{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:07:46Z","timestamp":1791302866732,"version":"4.1.0"},"reference-count":87,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T00:00:00Z","timestamp":1671667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017510","name":"UK Dementia Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017510","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Sports related head injuries can cause transient neurological events including loss of consciousness and dystonic posturing. However, it is unknown why head impacts that appear similar produce distinct neurological effects. The biomechanical effect of impacts can be estimated using computational models of strain within the brain.<\/jats:p><jats:p>Here, we investigate the strain and strain rates produced by professional American football impacts that led to loss of consciousness, posturing or no neurological signs. We reviewed 1280 National Football League American football games and selected cases where the team\u2019s medical personnel made a diagnosis of concussion. Videos were then analysed for signs of neurological events. We identified 20 head impacts that showed clear video signs of loss of consciousness and 21 showing clear abnormal posturing. Forty-one control impacts were selected where there was no observable evidence of neurological signs, resulting in 82 videos of impacts for analysis. Video analysis was used to guide physical reconstructions of these impacts, allowing us to estimate the impact kinematics. These were then used as input to a detailed 3D high-fidelity finite element model of brain injury biomechanics to estimate strain and strain rate within the brain.<\/jats:p><jats:p>We tested the hypotheses that impacts producing loss of consciousness would be associated with the highest biomechanical forces, that loss of consciousness would be associated with high forces in brainstem nuclei involved in arousal and that dystonic posturing would be associated with high forces in motor regions.<\/jats:p><jats:p>Impacts leading to loss of consciousness compared to controls produced higher head acceleration (linear acceleration; 81.5 g \u00b1 39.8 versus 47.9 \u00b1 21.4; P = 0.004, rotational acceleration; 5.9 krad\/s2 \u00b1 2.4 versus 3.5 \u00b1 1.6; P &amp;lt; 0.001) and in voxel-wise analysis produced larger brain deformation in many brain regions, including parts of the brainstem and cerebellum. Dystonic posturing was also associated with higher deformation compared to controls, with brain deformation observed in cortical regions that included the motor cortex. Loss of consciousness was specifically associated with higher strain rates in brainstem regions implicated in maintenance of consciousness, including following correction for the overall severity of impact. These included brainstem nuclei including the locus coeruleus, dorsal raph\u00e9 and parabrachial complex.<\/jats:p><jats:p>The results show that in head impacts producing loss of consciousness, brain deformation is disproportionately seen in brainstem regions containing nuclei involved in arousal, suggesting that head impacts produce loss of consciousness through a biomechanical effect on key brainstem nuclei involved in the maintenance of consciousness.<\/jats:p>","DOI":"10.1093\/brain\/awac485","type":"journal-article","created":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T11:41:51Z","timestamp":1671709311000},"page":"3063-3078","source":"Crossref","is-referenced-by-count":36,"title":["The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries"],"prefix":"10.1093","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1239-3414","authenticated-orcid":false,"given":"Karl A","family":"Zimmerman","sequence":"first","affiliation":[{"name":"UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London , London , UK"},{"name":"Department of Brain Sciences, Hammersmith Hospital, Imperial College London , London , UK"},{"name":"HEAD Lab, Dyson School of Design Engineering, Imperial College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janie","family":"Cournoyer","sequence":"additional","affiliation":[{"name":"Neurotrauma Impact Science Laboratory, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1600-8440","authenticated-orcid":false,"given":"Helen","family":"Lai","sequence":"additional","affiliation":[{"name":"UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London , London , UK"},{"name":"Department of Brain Sciences, Hammersmith Hospital, Imperial College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel B","family":"Snider","sequence":"additional","affiliation":[{"name":"Division of Neurocritical care, Department of Neurology, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fischer","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care, Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3250-2713","authenticated-orcid":false,"given":"Simon","family":"Kemp","sequence":"additional","affiliation":[{"name":"Rugby Football Union , Twickenham , UK"},{"name":"London School of Hygiene and Tropical Medicine , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Karton","sequence":"additional","affiliation":[{"name":"Neurotrauma Impact Science Laboratory, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas B","family":"Hoshizaki","sequence":"additional","affiliation":[{"name":"Neurotrauma Impact Science Laboratory, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5678-5124","authenticated-orcid":false,"given":"Mazdak","family":"Ghajari","sequence":"additional","affiliation":[{"name":"HEAD Lab, Dyson School of Design Engineering, Imperial College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Sharp","sequence":"additional","affiliation":[{"name":"UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London , London , UK"},{"name":"Department of Brain Sciences, Hammersmith Hospital, Imperial College London , London , UK"},{"name":"The Royal British Legion Centre for Blast Injury Studies and the Department of Bioengineering, Imperial College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,12,22]]},"reference":[{"key":"2023070312540483700_awac485-B1","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","article-title":"Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research","volume":"16","author":"Maas","year":"2017","journal-title":"Lancet Neurol"},{"key":"2023070312540483700_awac485-B2","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/neuros\/nyaa057","article-title":"Concussion guidelines in national and international professional and elite 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