) of a negative response also induces the rotational motion that is most harmful to the brain. This is referred to as the \u201cno\u201d motion.<\/p>\n

Ramesh believes that these disparities are the result of underlying structural differences in the orientation of the tissue-level fibers in the white matter that make the brain tissue more resilient in certain directions than others.<\/p>\n

\u201cUsing head models, we think we will be able to tell players when they have been injured and perhaps even when they can return to the game safely,\u201d says Ramesh.<\/p>\n","protected":false},"excerpt":{"rendered":"

With their \u201cdigital head\u201d a team of mechanical engineers is perfecting a computer model that could have profound implications\u2014from the battlefield\u00a0to the playing field. Knocked Out.\u00a0Bell Rung.\u00a0Punch Drunk.\u00a0Shell Shocked.\u00a0Seeing Stars.\u00a0The lexicon of concussion is\u00a0long and colorful, but creative as these twists of phrase are, they mask a much darker truth: Head trauma is no laughing…<\/p>\n","protected":false},"author":4,"featured_media":538,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[28],"tags":[],"class_list":["post-212","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-features","issue-summer-2014"],"acf":[],"yoast_head":"\nConquering Concussion - JHU Engineering Magazine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/engineering.jhu.edu\/magazine-archive\/2014\/05\/conquering-concussion\/\" \/>\n<link rel=\"next\" href=\"https:\/\/engineering.jhu.edu\/magazine-archive\/2014\/05\/conquering-concussion\/2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Conquering Concussion - JHU Engineering Magazine\" \/>\n<meta property=\"og:description\" content=\"With their \u201cdigital head\u201d a team of mechanical engineers is perfecting a computer model that could have profound implications\u2014from the battlefield\u00a0to the playing field. 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