Why didn’t my bike helmet prevent my TBI?

BY: SOPHIA VOUMVAKIS

15 per cent of the approximately 18,000 traumatic brain injuries (TBIs) that occur in a year in Ontario are a result of a cycling accident. Every year in Canada, over 11,000 people die as a result of a traumatic brain injury (TBI) – using the same 15 per cent – that’s over 1600 people in Canada who die as a result of a TBI caused by a cycling accident. 85 per cent of all cyclists’ deaths in Canada involve a brain injury.

A little over five years ago, I sustained a TBI while riding my bike. It was a beautiful spring morning, and I was riding my bike to work, as I had hundreds of times before. I remember leaving my home that morning, and then waking up in the emergency room at St. Michael’s Hospital, several hours later. I was told by the doctors in the emergency department that I had been knocked off my bike, hit the ground, passed out, and taken to the ER by ambulance. Several hours later I was diagnosed with a brain injury. To this day, I have no memory of the incident.

I was wearing a bike helmet, which I always did, but my helmet did not protect me against acquiring a TBI. I’d always wondered why, and recently I got my answer. I came across a TED Talk by bioengineer (and former football player) David Camarillo, who, along with his team at Stanford University, has been able to demonstrate what really happens to our brain during a concussion, and why bike helmets, and other sports helmets, such as football helmets are not designed to protect against concussion, but rather, they are designed and tested to determine how well they protect against skull fracture.

What happens to your brain during a concussion?

The standard thinking of what happens to your brain during a concussion is that the head moves, the brain lags behind, catches up, smashes into the skull, rebounds off the skull and then proceeds to run into the other side of the skull. This dynamic is repeated many times. This understanding of what happens to the brain during concussion suggests that the brain is damaged on the outer edges.

In his Stanford University lab, Camarillo and his team, with the aid of new technology, have looked closely at what happens to the brain when it is experiencing a concussion. Their investigations suggest that the current thinking about what occurs to the brain during a concussion is not entirely accurate. Firstly, he does not believe that the brain moves around as much as current wisdom suggests. Camarillo argues that there is very little room in our cranial cavity for movement, perhaps a few millimetres, and our cranial cavity is filled with spinal fluid, which acts as a protective layer. Secondly, he suggests that the brain does not move as a whole.

Football player with ball about to fall to the ground

Our brain is one of the softest organs in our body – the consistency of Jell-O – and as the brain moves around in our skull during a concussion, it is probably twisting and turning and contorting – the tissue is getting stretched. Concussion does not appear to be something that is happening to the outer edges of the brain, but rather it is happening somewhere much deeper, in the centre of the brain.

The Laboratory – The Stanford Football Team

To help Camarillo and his team better understand what is happening to the brain during a concussion they utilized a mouth guard equipped with sensors and a gyroscope, which most experts believe can tell us what happens to the brain during a concussion. When someone is struck in the head, the mouth guard records how the skull moves at a thousand samples per second.

The study’s laboratory is the Stanford football team, young men who regularly go out and hit their heads.  This allows for rich information to be obtained when the researchers extract the data out of the mouth guard.

When the data from the mouth guard, was combined with a finite element model of the brain, developed by Svein Kleiven in Sweden, it showed that the brain of football players, who have suffered a concussion does not smash around in the skull, as current thinking would lead us to believe, but rather twists and contorts. The data shows that the greatest amount of stretching occurs very close to the centre of the brain.

What’s there? The corpus callosum, the wiring which connects the left and right hemispheres of your brain. Camarillo believes that this might be one of the most common mechanisms of concussion, the wiring is being disrupted, which causes a disassociation between your right and left brain and could explain a lot of the symptoms one sees in concussion. This is consistent with what researchers see with Chronic Traumatic Encephalopathy (CTE) – when the corpus callosum of a middle aged, former football player is viewed, and compared to an individual who does not have CTE, his corpus callosum is greatly atrophied.

Although there is a rapid transmission of forces down to the corpus callosum when the head is struck, it does take a certain amount of time. What Camarillo and his team believe is that if we can slow the head down just enough so that the brain does not lag behind the skull, but instead moves in synchrony with the skull, then we might be able to prevent this mechanism of concussion.

How can we slow the head down?

The most currently used bicycle helmet is constructed of expanded polystyrene (EPS) foam within a thin plastic shell. The EPS liner absorbs the force of an impact by deforming, while the outer shell increases the area over which the force is dissipates. The main considerations when designing a bike helmet is the size and stiffness of the helmet, which impacts how efficiently energy is absorbed. As a result of the materials used in constructing an EPS helmet, the size of the helmet has been limited to a few inches. This does not slow down the head enough to enable the brain to move in synchrony with the skull, rather than lag behind the skull. It turns out that air, in an expandable helmet would be the ideal mechanism for slowing the head down enough during impact, so that the brain moves in synchrony with the skull, rather than lagging behind.

woman wearing a skirt standing with her bike

It turns out that a company in Sweden called Hovding, is using the principle of air to give the wearer of their ‘helmet’ some extra space to prevent concussion. Hovding has created what is essentially the world’s first airbag for cyclists. The Hovding is a collar, worn around the cyclist’s neck, that uses advanced sensors, similar to the sensors used in the mouth guards described in Camarillo’s research above, that can sense the cyclist’s movement patterns and will react in case of an accident. The airbag will then inflate, fixate your neck and provide a shock absorption. In experiments conducted by Camarillo and his team they have found that the Hovding collar can greatly reduce the risk of concussion in some scenarios, compared to a standard EPS bike helmet. The Hovding is currently for sale in Europe and Japan, and is CE labelled, which means it complies with European Union safety standards, but not for sale in the United States, and alas, Canada.

In the US, bike helmets are federally regulated by The Consumer Product Safety Commission. The Commission has jurisdiction over the type of helmets they approve. The test they use in order to grant approval to a bike helmet is testing the helmets capacity to prevent skull fractures, not whether the helmet is likely to prevent concussion. In Canada, The Canadian Standards Association accredits organizations to certify that bicycle helmets meet certain standards, such as CPSC bicycle helmet standard, which uses the tests described above by Camarillo.

I contacted Hovding and asked about the availability of their helmet in Canada – alas, it is not available here. They replied that, at this time, they have not investigated helmet certification in Canada. So it might take some time to get my head into one!

Even so, any helmet is better than no helmet, so keep wearing whatever helmet you have, and wear it properly.

 Resources

Modelling and Optimization of Airbag Helmets for Preventing Head Injuries,  published in The Annals of Biomedical Engineering in September 2016.


Since her TBI in 2011, Sophia has educated herself about TBI. She is interested in making research into TBI accessible to other survivors.

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#TBT Paralympian Frank Bruno carries the Pan Am torch for brain injury awareness

BY: MERI PERRA

If you’ve ever attended a BIST event, you’ve likely meet Frank Bruno.

For one, Frank’s been volunteering at BIST since before day one, during our predecessor’s Head Injury Association of Toronto (HIAT) days.

Frank Bruno at the Pan Am Relay

You can tell time by when Frank shows up, always a good 45 minutes early, to make coffee and set up for our monthly community meetings. He’s willing to do whatever it takes to help out – this past April, he used his connections in professional hockey to get us free tickets to the Hockey Hall of Fame. Frank’s the one who sets up an indoor golf game at our holiday party every year, and is our encouraging coach during our annual Frisbee golf games at Centre Island.

The point – we were pretty thrilled when Frank told us he’d been selected as a torch-bearer at the Pan Am Relay for the Toronto 2015 Games.

Why? Because – because on top of all of this Frank is a three-time Paralympic gold medal winner. He’s accomplished a lot, and inspired many.

Here’s our Q and A with Frank about the big day – which happened July 4th at the Parliament and Wellesley area in Toronto.

Frank Bruno Pan Am Relay

 BIST: What was it like to carry the Pan Am Torch?

FB: It was a great day for brain injury. I was the one who got to carry [the torch] , but it was for the brain injury community. Seeing all the happy smiles makes for a great day.

BIST: Who came out to see you at the relay?

FB: I had a lot of family and a number from the brain injury communities, plus several from my high school ( most of which I do not remember, because of the injury) and several from Durham College. My coach Faye Blackwood was also there.

Frank Bruno Pan Am Relay

BIST: What did you do after the relay?

FB: The day is filled with  a lot of hurry up and wait. Once you get there , you listen to what you are to do and when you are to do what. The wait is really very anxious, you wanna go out there and do your walk.

You all get loaded into a bus (14 of us on July 4, 2015 ) and one by one you get dropped off at your specific location. Then you wait for the flame to come to you. Once your torch gets lit from the previous person you are off on your way to do the 250 meters.

You are allowed to hop, skip,  jump or run, but with the lit torch in your hand do you wanna make the short course over in 30 seconds or make it last, and last as long as possible? I choose to walk, so many people got to see me carry the flame for brain injury. Once you light the torch after you, you walk off the street and they de-light your torch and they take your torch and your day is done. I went with my family to have dinner

BIST: What did the Pan Am Games give you for doing the relay (outfit, anything else you got to keep, free tickets?)

FB: I was given a Pan Am outfit, a shirt, shorts, a pair of socks and a wristband. Nothing else, no tickets no nothing, I had to buy the torch that I used for $550 plus taxes. [The day before posting this article, Frank told us he had managed to fundraise enough money to get his torch, see below.]

Frank Bruno Pan Am Relay
Frank poses with Tracy Moore, host of City’s Cityline who also did the relay on July 4th

BIST: Did you get to go to any Pan Am Games? What did you see?

FB: I only went to see the beach volleyball game. My friend was a line judge for beach volleyball. I went to see her in action. I actually only got to go to one day. I [attended] the opening ceremony for the Para Pan Am Games on Friday August 7 at York University. I saw 7-a-side football games, these are for Cerebral Palsy and neurologically impaired (brain injury) and para-athletic events and saw the closing ceremony as well.

Frank Bruno Pan Am Relay
Frank’s Pan Am Relay torch

Meri Perra is the communications and support coordinator at BIST.

Q + A with US 7-a-side football champ Gavin James Sibayan

BY: CELIA M.

On September 8, 2007, Sergeant Gavin James Sibayan’s life was changed forever. While on deployment in Iraq with the U.S. Army, he was the gunner for his squad when he was hit by a third improvised explosive device (IED) in thirty days. Despite being knocked unconscious for approximately 30 seconds, with shrapnel in the left side of his head, Sibayan managed to get it together and started to fire. It would not be until two weeks later, when he was medevaced to Tule, Germany for extreme headaches, that the severity of his head injury would be discovered.

Gavin James Sibayan
Gavin James Sibayan

Sibayan medically retired from the military in 2011, leaving the service with an Army Commendation Medal (ARCOM) and a Purple Heart.

Soon after retiring, he contacted the U.S. Paralympic National Team, and has been playing soccer with them ever since. In 2014, Sibayan was voted 2014 U.S. Soccer Disabled Athlete of the Year. Now he’s in Toronto playing midfield at the 2015 Para Pan AM Games for Team USA.

The field in which Sibayan serves and represents his country may be different but, his continued love, respect, and dedication for his country remains strong. Gavin Sibayan is a hero no matter the field and a true inspiration to all.

Thanks to the wonderful world of Internet and email I had the distinct of honour of posing some questions to Gavin:

CM: Can you talk about what it means to you to be competing in Canada for the Parapan AM Games?

GS: It means a lot to me to make the roster for the Para Pan AM Games and to have a chance to represent my country. Every time I put on the jersey with the U.S. crest on it, it feels like putting on my ARMY uniform and going to work for the United States again.

CM: Are you able to have friends/ family watch you compete? Who is coming?

GS: My family will be watching online and my dad and aunt are coming to Canada to watch me play.

CM: Can you describe what it is about your sport that you love?

Photo via
Gavin James Sibayan; Photo via gosanangelo.com

GS: I love the thrill of competition, playing with a team of talented players and friends – that makes it even better.

CM: Can you talk about your typical training day?

GS: In camp, we train twice a day, the morning session is ball skills and movements and the afternoon session is games and movements. At home I practice at Red line Athletics where I have a personal trainer who works with me on ball skills. Then I have another trainer who works with me on mobility, strength and conditioning. I practice at least three hours per day and it’s great doing something I love.

Photo:
Gavin James Sibayan; Photo via: blogs.va.gov

CM: Would you say there are challenges specific to brain injury that you have to deal with as an elite athlete? If so, what would these challenges be?

GS: The challenges that I have would be balance, feet coordination – these two are the big ones.

CM: It’s often said that elite athletes are inspiring – and it’s true. Do you have advice or a message you’d like to pass on to aspiring Para athletes?

GS: No matter what challenges you face in life you can always adapt and overcome them and drive on. They might be hard, but if you dig deep down you can strive to be the best athlete out there.


celia-mCelia is an ABI survivor who is dedicated to helping others move forward in their journey and live the life they dream of. She is the founder of the internationally read blog High Heeled Life – inspiration for living a luxurious and balanced life; featured author in Soulful Relationships part of the best-selling series Adventures in Manifesting; a Peer Mentor with BIST; a regular speaker for Canadian Blood Services – Speakers Bureau; certified Life Coach, certified Law of Attraction Practitioner and currently working on her Mind Calm Meditation certification. Learn more about Celia and be inspired: visit www.HighHeeledLife.com or www.CeliaMLifeCoach.com

US para-cyclist Jennifer Schuble shows us her toughness

WRITTEN BY: MERI PERRA; INTERVIEW BY KAROLINA URBAN

If anyone does, Jennifer Schuble exemplifies the strength and never-quit, give ’em heck attitude of para-athletism. The U.S. army veteran has sustained two brain injuries – one from an accident during a hand-to-hand combat class at the United States Military Academy at West Point – and another from a car crash in 2002. Then, in 2004, she was diagnosed with Multiple Sclerosis. Photo credit: Brian Hodes

Photo credit: Brian Hodes

“I grew up in a family of four kids, so it was like the survival of the fittest, you couldn’t just sit there,” Schuble said. “If you wanted to have a chocolate chip cookie you better go get it or else you won’t get any.”

By 2007, Schuble won her first world championship para-cycling title. She holds the Para Pan Am record for 500 meters race in para cycling, and fits in elite training in between working full-time at Mercedes-Benz. She also happens to have a Master’s degree.

“I learned a lot of time management when I was at West Point,” Schuble said. “I was a student, and tri-sport athlete for them. It was a very intense school … I really had to schedule everything and time manage.”

At the Toronto Pan Am Games, so far, Schuble has ranked an impressive fourth place in cycling track. She also a silver and bronze medal from the 2012 Paralympic Games and a gold and silver medal, and two world records, from the 2008 Beijing Games.

Photo: Jason Nuttle
Photo credit: Jason Nuttle

“Anytime I can race my bike I enjoy it,” Schuble said.

As an athlete with a brain injury, Schuble says balance is a big challenge in her sport. As an example, Schuble says she can’t take corners as high as other para-athletes. Cycling requires a lot of strategy, which can also be a challenge.

“I was [the only athlete with a brain injury on the team] for the longest time and it was difficult,” Schuble said.

Schuble races in the most functional para-cycling class, C1, though she says she qualifies for a lower class based on the MRI of her brain. She credits much of her recovery and abilities to the rehabilitation she received at the Walter Reed National Medical Centre.

Jenny Schuble competing at the World Championships
Photo credit: US Paralympics

“They taught me a lot of time management skills and ways to remember things, keep track of things,” Schuble said.

Currently Schuble trains six days a week, and manages to hit the weight room three of those days. She spends her weekends at the velodrome working on explosive starts.

“Basically all I do is work ride my bike, eat and go to bed,” Schuble said. “And play with my two bulldogs.”

Meri Perra is the communications and support coordinator at BIST.

Marie-Claude Molnar: bronze medal Paralympian hits Toronto for Para Pan Am Games

BY: KAROLINA URBAN

Canadian para-cyclist Marie-Claude Molnar grew up with a dream of representing Canada at the Olympics. At the age of 29, that dream became a reality when she won a bronze medal at the London Paralympic Games.

“It was incredible,” Molnar said about arriving in London. “The first thing that I noticed when we got to the Athletes’ Village, I told myself, ‘wow what I am doing here?’ I was just amazed and surprised to be surrounded by elite athletes.”

Marie-Claude Molnar
Marie-Claude Molnar

Now the St.-Hubert, QB resident is well into her second-round at the Para Pan Am Games, where she ranks seventh in the cycling track events and has come in fifth at the women’s 500 meter time trial C1-C5 finals. Molnar will be competing for a final time on Thursday, August 13th.

“I think everybody can try something that they love and see if they succeed at it,” Molnar said. “That’s the only way to find out, to try.”

What makes Molnar a particularly  inspiring athlete are the challenges she has faced and how she has overcome them through her work ethic and determination.

Molnar suffered a brain injury after being struck by a car in 2005. Soon after, with her love of sports guiding the way, she contacted Lyne Bessettea Canadian Olympic cyclist, who put her into contact with National team coach Eric Van den Eynde, who she continues to train with to this day..

Marie-Claude Molnair“I started training three years after my accident. Since I was very young I wanted to be an Olympic athlete in ice hockey ,” Molnar said

Perhaps it’s Molnar’s outlook on life that gave her the courage and determination to pursue a cycling career.  There is an inherent dedication and sacrifice which comes with being a para-athlete and representing Canada. Molnar trains five to six days a week, incorporating two or tree specific types of training into her schedule.

“[One type of] training [I do] is where you see what level you are at, and then you go push your limits.” Molnar said.

But despite the long training hours, for Molnar, and many athletes like her, sports are a get-away from the demands of life.

Image via
Photo:  paramanic.ca

“What I love about cycling, every time I get on my bike, I forget everything else,” Molnar said. “For me cycling is liberty. [When I ride] that’s all I can think about.”

Molnar says as a para-cyclist with a brain injury, she faces specific challenges in her sport.

“The main challenge is racing strategy, “Molnar said. “Like taking the right wheel or riding the fastest line, knowing when to attack or when not to.”

Molnar says her sport has become more competitive since the London Games, as more countries have begun to develop their para-cycling programs. For Toronto 2015, there’s the added bonus of being in her home country for the Games.

“Having the chance to compete at home in front of our fans I’m pretty sure it’s going absolutely incredible. The energy is going to be crazy,“ Molnar said.

 Karolina Urban is a former University of Toronto and Canadian Women’s Hockey League player. Currently she is a PhD student at the Concussion Centre in Holland Bloorview Kids Rehab Hospital. 

World champ para-cyclist Shelley Gautier set for Toronto Para Pan Am Games

BY: MERI PERRA

Even compared to other elite athletes, Shelley Gautier has a mad list of accomplishments under her belt.

Gautier and her trike
Gautier on  her trike

The 46-year-old para-cyclist holds eight world titles, and recently launched her own foundation, The Shelley Gautier Para-Sport Foundation, a Para Pan Am legacy project, which aims to make para-sports more accessible for people with disabilities. This year, she was the only Canadian to be nominated for the prestigious Laureus World Sports Award. Not to mention, she holds bragging rights as the first female T-1 rider (a classification for para athletes with neurological conditions, such as hemiplegia, who ride tricycles) on the international circuit. Now she’s heading into her second-stint at the Para Pan Am Games, as one of the #paratough featured athletes promoted by the Canadian Paralympic Committee, with all signs pointed to the Rio Paralympics next year.

So what, are you tired just reading this list?

Because before the Para Pan Am Games even begin, elite para-cyclists such as Gautier headed to Switzerland to compete in the Union-Cycliste International (UCI) Para-cycling Road World Championships – a competition Gautier has won for several years in a row.

“I’m trying to win again,” Gautier said, before leaving, and ultimately winning for the sixth time.

Originally from Niagara, Gautier has called Toronto her home for the past 20 years. Always an athlete, Gautier played hockey and soccer during her stint at the University of Toronto. After graduation, Gautier worked as a licensed physiotherapist, and mountain biked competitively in her spare time. That was when Gautier began dreaming of the Olympics – but not in the usual way.

“While I was a physiotherapist, one of my goals was to be at the Olympics as a caregiver and to help the athletes,” Gautier said. “But I decided to go as an athlete.”

That decision happened after Gautier acquired her TBI following a mountain bike accident in 2001. The accident put her in a coma for six weeks and resulted in hemiplegia (paralysis on one-side of her body). But Gautier held on to her competitive spirit and athleticism, and  began to sail, becoming heavily involved in the competitive para-sailing community. After a few years, she switched to cycling, thinking the sport would be better suited to her hemiplegia body condition.

To put it mildly, Gautier was right. By 2009, she broke onto the para-cycling scene, and began collecting UCI world wins.

“I think any aspect of your life, if you have a goal to meet one way or another you can [do] it” Gautier said. “Just try and don’t give up. I mean it might be the case that your goal is unrealistic, but realistic goals are achievable and putting your mind or your thoughts to it is very important.”

Gautier with her mom
One proud mom: Gautier with her mother, Suzanne Letourneau

Gautier’s mom, Suzanne Letourneau, says she often doesn’t get to see her daughter race as competitions are usually too far away. But for the Toronto Games, Gautier will have a crowd of friends and family cheering her on.

“I am always at the other end of all communication anxiously waiting for the results of her race,” Letourneau said over email. “Shelley and I have a very close relationship, we speak before and after every race.”

Gautier shares her mother’s excitement about competing in Toronto.

“Being in my hometown, where I live, I can have friends and people support me,” Gautier said. “So I’m really excited about going to the Para Pan Am Games, even though it’s after Worlds.”

No surprise, life as an elite athlete is busy. Gautier drives an hour and a half outside of Toronto to train with her training partner, Alan Greer. Among other things, Greer helps Gautier pack and un-pack her trike – no small job whether they’re driving out of the city or boarding an international flight.

“I have to bring six wheels [when I travel],” Gautier said. “[My] trike is a mobility device and it’s hard to pack because it doesn’t fit into a normal bike bag.”

Observant Torontonians may also catch a glimpse of this world-class athlete just doing her stuff around town. Gautier says she hops on her three-wheels to commute, for running errands or to meet with friends.

“Cycling is a great activity and something that I can do,” Gautier said “I can socialize, and I can help people. It’s something that I think health care professionals should either teach their students or they can tell their patients that getting on a bike is a great option.”

You can catch Gautier at the Para Pan Am Games on August 8th in downtown Toronto, and on August 13th in Milton. You can find a schedule of Para Pan Am competition dates and venues here and purchase Para Pan Am Tickets here.

Find out more about Shelley: https://shelleygautier.wordpress.com

Shelley Gautier - blog

ALL IMAGES COURTESY SUZANNE LETOURNEAU