... Safety precautions will not eliminate all injuries. Standardizing effective treatment protocols for interventions (e.g., when to intubate) can prevent the worst outcomes of traumatic brain injury (TBI). (...

... TBI prevention strategies are improved by collaborations between professional sports, the automotive industry, helmet manufacturing, and the military. (Kent, Langton)...

... Research has fostered improved helmet design, player guidance, and rule changes that have decreased TBI rates in professional football. (Langton)...

... vehicles enable all passengers to assume a variety of relaxed postures that increase the risk of serious injury. Current vehicle safety technology and traditional crash test methods are not equipped to address leaning and reclining positions. (Kent)...

... The Diffuse Axonal Multi-Axis General Evaluation (DAMAGE) algorithm predicts TBI risk from head kinematics and...

... 1 This list is the rapporteurs’ summary of points made by the individual speakers identified, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They are not intended to reflect ...

... could potentially enable vehicle evaluation for TBI risk. A DAMAGE injury criterion for the small female facilitates injury prediction for both sexes and could help address the TBI risk disparities in vehicles. (Kent)...

... Falls are the leading cause of TBI in older adults and contribute to high rates of morbidity and disability. Factors including degradation of vision, musculoskeletal and vestibular systems, and slower reactive recovery times increase fall risk. (...

... A wearable device and smartphone application can measure gait speed, postural stability, and dynamic stability to assess fall risk and target interventions to specific weaknesses. (Lockhart)...

... The third session of the workshop featured a firsthand account of a traumatic brain injury (TBI) before exploring selected examples of three major causes of TBI—sports injuries, motor vehicle collisions, ... and falls in older adults—with a focus on how technology and innovation can affect mechanisms of injury and the potential to personalize protection and prevention moving forward. Objectives of the session were (1) reviewing prevention strategies across several leading causes of TBI, (2) identifying ... in both low- and high-tech approaches to TBI prevention in various contexts, and (3) exploring future opportunities for personalized approaches to mitigate injury. The session was moderated by Kristy Arbogast, R. Anderson Pew ...

... A LIVED EXPERIENCE PERSPECTIVE...

... Wesley Ilana Schnapp, TBI survivor, graduate student at the University of Arizona, and Christine Mirzayan Science & Technology Policy Fellow at the National Academies of Science, Engineering, and Medicine, provided a personal ... of sustaining and recovering from TBI. As a teenager, Schnapp was a competitive downhill alpine ski racer. In April 2009, at the age of 15, she had an accident during ... the actual accident, she has pieced together her memories of the morning with the accounts others have given her. Schnapp, who began skiing at age 3 and racing at age 7, was an experienced skier at this point in her adolescence. The slopes were icy that morning,...

... not yet having warmed in the sun. With helmet in place, she was following a friend downhill when she hit an unexpected bump. On her landing, she struck the strip of her forehead between helmet and goggles. She immediately lost consciousness and her friend called the ski patrol, who ... her and transported her to the emergency clinic located on the slope. The clinic intubated her upon arrival, and she then received a life flight by helicopter to a hospital in Portland, Oregon. Schnapp remained in a coma in the intensive care unit (ICU) for 4 ...

... Schnapp awoke from the coma and became responsive, but her personal awareness did not begin to emerge until about a week after her injury, when she was transferred to a ... hospital. She described the weeks she spent at the rehabilitation hospital as surreal and dreamlike, as if she were in a parallel universe in which she sometimes believed herself to be dead. Despite being able to move and perform basic ... , Schnapp could barely speak, understand other people, or have the sense of knowing who she was. She recalled being asked if she knew where she was and—after searching for cues about her location—Schnapp saw markers a friend had brought her and replied that she was at Office Depot. When the ... was repeated, she responded that she was at Home Depot. Unable to comprehend her context and surroundings, she went through motions but felt as if her conscious being was separate from her body....

... Schnapp described that after several weeks, “something clicked” and she suddenly began comprehending her surroundings, no longer believed herself to be dead when reminded about the accident, and was able to recall ... , said Schnapp, noting that the malleability of her 15-year-old brain likely aided her recovery. This experience fostered her interest in the brain, and she is currently studying neuroscience in a doctoral program....

... avoid injury to those that avert the worst outcomes after injury, Schnapp stated. Recalling that she was wearing a top-of-the-line ski racing helmet and was a trained skier taking a routine ski run, she emphasized that having safety precautions in place will not eliminate all injuries. However, ... examples of ski racers who were not intubated immediately following their accidents, instead being flown by helicopter to ICU without intubation, and did not survive. Therefore, Schnapp believes that intubation helped prevent worse outcomes after her accident. She closed by highlighting that with ... TBI—which she considers a “second birthday” on which she celebrates her survival—she feels gratitude to be alive, to share her experience, and to dedicate her life’s work to the brain community....

... The risks of TBI associated with professional football have received significant attention. Jennifer Langton, senior vice president of Player Health and Innovation at the National Football League (NFL), described NFL programs to understand behaviors that lead to injuries in players, to develop safety ... , and to incorporate knowledge and technology into play. Since the days of leather helmets, the NFL has prioritized health and head safety as a leader in professional sports, she said, and has recognized the need to research and reduce brain injuries for their athletes. Over ... past decade, the NFL has accelerated its efforts in science, statistical rigor, and innovation and has created an injury prevention paradigm that combines engineering, education, and enforcement to keep players safe, she continued. By disseminating ... insights with other organizations and industries, the league hopes to advance technologies and practices for head injury prevention and detection in ways that are instructive beyond the context of professional football—which may include youth and collegiate sports, she said....

... The NFL Engineering Road Map, developed in 2016 in collaboration with biomechanical engineering and injury prevention experts, is a comprehensive effort to better understand how head injuries happen on the field and to adopt learnings from areas ... sports to catalyze the design of protective equipment.2 The program’s initial goal was to make advances in head protection by understanding and measuring on-field injury mechanisms. The next phase was the creation of laboratory tests for helmets under realistic conditions. Data collected from ...

... Langton stated, with better performing helmets contributing to an average 25 percent reduction in concussion (a form of mild TBI). Each year, the NFL and the NFL Players Association engineering partners collaborate to conduct laboratory tests to determine which helmets are best able to manage impacts ...

... 2 See https://www.nfl.com/playerhealthandsafety/resources/fact-sheets/nfl-engineering-roadmap-fact-sheet (accessed June 4, 2024)....

... as “not recommended” and “newly prohibited,” and displays this poster in all locker rooms across NFL facilities. Clubs, equipment managers, and medical personnel use the poster to educate players and encourage them to choose the safest helmet available to them. Helmets prohibited because of ... performance are indicated in red and are not eligible for use. Langton noted that helmet innovation is one reason for changes in the helmet rankings over time, with some helmets that ...

... Helmet Manufacturers and Marketplace...

... that offer protection tailored to the type of contacts players in these positions typically sustain. To help stimulate the marketplace, the NFL expanded collaboration efforts into advanced manufacturing and materials science, areas that have revolutionized design. For example, the NFL conducted ...

... Prevention Benefits and Next Steps...

... for NFL testing in 2024, the highest annual number since testing began, she said. Of these 12 helmets, 8 are position-specific, providing linemen and quarterbacks with an available range of tailored helmets. Position-specific helmets for other positions are expected to become available in the next ...

... is optional for positions where full contact with tackling defensive players is against the rules of play. This includes quarterbacks, kickers, and punters....

... She remarked that the NFL has entered a new era in injury prevention, prevention technology, and performance optimization. In 2019, the NFL and Amazon Web Services (AWS) introduced the Digital Athlete, technology that uses artificial intelligence and machine learning to build a virtual ... of each player. This “digital twin” captures a complete record of the player’s data from training, practice, and game play, drawing on video, sensors, and other sources to capture and analyze plays and impacts. These data feed risk mitigation models that help ... understand the precise needs of their players in terms of staying healthy, recovering quickly, and optimizing their performance. Langton described this development as the next generation of player health and safety in the NFL....

... The league’s prevention priority is reducing TBI, and the NFL is also working to reduce the quantity and severity of head impacts, said Langton. The Digital Athlete enables each hit a player sustains to be identified and counted. The NFL shares these ... with coaches and players to encourage certain techniques and behaviors that have demonstrated decreased head impacts. Furthermore, the NFL adjusts on-field rules in an effort to prevent unnecessary head contact, ... such as the recently announced kickoff modification and use of the helmet rule (Kasabian, 2024; Madani, 2024). These changes aim to reduce the head impacts most likely to cause player injury. Through ...

... AUTOMATION, CUSTOMIZATION, AND TBI TRENDS IN MOTOR VEHICLE CRASHES...

... Richard Kent, Frederick Tracy Morse Professor of Mechanical and Aerospace Engineering, Biomedical Engineering, and Orthopedic Surgery at the University of Virginia, discussed anticipated changes in the automotive environment and how they may affect TBI, with a ... on vehicle automation and customization of protection systems. Describing the biomechanics involved in brain injury, Kent stated that hitting one’s head in the automotive ... carries potential for TBI, and the harder the hit, the greater the risk of both injury and severe injury....

... front car seats from hitting their heads. Rather than a full-frontal impact, the crash represents a scenario in which another car crosses the lane and strikes the test car with a slight offset of approxi-...

... mately 15 degrees of obliquity to the driver’s side. In the video, the dummy in the driver’s seat is thrown to the left of the steering wheel, and its head slides between the steering wheel airbag and the side airbag. Kent noted that although the dummy’s head narrowly misses hitting the door ... or the A pillar (i.e., the pillar of the car frame between the windshield and the driver side window), the outcome could be different if the dummy was 4 inches taller or shorter, was obese, had breast tissue between the seat ... and rib cage, or was leaning to change the radio station. Should any of these circumstances lead to a driver striking their head on the vehicle interior, ...

... Vehicle Automation and TBI Risk...

... Partially automated vehicles are currently on the road, and marketing materials highlight that automation reduces the need to pay attention to the road, said Kent. Were a fully automated driving experience ... , he noted, passengers may be able to read, play cards, or rotate seats 180 degrees to sit backward and stretch their legs or talk to passengers in the back seat. Kent showed a marketing illustration in which a passenger is lying down on a long seat ... safety guy,” Kent stated his horror at this idea, given that researchers have dedicated decades of study on restraining people inside of vehicles, and nothing is yet known about how to restrain a person in a relaxed, partially prone position. Emphasizing this point, he noted that crash test dummies ... that is unable to recline4. Kent added that implementing a new dummy model—one able to sit in a reclined position—into federal compliance standards is a lengthy, challenging process. Moreover, vehicle evaluations are performed using repeatable methods. Hours are spent positioning each dummy ... a millimeter of where it needs to be placed for repeated tests, and no methodology currently exists to repeatedly test dummies in the array of positions envisioned by innovators and marketers, said Kent....

... bones, which enabled array tracking. After the crash tests, researchers processed the motion capture system data to re-create the skeletal kinematics and performed CT scans to obtain comparison imaging. The cadaver head ended each crash test in a similar location regardless of whether it began in the ...

... traveling more than 2 inches beyond the trajectory of the head in the neutral position. This translates to a 27 percent increase in forward excursion and results in a higher risk of impact with the vehicle interior or another occupant. Furthermore, the head that began in the leaning position had a ... velocity than the head in the neutral position, demonstrating a 40 percent increase in relative velocity and a two-fold increase in kinetic energy over the neutrally positioned head. Thus, should the head come into contact with another object, higher kinetic ... severity of the head strike, Kent explained. He summarized that leaning 20 degrees to the side increases the risk of a passenger hitting their head and increases the likelihood that it will be a hard hit....

... Kent and colleagues have also studied the kinematics of car crash impact on a person leaning backward in a reclined car seat, again using cadavers owing to ... in which a person leaning back in a reclined car seat is pitched forward upon impact. The simulation shows that the pelvis slides forward in the seat and, because the spine began the trajectory in a reclined position, the abdomen is exposed to impact and is crushed by the lap belt. The spine then ... forward, with the head pitching so far forward that it strikes the thighs and sternum. Kent emphasized that possible injuries from this scenario could include a lacerated liver, perforated colon or bowel, lumbar spinal ... , and cervical spine fracture. A seat belt prevents a person in a typical seated position from hitting their head on their sternum, but the kinematics of ... working to solve this problem in order to market autonomous cars. He cautioned that relying on autonomous cars to eliminate crashes is unrealistic, and he highlighted that this technology entails moral and ethical decisions moving forward. Solutions are needed to protect people in autonomous vehicles ...

... Airbag technology and 90 percent seat belt use rates have greatly reduced the incidence of subdural hematomas, massive skull fractures, and diffuse axonal injuries associated with car crashes, Kent stated. With these preventative gains in place, the physical factors that can influence ... . Researchers are beginning to study the effects of body shape on impact reaction through the use of obese dummies. The role of biological sex—and the associated differences in size, shape, and other factors—in crash injuries is not well understood. Improving prevention efforts for people of ... ages and physical conditions is another area of study....

...-old woman in a frontal 56 kilometer per hour impact has decreased from approximately 41 percent to 29 percent—almost twice the risk rate for men—and the risk for severe injury has fallen from nearly 16 percent to approximately 8 percent. Thus, a significant sex effect has remained fairly constant ...

... Scientists do not yet fully understand the causes for the car crash injury risk disparity between men and women, which is driven largely by extremity injuries, said Kent. Men tend to drive heavier vehicles than women, and this may factor into injury rates. ... In addition, most testing is performed with male crash test dummies, and therefore research gaps on female bodies could be at play, he noted. Moreover, the greatest sex disparity in car crash injuries is seen in lower ... crashes and less severe injuries, areas that historically have not been studied as thoroughly as more severe crashes, he added. Research indicates that sex has ... injury is 1.7 for sex (Forman et al., 2019), indicating a fairly dramatic effect of sex on brain injury, he explained. Research in this area is new and the reasons for this effect have not been established....

... acceleration, and subsequent car design has greatly reduced the risk of skull fracture. However, Kent stated that tools are not yet in place for predicting risk of ...

... the automotive world, which he noted are in part based on NFL research. Angular velocity is used to predict risk of injury from impact that is fast, and angular acceleration is a better predictor of risk for impact that is slow. The Diffuse Axonal Multi-Axis General Evaluation (DAMAGE) algorithm ... for various tolerances and sensitivities within different anatomical axes in the brain (Gabler et al., 2018, 2019). Moreover, DAMAGE incorporates the entire history of the ... TBI risk. He described recent research progress using the DAMAGE algorithm with crash test dummies (Gabler et al., 2018, 2019; Reynier et al., 2022), and correlating these calculations with strain within brain tissue and along axonal pathways in the brain. The goal of this research is to develop a tool ...

... Approximately 2 years ago, a collaboration between Kent’s laboratory and the Insurance Institute for Highway Safety (IIHS) yielded a DAMAGE injury criterion specifically for the small female, enabling injury prediction for ... males and females (Reynier et al., 2022). IIHS sponsored this research in hopes of using the DAMAGE injury criterion in ranking vehicles according to safety. ...

... Thurmon Lockhart, MORE Foundation Professor of Life in Motion in the School of Biological Health and Systems Engineering at Arizona State University, provided an introduction to issues related to falls in older...

... adults, mechanisms related to fall accidents, and current approaches to reducing falls, including a wearable assessment tool.5...

... Significantly influenced by aging, TBI disproportionately affects older adults, with people aged 75 years and older making up approximately 40 percent of TBI-related hospitalizations and TBI-related deaths (CDC, 2021). The leading cause of TBI in this age ... , or stumbling. Furthermore, rates of TBI in older adults have increased substantially since 2001, with fall accidents increasing annually (Harvey and Close, 2012). Lockhart noted that the U.S. government expects 52 million falls with 12 million resulting in hospitalization annually by 2030. ... , 1994). Many older adults who survive falls experience a diminished quality of life after developing a fear of falling that leads to reduced activity and outings, which in turn fosters degradation. He highlighted that after experiencing a fall, 20–36 percent of older adults develop a fear of falling ( ... et al., 1997) and 25 percent require nursing home care within a year (Magaziner et al., 2000). Thus, prevention efforts to avoid a first fall are needed, said Lockhart....

... Fall Risk Factors and Assessment...

... Fall intervention is divided into fall protection and prevention. Fall protection includes personal protective equipment, such as helmets and harnesses. Fall prevention is complicated by environmental context and the coefficient of friction, which change with humidity and other factors that ... nearly impossible to standardize, he explained. Interventions such as strength training and balance exercises can reduce falls. Lockhart highlighted the importance of assessment in implementing appropriate interventions. For instance, a ... musculoskeletal degradation. However, current fall assessment tools, such as the Morse Fall Scale,6 do not provide the underlying cause of fall risk and therefore cannot be used to selectively...

... noted that the research he discussed was supported by grants from the National Science Foundation, National Institute for Occupational Safety and Health, and National Institutes for Health....

... target interventions to specific weaknesses, he explained. Moreover, Lockhart stated these existing tools are somewhat qualitative and feature low sensitivity and specificity, which limit the usefulness of these assessments....

... To address this gap, Lockhart and colleagues obtained a National Science Foundation grant to develop a technology to assess gait, posture, and musculoskeletal degradations. Using inertial measurement unit sensors, the wireless device is able to collect data on patients in their home ... and provide it to their physicians. Characterizing fall risk for older adults before a fall occurs is valuable, he said. Achieving this goal requires ... the mechanisms that increase fall risk for older adults in comparison to younger individuals. Degradation of vision and the vestibular and proprioceptive systems occurs with aging, and he noted that no interventions are available to stop that process. Cognitive impairment and gait ... also occur with age. Lockhart emphasized the importance of understanding how these various factors integrate to influence falls in older adults....

... Lockhart and colleagues have conducted perturbation experiments over the past 25 years to understand reactive behavior to various fall scenarios. For instance, bathtub testing has revealed that risk of falls is higher when stepping out of the bathtub ... when stepping in, he said. Conducting research with younger and older participant groups yielded an understanding of gait adaptation that occurs with age. The gait of fall-prone older adults features changes in gait characteristics such as shorter step length, ... wider base of support, slower acceleration, and slower transition of whole-body center of mass. These gait adaptations were thought to improve one’s stability; however, closer study revealed that ... et al, 2003). Furthermore, in experiments that posed slip or trip hazards to participants wearing safety harnesses, the initiation of the fall and the middle of the slipping or tripping action were very similar between young and older adults, he continued. The key difference between the groups ... reactive recovery, which was 70–120 milliseconds faster in younger adults, enabling them to interrupt the trajectory of the fall and regain balance (Kim et al., 2005). Lockhart attributed this delayed reactive behavior to sensory degradation and musculoskeletal weaknesses, and he ...

... Stability Assessment and Temporal Variabilities...

... Lockhart and colleagues modeled a person’s dynamic stability during walking. He explained that regardless of how advanced a measurement device is, it will yield ... qualities such as mean values, standard deviations, and variance. However, the gait cycle involves variability as a person...

... that yields the most helpful data or may only describe one instant in time, such as when the heel strikes the ground. Thus, a measure such as the standard deviation of heel contact does not capture all temporal information, and he maintained that complete time-series data are needed to more ... assess fall risk. Therefore, the system Lockhart and colleagues developed uses nonlinear dynamics, the Lyapunov exponent, and Floquet multipliers to capture temporal information and illuminate variability that affects fall risk....

... The gait-cycle data Lockhart and colleagues obtained indicate significant variability in the leg angle involved in the heel strike and less variation in the middle of the stride. Applying the Maximum Lyapunov exponent, a gait-stability metric, revealed much higher instability in ... that there is age-related loss of biocomplexity in the structure of giant pyramidal Betz cells found in the motor cortex of the brain (Lipsitz and Goldberger, 1982). In a healthy, younger adult, the cell structure is complex and features many branches; in an older adult, it has far fewer ... . The branch complexity enables faster reactions to perturbations, he said, and therefore reduces the risk of fall accidents....

... Understanding and assessing linear and nonlinear gait parameters fueled development of a wearable fall risk prediction system that uses inertial measurement unit sensors and a smartphone, ... Lockhart. He and colleagues tested this system by modeling 171 community-dwelling older adults. On measures used to evaluate algorithms’ predictive ability, the ... performing model (which included both linear and nonlinear dynamics) achieved areas under the curve (AUC) specificity and sensitivity, rates of approximately 90 percent when testing 10-meter gait (Doshi et al., 2023; Lockhart et al., 2021). Predictive accuracy of the ... was further tested with 44 adults who were measured and followed for 6 months after testing. In that time, nine individuals experienced falls, and eight of these were predicted by the fall risk prediction system....

... This system is a digital health platform called MyACTome, said Lockhart.7 The app measures gait speed, postural stability, and dynamic stability, and it generates a Lyapunov exponent. He recalled that less than a...

... 7 More information about MyACTome is available at https://www.myactome.com/ and https://pitchbook.com/profiles/company/541550-71 (accessed May 31, 2024). Lockhart indicated that the iPhone application version of this tool is ... the Lockhart Monitor and is available free of charge....

...’s group began collaborating with industry partners. After 2 years of validation, Healthcare Outcomes Performance Company acquired MyACTome,8 and this development is expected to foster clinical use of the tool. Lockhart stated that the company views the tool as a technology to promote safety ... patient–provider communication. He continues to work with the company to improve the system. Additionally, he and colleagues are developing a skin patch to calculate the frequency of muscle fiber contractions. In older adults, type II A and B muscle fibers—the ... , increasing proneness to falls. This patch will monitor muscle fiber frequency to inform fall risk assessment unobtrusively. Furthermore, Lockhart and colleagues are developing a physics-informed machine learning model, which will require far less data than that required by a data-driven machine ...

... Christopher Loftus, chief medical officer at the U.S. Food and Drug Administration’s Division of Neurological and Physical Medicine Devices, and Uzma Samadani, founder of Oculogica and neurosurgeon at the Minneapolis Veterans Administration Medical Center, both asked about mechanisms other ... direct head impact that may cause TBI, such as rapid chest deceleration from a seat belt or airbag and decreasing jugular venous return that elevate intracranial pressure, including whether research models have monitored intracranial pressure. Kent ... that he is unaware of research on transient increases in blood pressure and intracranial pressure in this context. Although other mechanisms for acquiring TBI exist, his prevention research—and the field’s as a whole—...

... He added that the models he uses do not model cerebral vasculature, and that even the most complex finite element models of the brain are only now approaching accurate boundary conditions. Emphasizing the difficulty in ... modeling the brain stem and brain interactions with the skull, Kent stated that research is examining stress distributions around blood vessels in the brain, but understanding ... blood pressure changes that increase intracranial pressure place mechanical strain on brain tissue and whether that leads to TBI is not likely in the near future....

... Athlete technology performs in less than 1 minute—she emphasized that the NFL is working to reduce TBIs by providing head impact data to coaches and players. The goal is to help teams better understand the number of head impacts each player has sustained since 2015, and to identify scenarios where ... frequency of head impacts is high. Analysis of the player behaviors associated with frequent head impacts adds to an understanding of when head impacts result in a TBI, said Langton....

... Prevention Equipment Implementation and Innovation Accessibility...

... Kristy Arbogast, R. Anderson Pew Distinguished Chair of Pediatrics at Children’s Hospital of Philadelphia, queried how preventative innovations for athletes, automobile ... , and older adults can be widely disseminated to enable access for all....

... Schnapp described adoption of helmets in professional sports such as the ski racer environment as one in which competitors understand the risks involved and always wear helmets in races, speculating that failure to wear a helmet is likely more common in the general population than ... . Although the adoption of helmets seems to have improved among the general population, she continued, not all helmets provide equal protection and more protective equipment may be more expensive, contributing to inequities in access to and use of highly protective ski helmets....

... Lockhart agreed on the importance of innovation dissemination and accessibility to the general population. To this end, he referred back to his group’s creation of a digital health platform (the Lockhart Monitor, ... MyACTome, see above) for detecting a suspected TBI. This free tool is a mobile phone application that assesses gait, posture, and balance. Arbogast asked about efforts to ensure that people are aware of the app and use it correctly. Noting that distribution is a challenge, ...

... target the person in the vehicle as the end user of the technology. Instead, he considers implementation in terms of enabling other innovators to use and...

... incorporate knowledge and technology into the design and development of their own products. For instance, the National Highway Traffic Safety Administration provides access to its crash test biomechanics ... free of charge. The NFL Helmet Challenge funds innovators to advance helmet design and shares its findings with other industries and at forums such as this workshop, said Langton....

... ago, he died from CTE while in his late sixties. Her nephew was a Texas all-star Division I football player but quit the sport after witnessing his grandfather contend with CTE. Acknowledging that protective equipment has improved in the decades since her brother-in-law played professional football, ... risks could lead to a declaration that the sport is not safe. Wise drew an analogy to smoking, asking whether any type of smoking is considered safe and whether prevention can truly be created in football, given the repetitive impacts. She noted that long before players reach professional status, they ...

..., Langton reflected that recent years have seen efforts to make football safer as a contact sport, including improvements to protective equipment and research efforts to understand the play conditions where TBIs occur....

... here, Kent turned the dialogue to briefly comment on TBI prevention efforts in youth sports. He reflected that, broadly speaking, children’s mental and physical health benefit from participation in athletics, but some sports do involve a higher risk of concussion. Arbogast emphasized the importance ... disseminating prevention knowledge and equipment throughout youth sports and described education efforts at various levels of sports as an ongoing challenge. Highlighting the increasing popularity of flag football and its ...

... Given that federal motor vehicle safety standards do not prohibit drivers from using aftermarket protective devices, Max Sevareid, emergency...

... be considered to improve passenger safety in autonomous vehicles. Kent replied that people do not consistently comply with voluntary safety measures and that prevention mechanisms that protect people without requiring active engagement tend to be more effective. Thus, asking people to wear helmets ... cars is likely unrealistic. Furthermore, a helmet increases the space a person’s head occupies and may not necessarily increase safety if it increases the frequency of impact, he added....

... the lap belt pulls the pelvis downward. A mechanism that locks the pelvis in place holds potential in addressing the poor restraint performance of standard seat belts on a person in a reclined position. Kent emphasized that due to the strength of the pelvis, seat belts can apply large forces directed ... . Helmet manufacturers have far smaller research budgets than those of Toyota or General Motors. Kent noted that collaborations between the sports and automotive industries may yield beneficial innovations....

... included in the scope of the NFL’s research activity in TBI, Langton mentioned a few relevant initiatives. First, the NFL hosts helmet technology and performance innovation challenges.9 Second, the NFL supports a research portfolio that includes longitudinal studies on neuroscience and pain ... . This work is supported by a scientific advisory board and recipients of NFL research support are listed on the NFL Player Health and Safety Portal.10 She further noted that the NFL and the NFL Players Association collaborate on crowdsourcing challenges and grant investing. Arbogast ... fund some projects examining the long-term health of their player population. Further, Langton described how, in 2024, the NFL held its first Health and Safety summit to engage different disciplines within the NFL teams in education about the league’s research findings....

... 9 See https://www.nfl.com/playerhealthandsafety/equipment-and-innovation/innovationchallenges/ (accessed September 16, 2024)....

... 10 See https://www.nfl.com/playerhealthandsafety/ and https://www.nfl.com/playerhealthandsafety/resources/ (accessed September 16, 2024)....

... Peek-Asa, vice chancellor for research at University of California San Diego, remarked that a cataclysmic interaction between health disparities and technology disparities lies ahead, involving technology access issues and considerations regarding the computing power needed to sustain future ... . Arbogast echoed this view, noting that epidemiological data clearly indicates disparities in TBI injury and outcomes, and unequal access to innovations such as those discussed during the session may further emphasize such disparities. Noting that the second session of ...