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.

Without action, awareness does little

BY: ALYSON ROGERS

Nine years ago, I walked into an emergency room with very obvious signs of a concussion. Despite glaring symptoms, no one would even utter the word ‘concussion’. Doctors told me I had whiplash, which didn’t even come close to describing the traumatic brain injury diagnosis I was given six months later.

Hospital emergency room entrance

This year, I walked into the same emergency room, with very obvious signs of a concussion. Despite nine years of brain injury awareness in the media, in hospitals, in schools and in sports, my experience was no different.

What good is brain injury awareness if we don’t put it into practice?

April 2017 marked nine years since I acquired my brain injury. I experience symptoms every day and it looks like they are here to stay.  Like many others, I navigated the health care and education systems before brain injury awareness hit the mainstream. My family and I had to research and advocate for every bit of care I received. Even with a CT scan in hand, it was difficult to get doctors to believe, let alone treat my symptoms. This was before Sidney Crosby, NFL lawsuits and head injury protocols; the dark ages of brain injury.

This year, I learned that we are still living in the dark ages. Last month, I was hit in the head with a locker by accident at work. When my symptoms continued to get worse instead of better, I went to the same emergency room I went to nine years ago. It didn’t even cross my mind that I would be treated exactly the same as I was back then, this was the new era of brain injury awareness, right? Wrong.

locker room

There were three of us in the emergency room with concussion symptoms; the doctor barely looked at any of us and sent us on our way.  I returned to my family doctor, who has seen me do this concussion dance with the health care system before, and was sent to another emergency room. The second ER doctor told me what I was experiencing was impossible and seemed shocked when I dared to ask for WSIB forms to be filled out. Despite the blurred vision, noise sensitivity, nausea and fatigue he put a question mark beside the concussion diagnosis on my papers.

June is Brain Injury Awareness month in Canada and it’s a month I’m excited for and take pride in every year. Considering how prevalent concussions / brain injuries are, I think awareness is important for everyone,  but awareness isn’t enough.

Being aware is the first step but it is by no means the only step in preventing and responding to brain injuries. The next step is to put that awareness into action; this action is going to require effort and change by professionals and individuals.

It’s easy to say we are aware and be done for the day but if we don’t put in this effort for people with brain injuries, awareness falls flat and nothing changes. The very people brain injury awareness is supposed to be helping are failed all over again- stuck in the dark ages of brain injury.

The other piece of brain injury awareness that requires action to be effective is prevention. Awareness that leads to policies such as concussion protocols are great (if they are put into action and enforced) but this doesn’t lead to a decrease in people sustaining brain injuries. Brain injury prevention is going to have to come from individual change; with the increase in brain injury awareness, we know that a hit to the head can have lifelong impacts. With that being said, there is no excuse for deliberately hitting someone in the head.

Many brain injuries, especially sports-related brain injuries, are entirely preventable and occur due to individuals decisions. My brain injury stems from a youth athlete’s decision to use physical force instead of skill to win a basketball game. This is similar to Sidney Crosby, during the NHL playoffs he sustained another concussion at the hands of a player on the opposing team. It is very well known that Crosby has a history of concussions and another hit to the head could, at the very least, end his career. With the increase in brain injury awareness, we should be seeing a decrease in these types of injuries simply by individuals changing their behaviour.

Woman playing basketball

My hope for this Brain Injury Awareness Month is to move beyond awareness and towards action.  This includes a decrease in the number of brain injuries and better outcomes for survivors.


Alyson is 25-years-old and acquired her brain injury nine years ago. She graduated from Ryerson University and is a Youth Worker at a homeless shelter. In her spare time, Alyson enjoys writing, rollerblading and reading. Follow her on Twitter @arnr33

 

 

 

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Feeling what you cannot see

BY: MARK KONING

As I lie in my bed I breathe in and out while staring at the ceiling. I can feel all of the bones in my body as I stretch myself awake. I rub the sleep from my pupils and rise to a seated position.

Five fingers;

Five toes;

I extend and wiggle.

I climb to my feet and slowly shuffle my way into the bathroom.

The mirror on the wall stares at me.

Two eyes to see with;

One nose to smell with;

A mouth full of teeth.

Mark Koning in a hoodie, looking down
Mark Koning

There are no physical scars or indentations on my head. There is no numbness to my face. My arms and legs have full motion, so there is no need for a wheelchair or use of any other kind of assistive device that can be seen. I know that not all injuries are the same, but still…

What is wrong with me?

Do they know what they cannot see?

Do I?

I feel the skin on my cheekbones and look toward the mirror with pretty clear vision.

I sometimes feel that part of me is forever hidden.

Shadowed; unseen.

Maybe it is not what they don’t see, maybe it is what they don’t understand.

While I may live with a brain injury, my brain lives without borders, and what I mean by this is that my limitations only go as far as I let them bother me. For me, one plus one may not always equal two, and what I need to do is come to the conclusion that this is alright. There is no shame in it. It hurts me to know that not everyone else can find this same reasoning.

Because of it though, I still often find myself waking up only to look into that mirror and wonder. What is depression supposed to look like? Is this chronic fatigue that I feel, this confusion and frustration, this struggle to retain information, this cognitive search for words that quite often get lost, this uncertainty that I am challenged with, the extra time I require and need to slow down, are these things real? Are these things a result of my brain injury?

But I know the answer to these questions. And even though it is a continuing struggle between what I feel and that which cannot be seen, I know. I know of the strength and of the beauty and of the patience. I know of the possibilities, the potential, and the greatness that lies within. I know that if you only allow your eyes to see, you can end up missing out on a lot.


During Brain Injury Awareness Month this June, Mark Koning is donating  50% of the proceeds of his book, Challenging Barriers and Walking the Path to BIST! Contact Mark over Twitter or Facebook.

Island Pork Tenderloin Salad

BY: CHEF JANET CRAIG

Blow your mind by taking the ordinary and creating something unique with this delicious pork tenderloin salad – I always make the full amount because people go through the entire pork! The meat freezes well and is great on a sandwich.

This recipe isn’t as cumbersome as it might seem initially. With the exception of the avocados, everything can be prepared separately beforehand and put together at the last minute.

SAMSUNG

Pork

2 tsp salt

½ tsp black pepper

1 tsp ground cumin

1 tsp chilli powder

½ tsp cloves

½ tsp cayenne

1 tsp cinnamon

2-3 pork tenderloins (2 ½ – 3 lbs. total)

2 tbsp olive oil

Glaze

1 cup packed dark brown sugar

2 tbsp finely chopped garlic

1 tbsp Tabasco

Vinaigrette

3 tbsp fresh lime juice

1 tbsp fresh orange juice

1 tbsp Dijon mustard

1 tsp curry powder

¼ tsp black pepper

½ cup olive oil

Salad

3 navel oranges, peeled, white pith removed

6 cups baby spinach, trimmed

4 cups thinly sliced Napa cabbage

1 red pepper, cut into thin strips

½ cup golden raisins*optional

2 firm-ripe avocados, peeled and cut diagonally into thin slices

To Prepare Pork:

Combine all spices for the “rub”. Coat pork with spices, for three-hours or overnight in the refrigerator.

Preheat oven to 375˚F.

To Make Glaze:

Combine ingredients and pat onto tops of tenderloins. Roast in middle of oven for about 20-30 minutes. Tent with foil and let stand at room temperature for 10 minutes.

To Make Vinaigrette:

Whisk together juices, mustard, curry powder and pepper. Add oil in a stream, whisking thoroughly.

For the Salad:

Cut oranges crosswise into thin slices. Toss spinach, cabbage, peppers and raisins in a large bowl with ½ cup vinaigrette.

To assemble salad:

Cut pork at a 45˚ angle into ½ inch slices. Line a large platter with dressed salad. Arrange sliced pork, oranges and avocado in rows on top. Drizzle some vinaigrette over avocado and oranges. Serve juices from roasting pan over pork.

Chef Janet Craig’s recipes are simple, healthy, delicious and ABI friendly.  You can find out more about her HERE.

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The passage of time after brain injury

BY: MARK KONING

Time flies over us, but leaves its shadow behind. ~ Nathaniel Hawthorne

Being a brain injury survivor sometimes feels as though I have both lost and gained time. My injury occurred when I was six-years-old, and it is as if those first six years of my life have been erased. (It is hard to say for certain, because, well, I was six.)

Screen Shot 2017-03-24 at 2.23.51 PM
PHOTO: MARK KONING

I have some ideas of what things were like in my early years, mostly because my Oma (Grandma) shot many home movies and my mom took tons of pictures, plus all the stories I’ve heard along the way. It’s hard to tell what is my own memory, and what has been planted there by someone else.

It wasn’t until many, many years later, that I was diagnosed with an acquired brain injury. (You can learn more about that in my memoir ‘Challenging Barriers & Walking the Path’)

Growing up without the knowledge that I had an ABI, but at the same time sensing something was wrong, I often wonder if I spent too much time questioning things or if I was spared certain other anxieties. Ignorance is bliss, right?

Regardless of my past, I can say this about my present: while I might seem to have enough time to get things done, I do not. I do pretty well, but there are things on my list that don’t get checked off. No matter how much I have trained my brain, and knowing my need to slow down, it can still be frustrating to not get stuff done!

My accommodation for work, and life in general, is needing extra time.

In some ways, taking things slow and affording yourself more time is good, but I still only have 24 hours in a day like everyone else. You see? Frustrating!! I do what I do with the time I have, just like we all do.

I feel pretty lucky, regardless of time; and I still cherish it all. As much as I may need things to slow down, taking things at a calm pace allows me to appreciate those little things I think sometimes tend to get forgotten or taken for granted.

For those of us who have come to appreciate a cautious approach to life offer a unique ability for the serene. ~ Mark Koning #challengingbarriers

Mark’s passion to lend a helping hand, offer advice and give back has developed into a moral and social responsibility with the goal of sharing, inspiring and growing – for others as well as himself. His experience as a survivor, caregiver, mentor and writer has led to his credibility as an ABI Advocate and author of his life’s story, Challenging Barriers & Walking the Path. Follow him on Twitter @Mark_Koning or go to www.markkoning.com

15 things you don’t know about: Diana Rockbrune, BIST Volunteer of the Year, Ambassador Category

If the definition of a superhero is someone who swoops in just in time and saves the day,  it can be said that Diana Rockbrune, a marketing and events coordinator at Oatley Vigmond, is the superhero of our 2016 Birdies for Brain Injury Golf Tournament.

Last year, Diana came in literally at nick of time to help an overstretched golf committee and under-staffed BIST team organize a successful golf tournament. From the BIST office side of things, we were on the phone with Diana every day, as she guided us with her expertise, made suggestions and did a heck of a lot of grunt work. Simply put, we can’t thank her enough!

Diana Rockbrune with her sons
DIANA ROCKBRUNE WITH HER SONS, (TOP LEFT) COLE WHITE, A BASEBALL PITCHER ON SCHOLARSHIP IN COLORADO, (BOTTOM LEFT) TY WHITE, A SNOWBOARDER AND ASPIRING FIREFIGHER AND (RIGHT) LUKE ROCKBRUNE, WHO PLAYS AS A HOCKEY GOALIE

How I became involved with BIST:  

I am a marketing and events coordinator with Oatley Vigmond and was approached by a partner to assist in the preparation and execution of the BIST golf tournament in 2016.  I was thrilled to help and in the end see the event all come together as a big success.  I felt like I made a difference. Now I’m hooked – I love this organization.

If I could pick any job in the world, it would be:

An international photographer.

I have an (irrational or otherwise) fear of:  

The dark. Shhh…. Don’t tell anyone.

My greatest assets as a volunteer are:

That I have a great ability to meet people (network) and empower people. My flexibility and ability to solve problems while remaining calm in a pinch makes me good at event planning.

My friends would describe me as:  

Someone who is compassionate and caring who enjoys meeting people and making people feel welcomed.

If I could invent a superpower, it would be:  

To eliminate pain and suffering in the world as a superhuman healer.

What inspires me most about BIST is: 

Being connected to an organization that helps so many people. I have had the pleasure of meeting so many new people that inspire me to become the best I can be. I have learned the true meaning of gratitude.

 If I won $1 million dollars I would:   

Adopt children and provide a loving home for them.

My personal hero is: 

My grandmother who passed away from breast cancer when I was a young girl of nine-years-old. While I did not fully understand the disease, it had a big impact on me growing up. She fought the disease alone at first, not telling the family while she proceeded to take the subway to her treatments at Princess Margaret hospital. She showed much mental toughness and bravery, and for that I truly admire her. I have always had a connection with her despite her passing away when I was so young.

(L-R) BIST BOARD MEMBER COLLEEN WORSLEY, DIANA ROCKBRUNE, BIST COMMUNICATIONS COORDINATOR MERI PERRA AND FORMER PROGRAMS COORDINATOR KAT POWELL AT BIST'S BIRIDES FOR BRAIN INJURY GOLF TOURNAMENT IN 2016
(L-R) BIST BOARD MEMBER COLLEEN WORSLEY, DIANA ROCKBRUNE, BIST COMMUNICATIONS COORDINATOR MERI PERRA AND FORMER PROGRAMS COORDINATOR KAT POWELL AT BIST’S BIRIDES FOR BRAIN INJURY GOLF TOURNAMENT IN 2016

My celebrity “crush” is: 

Matthew McConaughey.

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PSST: FOR DIANA’S EYES ONLY  – via GIPHY

My favorite BIST event is: 

The Mix and Mingle. It is always great to see the number of people supporting BIST all in one location. It is overwhelming how many people BIST empowers. This event is a true testament to the popularity of such a wonderful organization that helps so many people with brain injury.

A quote/motto I try to live by is:  

Living by the words I heard a long time ago. I am pretty sure it was my Mother that said this to me – A wise old owl sat in an oak; The more he saw the less he spoke;  The less he spoke the more he heard;  Why can’t be all be like the wise old bird?

If I could volunteer anywhere in the world I would:

Help with community development in Fiji.

As a Kid, I:  

Lived on a hobby farm. We were from Toronto and had no idea how to run a farm. My Mom and Dad wanted us to experience responsibility and hard work in addition to balancing school. We had dogs, cats, chickens, geese, rabbits, cows, horses and even a pig. Before and after school I had to do my chores. At the time I thought I was born into slave labor but now I see it as a rewarding childhood. Our local friends called us “city slickers”.

I am most proud of:  

 I’ve been married for 11 years to my husband Joe. He is someone really special and has been an excellent father to our three amazing, athletic sons. Our sons astonish me with their talent in their respective sports. They make me proud when I hear people tell me that they are good ambassadors.  I am blessed.

Creamy avocado dressing for spring

BY: CHEF JANET CRAIG

The biggest issue I have with salads is the dressing, they can either make or break the whole dish. Salad dressing must be homemade, I can taste the chemicals in the commercial ones.

This is a low fat, vegan and rich tasting salad dressing made in a blender or food processor – all you do is throw in all the ingredients, blend and enjoy!

Avocado Dressing
PHOTO: JANET CRAIG

Ingredients

2 ripe avocados, peeled & seeded

1 cup plain Greek yoghurt

2 garlic cloves

Juice or zest of a whole lemon or a large lime

1/3 cup extra virgin olive oil or avocado oil

Directions

Blend and use on salads or toast and enjoy!

Chef Janet Craig’s recipes are simple, healthy, delicious and ABI friendly.  You can find out more about her HERE.

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