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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The Pinky and Sarah love story

BY: JOHN STEVENS

This is the story of how two BIST members – Pinky and Sarah – met  (spoiler alert: it was at a BIST community meeting) and found love. 

PINKY AND SARAH HAVING FUN AT A BIST COMMUNITY MEETING
PINKY AND SARAH PERFORM WITH THE BAND COUGAR BAIT AT A BIST COMMUNITY MEETING IN 2013

Sarah Briggs was 19-years-old in January of 1994, and competing at the provincial level in the seventh race of the season in a downhill skiing event at Mont-Sainte-Anne, Que., when she suffered her brain injury.

Two other skiers had already lost control earlier in the competition in a very rough and steep area of the course, halfway down the hill. One had broken her leg.

As Sarah entered the section at a speed of more than 100 kilometres an hour, she lost one of her skis. She doesn’t remember much of the crash, only that she was trying to get up.

Sarah suffered severe facial injuries, lost two litres of blood and required 12 hours of surgery. She spent eight days in the hospital, five of which were in intensive care. Despite this, there was no mention that she might have acquired a brain injury.

Pinky’s real name is Michael Clouthier, but what he writes on his BIST name tag, and what he prefers to be called, is Pinky. He got his nickname in grade seven when his classmates noticed he liked to wear pink most of the time. Over the years, that part of Pinky’s style hasn’t changed. Spot the guy in pink at a community meeting, and it’s likely him.

Pinky says his brain injury is one of the best things that ever happened to him. That may sound strange to most people, but Pinky says nearly dying saved his life.

He says he was a ‘badass’ as a teenager, heading down a path that took him on the wrong side of the law with all the violence and danger that is involved. His mother and a friend each told him he would either be dead, or in prison, if not for a fateful day in October, 1991.

Pinky, then 18 years-old, was riding his mountain bicycle and on his way to a party to sing reggae songs at a friend’s place. He was listening to music on his headphones as he crossed a busy intersection in Scarborough. He never heard or saw the car as it quickly approached him on his right. By coincidence, a close friend happened to be getting off a TTC bus at the moment of his accident. That friend comforted and kept Pinky conscious until the ambulance arrived.

Doctors told Pinky they had to revive him three or four times. He was on life support for five weeks and spent 40 days in an induced coma. Pinky knew as soon as he became conscious that his life had changed. He spent the next year in hospital, learning how to walk and talk again.

Pinky hams it up during a Cougar Bait performance
PINKY (WEARING HIS FAVOURITE COLOUR)  HAMS IT UP DURING THE COUGAR BAIT PERFORMANCE AT BIST

Pinky says one of his mother’s friends came to visit him in the hospital. The man brought him a stuffed dog and they spoke, briefly, about religion. Their short conversation changed the course of Pinky’s life.

I thought … I went through all this and I’m still alive … (maybe God) has plans for me. God … I’m sorry I had to go through all this to be a believer. – Pinky

Pinky still has the stuffed dog from that fateful day in the hospital. He calls it CB, short for coma buddy, and still sleeps with it from time to time.

After recovering from their physical injuries, both Pinky and Sarah tried to rejoin the world they had known before. Sarah carried on with her life plan after her accident. She finished OAC and moved to Alberta to work on a Bachelor of Kinesiology at the University of Calgary. “To be a gym teacher,” she quipped.

Sarah seemed to be doing well, until she got into her fourth year. That’s when her workload changed and she noticed that everything became much harder. She also noticed she was not making good decisions in her personal life. She decided to move back to Toronto and re-enrol at the University of Toronto, closer to family and friends. It took her six years, in all, to finally finish her bachelor degree. The stress, however, was too much for her and Sarah suffered a mental breakdown.

Not one to give up, in 2000, Sarah enrolled in teachers college at Queens University. Her workload was even more intense than the fourth year of her bachelor’s degree. Things did not go well when, three weeks into school, Sarah began a teaching placement in Peterborough.

I was just trying to act like everything was normal. I didn’t know I had a brain injury. – Sarah

Sarah underwent a number of examinations and tests to try to determine what could be causing her problems. Finally, the doctors diagnosed her brain injury symptoms and told her she had probably suffered an acquired brain injury as a result of her skiing accident.

SARAH ON A BIST COMMUNITY FIELD TRIP IN 2014
SARAH ON A BIST COMMUNITY FIELD TRIP IN 2014

Sarah withdrew from teachers’ college. She says she had trouble, similar to other survivors, accepting her new reality and life. With her new diagnosis, Sarah entered the first stage of recovery, denial.

Sarah tried to go on, moving in with a sister and brother-in-law. She helped to care for their four children as a live-in nanny would. She worked part-time as a ski instructor in winter and at various odd jobs in the summer such as landscaping.

Pinky tried working at Walmart, but he had trouble keeping his interest in a job for very long. So he worked at almost every position in the store, except the cash register. After a year, he left.

At BIST community meetings, Pinky will often one of the first members to introduce himself to a newcomer. He’ll break the ice and calm first-timer nerves by showing off his rhyming-on-the-spot skills. (He can rhyme pretty much anything, except for the word ‘orange’, he says.) He enjoys music, sings and raps – even about his accident. When he and a partner decided to start a karaoke business the year after he left Walmart, Pinky thought his extraverted personality and love of music meant he was bound for success.

PINKY TAKES THE STAGE AT A BIST HALLOWEEN PARTY IN 2012
PINKY TAKES THE STAGE AT A BIST HALLOWEEN PARTY IN 2012

For three years, at least, there was success. Pinky found he had no patience dealing with drunken customers at various bars around the city. But the venture did give Pinky, an avid wrestling fan, the opportunity meet retired professional wrestler Reginald ‘Sweet Daddy’ Siki, who also happens to be in the karaoke business in Toronto.

One day in 2005, a friend told Sarah about an organization for people with brain injuries. Sarah’s friend had also suffered a brain injury after a car landed on her car from an overpass. This friend took Sarah to her first BIST meeting. Sarah says she noticed another survivor, Pinky, as she went to BIST events.

I was in awe, because I was so devastated by this thing (the brain injury) and I saw this guy. He was so positive and he was making people laugh. [His brain injury] hadn’t totally destroyed him. I thought that was so cool. – Sarah

SARAH AT A BIST COMMUNITY FIELD TRIP IN 2014
SARAH AT A BIST COMMUNITY FIELD TRIP IN 2014

Someone once asked Pinky how come he is so happy and he replied, “Like Tupac said, ‘keep your head up’…in all things.”

Pinky says he noticed Sarah too:

I thought she was a high-class woman. I (really) didn’t think she would be interested (in me). – Pinky

Both were in relationships with other people when they met, but they got to know each other as they went to more BIST meetings. Getting to know Pinky over the next three-years helped Sarah get to the point many survivors face, acceptance. “Well, this is new me, and I can live with that,” she said.

Sarah says she and Pinky eventually exchanged phone numbers, but Pinky didn’t call. Sarah later recalled being on a dinner date with someone, who happened to be friends with Pinky, and all she wanted to do was talk and ask questions about Pinky.

She was at a jazz festival in the summer of 2008, when Sarah decided to ‘take the initiative’ and call Pinky. He came by with a friend, in a car, and picked her up. The two started dating, and the “rest is history”.

Early in 2009, Pinky and Sarah were finishing a presentation about relationships after brain injury at BIST. Pinky asked Sarah to close her eyes. He told the crowd that he had to make ‘good’ on his words as he got down on one knee, pulled a small box from his pocket, opened it, and asked Sarah to marry him. They were married that summer.

Pinky has another reason to smile and another ‘best thing’ coming into his and Sarah’s life soon. They are expecting a baby this July. Pinky laughs when asked about his thoughts on becoming a father:

Daddy O…Daddy Pinky. What do you want Pinky Junior?

John Stevens is a former writer, journalist and television producer. He is a nine-year brain injury survivor and six-year member of BIST. This is his first feature since his injury.