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Kinematics clustering enables head impact subtyping for better traumatic brain injury prediction

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 Added by Xianghao Zhan
 Publication date 2021
and research's language is English




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Traumatic brain injury can be caused by various types of head impacts. However, due to different kinematic characteristics, many brain injury risk estimation models are not generalizable across the variety of impacts that humans may sustain. The current definitions of head impact subtypes are based on impact sources (e.g., football, traffic accident), which may not reflect the intrinsic kinematic similarities of impacts across the impact sources. To investigate the potential new definitions of impact subtypes based on kinematics, 3,161 head impacts from various sources including simulation, college football, mixed martial arts, and car racing were collected. We applied the K-means clustering to cluster the impacts on 16 standardized temporal features from head rotation kinematics. Then, we developed subtype-specific ridge regression models for cumulative strain damage (using the threshold of 15%), which significantly improved the estimation accuracy compared with the baseline method which mixed impacts from different sources and developed one model (R^2 from 0.7 to 0.9). To investigate the effect of kinematic features, we presented the top three critical features (maximum resultant angular acceleration, maximum angular acceleration along the z-axis, maximum linear acceleration along the y-axis) based on regression accuracy and used logistic regression to find the critical points for each feature that partitioned the subtypes. This study enables researchers to define head impact subtypes in a data-driven manner, which leads to more generalizable brain injury risk estimation.



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Brain tissue deformation resulting from head impacts is primarily caused by rotation and can lead to traumatic brain injury. To quantify brain injury risk based on measurements of kinematics on the head, finite element (FE) models and various brain injury criteria based on different factors of these kinematics have been developed, but the contribution of different kinematic factors has not been comprehensively analyzed across different types of head impacts in a data-driven manner. To better design brain injury criteria, the predictive power of rotational kinematics factors, which are different in 1) the derivative order (angular velocity, angular acceleration, angular jerk), 2) the direction and 3) the power (e.g., square-rooted, squared, cubic) of the angular velocity, were analyzed based on different datasets including laboratory impacts, American football, mixed martial arts (MMA), NHTSA automobile crashworthiness tests and NASCAR crash events. Ordinary least squares regressions were built from kinematics factors to the 95% maximum principal strain (MPS95), and we compared zero-order correlation coefficients, structure coefficients, commonality analysis, and dominance analysis. The angular acceleration, the magnitude, and the first power factors showed the highest predictive power for the majority of impacts including laboratory impacts, American football impacts, with few exceptions (angular velocity for MMA and NASCAR impacts). The predictive power of rotational kinematics in three directions (x: posterior-to-anterior, y: left-to-right, z: superior-to-inferior) of kinematics varied with different sports and types of head impacts.
The prediction and prevention of traumatic brain injury is a very important aspect of preventive medical science. This paper proposes a new coupled loading-rate hypothesis for the traumatic brain injury (TBI), which states that the main cause of the TBI is an external Euclidean jolt, or SE(3)-jolt, an impulsive loading that strikes the head in several coupled degrees-of-freedom simultaneously. To show this, based on the previously defined covariant force law, we formulate the coupled Newton-Euler dynamics of brains micro-motions within the cerebrospinal fluid and derive from it the coupled SE(3)-jolt dynamics. The SE(3)-jolt is a cause of the TBI in two forms of brains rapid discontinuous deformations: translational dislocations and rotational disclinations. Brains dislocations and disclinations, caused by the SE(3)-jolt, are described using the Cosserat multipolar viscoelastic continuum brain model. Keywords: Traumatic brain injuries, coupled loading-rate hypothesis, Euclidean jolt, coupled Newton-Euler dynamics, brains dislocations and disclinations
Mild traumatic brain injury (mTBI) is a complex syndrome that affects up to 600 per 100,000 individuals, with a particular concentration among military personnel. About half of all mTBI patients experience a diverse array of chronic symptoms which persist long after the acute injury. Hence, there is an urgent need for better understanding of the white matter and gray matter pathologies associated with mTBI to map which specific brain systems are impacted and identify courses of intervention. Previous works have linked mTBI to disruptions in white matter pathways and cortical surface abnormalities. Herein, we examine these hypothesized links in an exploratory study of joint structural connectivity and cortical surface changes associated with mTBI and its chronic symptoms. Briefly, we consider a cohort of 12 mTBI and 26 control subjects. A set of 588 cortical surface metrics and 4,753 structural connectivity metrics were extracted from cortical surface regions and diffusion weighted magnetic resonance imaging in each subject. Principal component analysis (PCA) was used to reduce the dimensionality of each metric set. We then applied independent component analysis (ICA) both to each PCA space individually and together in a joint ICA approach. We identified a stable independent component across the connectivity-only and joint ICAs which presented significant group differences in subject loadings (p<0.05, corrected). Additionally, we found that two mTBI symptoms, slowed thinking and forgetfulness, were significantly correlated (p<0.05, corrected) with mTBI subject loadings in a surface-only ICA. These surface-only loadings captured an increase in bilateral cortical thickness.
Multiple brain injury criteria (BIC) are developed to quickly quantify brain injury risks after head impacts. These BIC originated from different types of head impacts (e.g., sports and car crashes) are widely used in risk evaluation. However, the accuracy of using the BIC on brain injury risk estimation across different types of head impacts has not been evaluated. Physiologically, brain strain is often considered the key parameter of brain injury. To evaluate the BICs risk estimation accuracy across five datasets comprising different head impact types, linear regression was used to model 95% maximum principal strain, 95% maximum principal strain at the corpus callosum, and cumulative strain damage (15%) on each of 18 BIC respectively. The results show a significant difference in the relationship between BIC and brain strain across datasets, indicating the same BIC value may suggest different brain strain in different head impact types. The accuracy of brain strain regression is generally decreasing if the BIC regression models are fit on a dataset with a different type of head impact rather than on the dataset with the same type. Given this finding, this study raises concerns for applying BIC to estimate the brain injury risks for head impacts different from the head impacts on which the BIC was developed.
Brain strain and strain rate are effective in predicting traumatic brain injury (TBI) caused by head impacts. However, state-of-the-art finite element modeling (FEM) demands considerable computational time in the computation, limiting its application in real-time TBI risk monitoring. To accelerate, machine learning head models (MLHMs) were developed, and the model accuracy was found to decrease when the training/test datasets were from different head impacts types. However, the size of dataset for specific impact types may not be enough for model training. To address the computational cost of FEM, the limited strain rate prediction, and the generalizability of MLHMs to on-field datasets, we propose data fusion and transfer learning to develop a series of MLHMs to predict the maximum principal strain (MPS) and maximum principal strain rate (MPSR). We trained and tested the MLHMs on 13,623 head impacts from simulations, American football, mixed martial arts, car crash, and compared against the models trained on only simulations or only on-field impacts. The MLHMs developed with transfer learning are significantly more accurate in estimating MPS and MPSR than other models, with a mean absolute error (MAE) smaller than 0.03 in predicting MPS and smaller than 7 (1/s) in predicting MPSR on all impact datasets. The MLHMs can be applied to various head impact types for rapidly and accurately calculating brain strain and strain rate. Besides the clinical applications in real-time brain strain and strain rate monitoring, this model helps researchers estimate the brain strain and strain rate caused by head impacts more efficiently than FEM.

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