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Research Papers

The Mechanics of Traumatic Brain Injury: A Review of What We Know and What We Need to Know for Reducing Its Societal Burden

[+] Author and Article Information
David F. Meaney

Departments of Bioengineering
and Neurosurgery,
University of Pennsylvania,
Philadelphia, PA 19104-6392
e-mail: dmeaney@seas.upenn.edu

Barclay Morrison

Department of Biomedical Engineering,
Columbia University,
New York, NY 10027

Cameron Dale Bass

Department of Biomedical Engineering,
Duke University,
Durham, NC 27708-0281

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the Journal of Biomechanical Engineering. Manuscript received September 20, 2013; final manuscript received December 20, 2013; accepted manuscript posted December 27, 2013; published online February 5, 2014. Editor: Victor H. Barocas.

J Biomech Eng 136(2), 021008 (Feb 05, 2014) (14 pages) Paper No: BIO-13-1439; doi: 10.1115/1.4026364 History: Received September 20, 2013; Revised December 20, 2013; Accepted December 27, 2013

Traumatic brain injury (TBI) is a significant public health problem, on pace to become the third leading cause of death worldwide by 2020. Moreover, emerging evidence linking repeated mild traumatic brain injury to long-term neurodegenerative disorders points out that TBI can be both an acute disorder and a chronic disease. We are at an important transition point in our understanding of TBI, as past work has generated significant advances in better protecting us against some forms of moderate and severe TBI. However, we still lack a clear understanding of how to study milder forms of injury, such as concussion, or new forms of TBI that can occur from primary blast loading. In this review, we highlight the major advances made in understanding the biomechanical basis of TBI. We point out opportunities to generate significant new advances in our understanding of TBI biomechanics, especially as it appears across the molecular, cellular, and whole organ scale.

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Fig. 2

(a) The relative incidence of TBI in the civilian and military population, and their causes. Excluding penetrating TBI and unclassified injuries, the relative incidence rates for the military and civilian population appear distinct. However, the possible underreporting of mild TBI in the military may alter the relative incidence rates significantly. (b) Within each population, the causes of TBI span a broad range. Primary blast TBI is unique to the military environment.

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Fig. 1

The research cycle of reducing the societal burden of traumatic brain injury. Epidemiological evidence collected from clinical studies, and analysis of motor vehicles crashes, forms part of the first tier for defining where the most significant brain injuries occur and if these injuries change over time (red). The work transitions to the research laboratory (green) for defining how these injuries occur, establishing key relationships between the physical inputs in these environments and their resulting injuries. The inevitable translation of this new knowledge into the next generation of protection technologies completes the cycle and also triggers the next research cycle for focusing efforts on the most significant injuries in the population. One broad research cycle has already occurred for moderate and severe brain injuries, resulting in advances in helmet protection technologies and passive safety systems. Emerging efforts have now shifted to include more focus on mild TBI, which occurs across both the civilian and military population.

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Fig. 3

Large variance in reported white matter and brain material properties by study. Early work estimated both bulk and shear modulus. In the past two decades, work has shown that brain is one of the softest biological tissues, more than ten times more compliant than the earliest measurements.

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Fig. 4

Multimodal modeling approaches for defining the structural response of the brain to applied mechanical loading. Historically, experimental approaches led to insight into the most important types of mechanical loading associated with severe brain injuries. These experimental approaches span both human and animate models and use physical surrogates to complement either scale. The most significant development in the past decade is the growth of computational approaches to examine the biomechanics of TBI in both experimental models and humans. However, the need to validate these models for numerical issues (e.g., mesh convergence, mesh quality) as well as biofidelic output is even higher given their increased complexity and proliferation.

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