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Old 04-11-10, 04:14 PM   #1
jeff juel
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A type of brain injury that could be made worse by wearing a bike helmet

A few years ago I flew over my handlebars while cruising at about 25 mph. I landed head-first on the road and proceeded to do three cartwheels (per a witness). I was wearing a helmet at the time. It got scuffed up and cracked, but it stayed on, held together, and did its job. Unfortunately, I was knocked out cold and was looking pretty lifeless - other than a few grand mal seizures. I spent three days in a coma and ultimately I was diagnosed with Diffuse Axonal Injury or DAI. Most people with DAI are vegetables until they die. I was lucky.

I had what is called a closed-head traumatic brain injury. My skull was perfectly intact. (I'm still pretty - to quote Ali.) The damage to my brain was the result of rapid angular acceleration. In essence, my head suddenly rotated when my helmet hit the pavement. If you ever watch a plane's wheel make contact with the ground when it's landing, you get an idea how your head would experienced a rapid acceleration in a case like this.

The rotation/acceleration generated shearing forces that tore up bits of my brain. There was bleeding here there and everywhere inside my head.

I'm an engineer, so I've given this a little analysis...

The helmet effectively increased the twisting force that was spun into my brain in two ways:

1) The helmet "grabbed" the pavement better than my scalp would have. (Without the helmet, a piece of my scalp might have been ripped off. Not pretty, but it's better than a large torque causing a TBI and being a vegetable for life.)

2) The helmet increased the length of the moment arm that the friction force acted through. This resulted in a greater torque and an increased angular acceleration of my head.

My helmet resulted in a more severe twisting force being cranked into my head by the impact. I'm very confident that in my case, my helmet exacerbated my injury.

For many or most accidents, it's likely that a helmet reduces the severity of an injury. But there are exceptions.

I would love to know if any of the helmet manufacturers have considered this scenario and if they have determined how frequently this type of injury happens to crashing bike riders wearing helmets.
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Old 04-11-10, 04:44 PM   #2
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A "hard" shell which would have less friction effect with the road would have reduced this type of injury. I have had no similar experiences. There are also rare cases where seatbelts have aggravated injuries in cars.
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Old 04-11-10, 05:01 PM   #3
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I think what you may have missed in your calculations is that, in order for the helmet to'grab' the pavement, there had to be significant force involved in the helmet/asphalt interface -- likely enough force to crack and displace bone, not just remove scalp. So you would have been left with two choices -- where you are, or vegetative/deceased after having some brain matter ooze out of the open skull fracture.

Not saying this as an absolute, of course, but the odds are pretty remote against the helmet making it worse. Now, MOTORCYCLE helmets, the full-face type, have been proven to be deadly in a 'faceplant' type of accident, as the impact is transferred directly from the helmet to the jawbone, effectively locking it in place, and rotating the skull away from the spine -- severing the spinal cord. (That's just a bit of barely related info, for no special reason.)
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Old 04-11-10, 07:22 PM   #4
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This sounds like a good argument for a spherical helmet, such as my Giro Xen, rather than an aerodynamic teardrop.
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Old 04-12-10, 07:36 AM   #5
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Robert Hurst talks a little about this type of injury in The Art of Urban Cycling... a good introductory discussion. What happens in many cases is that the vents on many of the higher-end helmets can catch on the pavement can create torsion that aggravates neck and spinal injuries. Bike helmets are designed and tested for direct impact, intending to protect against skull fractures and concussion... but hitting the ground at speed can do other types of damage.

The Bicycle Helmet Safety Institute recommends a helmet that uses a substantial amount of foam, as well as not a whole lot of venting... something more like the Bell Citi or Metro models.
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Old 04-12-10, 07:37 AM   #6
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How were you able to conclusively determine the brain injury was caused by rotation as a result of the helmet "grabbing" the asphalt. Its seems just as plausible that the injury was caused by the sudden deceleration caused by you hitting the pavement head first after the endo.

Glad to hear that you are ok.
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Old 04-12-10, 07:47 AM   #7
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To me, this reads as if the OP is a first rate social engineer.
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Old 04-12-10, 07:51 AM   #8
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Originally Posted by DX-MAN View Post
I think what you may have missed in your calculations is that, in order for the helmet to'grab' the pavement, there had to be significant force involved in the helmet/asphalt interface -- likely enough force to crack and displace bone, not just remove scalp. So you would have been left with two choices -- where you are, or vegetative/deceased after having some brain matter ooze out of the open skull fracture.

Not saying this as an absolute, of course, but the odds are pretty remote against the helmet making it worse. Now, MOTORCYCLE helmets, the full-face type, have been proven to be deadly in a 'faceplant' type of accident, as the impact is transferred directly from the helmet to the jawbone, effectively locking it in place, and rotating the skull away from the spine -- severing the spinal cord. (That's just a bit of barely related info, for no special reason.)
Also consider that a helmet can increase the peak force of impact. Imagine that you fall sideways, so that your shoulder hits the ground first. Your neck head approximately pivots about a point at the base of your neck. This means that your shoulder stops when it hits the ground and your head continues to rotate. For most people, the neck will bend until your ear hits your shoulder. The scalp will just touch the ground at a skimming angle. I would imagine that this is not merely a coincidence of human anatomy, but a product of millions of years of experience falling out of trees. If you add an extra 1.5 inches of radius around your head, now the shoulder hits the ground, and the arc of the larger head+helmet goes directly into the ground rather than into your own shoulder.

I imagine that this factor may bias some of the stories of, "My helmet took a huge impact and shattered. Surely I would have died otherwise" Without the helmet, there may not have been any great impact. Unless you fall backwards onto the back of your skull, head first into the ground like a lawn dart, or there is some hard object sticking up, it is difficult for the ground to deliver a crushing blow to your skull. These are all very possible situations to have in a bad crash, but not the most likely.

Also, to the OP, remember that you are still dealing with a finite amount of energy when you talk about increasing lever arms. The longer the lever arm the greater the torque, but the lower the rotational velocity for the same situation. If your scalp caught the ground like a helmet, there may be less torque, but it could spin your head about much faster, delivering the same amount of energy to the brain. The argument is whether the scalp-pavement interface, delivers more rotational momentum to your brain than the helmet-pavement-head interface.
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Old 04-12-10, 07:59 AM   #9
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I would think there is very little difference in the torque applied to the head when wearing a helmet vs non helmet. For one thing the helmet isnt very thick so it adds very little to the radius from the pivot point. Second most helmets have the smooth outer coating so unless there was something sticking out of the road to catch in a vent it would tend to slide arond the road easier than your skin/hair. My bet is that without the helmet your skin would have dug into the road and tore it open pretty good, probably even damagng the bone under and still rotate your head and flip you over as happened with the helmet. You would have more likely sustained more injuries.
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Old 04-12-10, 08:17 AM   #10
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I don't think this is really cause to not wear a helmet. This type of brain injury seems rare... but then again, brain injuries are rare to begin with.

The real key to preventing these types of injuries, is helping riders learn how not to flip over their handlebars and to prevent other serious types of crashes. Its crash prevention over injury mitigation.

Seems backwards we focus so much in this forum on helmets, yet, there isn't very many good discussions about safe bicycling techniques, avoiding crashes, etc.
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Old 04-12-10, 09:25 AM   #11
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Grease your helmet.

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Old 04-12-10, 09:32 AM   #12
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twisting and body parts never has a good outcome. my tibia broke because it was twisted like a pencil.

glad you recovered enough to analyze the accident! any side effects that lasted until now?
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Old 04-12-10, 09:44 AM   #13
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Check out "Blowing the Lid Off" in motorcyclist magazine back in about 2005. That was a very indepth article about TBI and helmets that should give you plenty to think about, even if they're motorcycle helmets.
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Old 04-12-10, 09:54 AM   #14
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This issue has been discussed in detail on the Helmets Cramp my Style thread. (part 2, for sure. It's possible it was discussed in part 1. Hasn't come up yet in part 3)

It goes hand in hand with the point that no helmet can prevent concussion and speaks specifically to the point of brain injury, which I believe, is what is of prime concern to cyclists. I don't believe cuts and scrapes are thought of as nearly as serious as brain injury is.

There have been many links provided and a few personal examples of DAIs devastating effects.

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Old 04-12-10, 09:56 AM   #15
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What someone should design is something like the avalanche airbag. It is a really expensive backpack for backcountry skiing that inflates when the skier pulls the ripcord. The big balloon helps keep their head above the snow and pushes them to the surface.

Well imagine the same sort of thing that inflates when it detects that you enter free fall (flying through the air and nothing resisting the force of gravity). It could stabilize your neck a bit and and cushion impact to your head, spine, and any vital organs. The large volume would also increase your drag and dissipate some of your kinetic energy as you fly through the air.

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Old 04-12-10, 10:06 AM   #16
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I don't have time to make a full contribution to this thread.

I will only point out that you absolutely cannot judge the "smoothness" or "slipperiness" of a helmet by running your fingers across the shell. Depending on the material that it interacts and the pressure it is subject to, the helmet may generate a completely unpredictable level of friction.
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Old 04-12-10, 10:16 AM   #17
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Point. However, NOTHING is absolute, so let's ease off of that, ok? Everyone, me included?
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Old 04-12-10, 10:38 AM   #18
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Quote:
Originally Posted by jeff juel View Post
...I would love to know if any of the helmet manufacturers have considered this scenario and if they have determined how frequently this type of injury happens to crashing bike riders wearing helmets.
The manufacturers have known about this mechanism since it's been understood for a long time. Designs have been developed that could possibly reduce this type of injury but have been rejected by manufactures because they would be too complex and expensive to make. As a result, a couple of small companies have tried to sell these, better designed helmets but with limited results.

Current manufacturers are doing well with the simple design they already have. They've managed to convince the public that these helmets are "safe" and that they "save lives" so there is no need to improve on design as long as the public is already sold on it.
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Old 04-12-10, 10:50 AM   #19
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My cousin has DAI. You sound like you got very lucky.
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Old 04-12-10, 10:59 AM   #20
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Most people with DAI are vegetables until they die.
Really? I thought that DAI was just a description of a mechanism of axon damage that could be experienced as a spectrum of problems[1] ranging from some functional problems through to vegetative coma. The same citation also claims that DAI is more common in road-traffic accidents than simple falls (making your case rarer.)

Quote:
Originally Posted by jeff juel View Post
I had what is called a closed-head traumatic brain injury.
I've got to say that your post reads as though you've made an incredibly good recovery. I'm glad for you.

Quote:
Originally Posted by jeff juel View Post
I'm an engineer, so I've given this a little analysis...

The helmet effectively increased the twisting force that was spun into my brain in two ways:

1) The helmet "grabbed" the pavement better than my scalp would have. (Without the helmet, a piece of my scalp might have been ripped off. Not pretty, but it's better than a large torque causing a TBI and being a vegetable for life.)

2) The helmet increased the length of the moment arm that the friction force acted through. This resulted in a greater torque and an increased angular acceleration of my head.

My helmet resulted in a more severe twisting force being cranked into my head by the impact. I'm very confident that in my case, my helmet exacerbated my injury.
It sounds plausible, but I don't see how you can be any more confident that it's correct than the people that claim that a "helmet saved my life." On the Helmets Cramp My Style thread that closetbiker posted about one of the contributors is fond of quoting a paper by Mills et al which claims to show that the increased rotation due to a helmet is negligible[2]

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Originally Posted by jeff juel View Post
For many or most accidents, it's likely that a helmet reduces the severity of an injury.
That's an assumption that is completely at odds with the data gathered in Australia over the past decade. There's a further problem in that you're lumping together all sorts of head injuries: it may be true that helmets can prevent tears to the scalp, but it remains to be shown that they prevent the sort of life-threatening problems you've experienced.

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I would love to know if any of the helmet manufacturers have considered this scenario and if they have determined how frequently this type of injury happens to crashing bike riders wearing helmets.
Wow, almost reads like a viral-marketing exercise for the Phillips helmet[3].

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1031929/

2. Mills, N.J. & A. Gilchrist. International Journal of Impact Engineering Volume 35, Issue 9, September 2008, Pages 1075-1086

3. http://www.newscientist.com/article/dn418-soft-hat.html
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Old 04-12-10, 11:09 AM   #21
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I think what you may have missed in your calculations is that, in order for the helmet to'grab' the pavement, there had to be significant force involved in the helmet/asphalt interface -- likely enough force to crack and displace bone, not just remove scalp.
Wrong. Try again.
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Old 04-12-10, 11:14 AM   #22
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Look at all the armchair physicists!

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Old 04-12-10, 11:15 AM   #23
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Lets see... a bit of digging through the thread and I pulled up (HCS pt. 2)...

Diffuse axonal injury is one of the most common and devastating types of traumatic brain injury. It occurs in about half of all cases of severe head trauma and also occurs in moderate and mild brain injury.

DAI is the result of traumatic shearing forces that occur when the head is rapidly accelerated or decelerated. It usually results from rotational forces or severe deceleration. Vehicle accidents are the most frequent cause of DAI; it can also occur as the result of child abuse such as in shaken baby syndrome. The violent shaking of an infant that causes shaken baby syndrome commonly manifests as diffuse injury.

Concussion, is the most common type of traumatic brain injury. It may be caused by impulsive forces, in which the head moves without itself being subject to blunt trauma. The amount of rotational force is thought to be the major type of force to cause concussion and the largest component in its severity. Studies with athletes have shown that the amount of impact force and the location of the impact are not necessarily correlated to the severity of the concussion or its symptoms.

and from the New England Journal of Medicine:

Mechanism of Concussion.

Biomechanical investigations dating back to the beginning of the 20th century suggest that concussion results from a rotational motion of the cerebral hemispheres in the anterior–posterior plane, around the fulcrum of the fixed-in-place upper brain stem...Concussions as portrayed in movies and cartoons, in which the back of the head is struck with a blunt object and no motion is transferred to the brain, are implausible. The modern view is that there is disruption of the electrophysiological and subcellular activities of the neurons of the reticular activating system that are situated in the midbrain and diencephalic region, where the maximal rotational forces are exerted.




JWC posted in part 1 of the original HCS thread and related his story in several posts...

Quote:
I had a car wreck in 1998. As a result, I sustained a brain injury. At the accident scene, I declined a trip to the emergency room, since I was thought to be uninjured and the police thought so too. You see, my head didn't impact anything, but a few days later, I would find that I did indeed sustain a serious injury...to my brain. It wasn't until it was explained to me by a specialists that I understood how the brain is injured.

Here is how the specialist explained it to me when I told him that I didn't hit my head, so didn't believe there was any injury.

Break an egg into a bowl. Move the bowl rapidly and you'll see the egg move in the opposite direction, hitting the side of the bowl. Stop the bowl suddenly and the egg will hit that side of the bowl. That is how your brain reacts inside your skull.

It amazes me that no matter how many times I repeat the story of my brain injury and how it occurred, everyone just ignores it...Again, my injury occurred without ANY impact at all. Just a sudden jolt... My accident involved being broadside by another car going about 20 miles per hour. I had a whole car absorbing the direct impact, but it couldn't protect my brain from the sudden change in direction.

I think we're forgetting that it isn't always about how much the helmet can absorb in any kind of sudden motion...but how much the brain can absorb when it impacts the inside of the skull.

...As my specialist told me...nothing can protect you from a concussion that will do serious damage to the brain.

In other words, with a helmet, you'll still be drooling, but you'll look better...

One of my co-workers always asked where my helmet was if it was a day I decided not to wear it. Until she had to do clinicals in the brain injury unit at the local hospital. She walked up to me and said that now she understood what I had been telling her about how the brain is injured and related what doctors had told her about helmets (all kinds) and how ineffective they are or can be. The point is, she just took everything said about how safe helmets are at face value and tried to force that belief on those she thought were doing dangerous things, like riding a bicycle.

based on my experience, I do not take too seriously a comment from a paramedic or ER doctor...who states as fact that death would have been the result if a helmet had not been present....since I had a brain injury and each missed all the symptons and signs. If they don't understand brain injuries and how they occur, their remarks are simply opinion. For me, since I had no external injury, the doctors I first visited believed I had no head injury and released me.
And as I said earlier, no helmet can prevent a concussion, but there have been a couple of companies that have improved designs of bicycle helmets (like Ridell has tried to improve the design of the football helmet)

Phillips helmets has developed a better designed helmet that, doesn't eliminate, but helps reduce rotational forces.

A Swedish company (MIPS) has also done this.

It's widely acknowledged that the current, popular design of bicycle helmets do nothing to prevent this type of injury and in fact, can increase the chances of rotational injury occurring.

I still think the chances of receiving a head injury while cycling are low enough to go without a helmet but if one were to impact the head in a fall, wearing one of these brands would be of better use than the current models of bicycle helmets.

Last edited by closetbiker; 04-12-10 at 02:19 PM.
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Old 04-12-10, 12:26 PM   #24
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Bike Helmets and brain injury

Thanks for all the feedback. The Phillips helmet is exactly what I've been thinking makes sense for solving the problem.

I was inspired by the info so I browsed and found: http://www.cycle-helmets.com It's wonderful - but I'm a bit of a heretic, so it appealed to me more than it probably should have.

http://www.cycle-helmets.com/helmet_compensation.html is particularly thought-provoking.

I love finding stuff that flies in the face of common sense and proves conventional wisdom wrong. Remember the tourniquet? That thing seemed like it made perfect sense.

I was agnostic.... now I'm pretty certain that helmets are a bad idea. Besides not being very effective at preventing injury, they: provide a false sense of security; could cause greater forces on your brain; discourage chicks from riding bikes and messing up their hair; make your head bigger (and a bigger target for passing signs etc); be a distraction.

Speaking of a distraction, check out this underpass on the Samammish River Trail near Seattle WA

A kid hit me head-on coming around the corner a few weeks ago. The Sheriff's accident report said nothing about what a crappy alignment the trail has here - but helmets were accounted for. Ridiculous. MAKE THE TRAILS AND ROADS SAFE!!!! Helmets are a panacea!
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Old 04-12-10, 02:57 PM   #25
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If you're interested, you might want to check out the third version of the Helmets Cramp My Style thread.

At this point, it's only 8 pages long, has little in the way of arguing (although there is some...), and is mostly composed of various helmet blogs I've seen on the web and posted on the thread.
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