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Steenstrup 2018.Pdf (10.87Mb) Sophie E. Steenstrup // Head injuries in FIS World Cup alpine skiers, snowboarders and freestyle skiers and freestyle skiers, snowboarders Cup alpine in FIS World // Head injuries Sophie E. Steenstrup DISSERTATION FROM THE NORWEGIAN SCHOOL OF SPORT SCIENCES 2018 Sophie E. Steenstrup Head injuries in FIS World Cup alpine skiers, snowboarders and freestyle skiers - Epidemiology and video analyses of head impact injury mechanisms Sophie E. Steenstrup Head injuries in FIS World Cup alpine skiers, snowboarders and freestyle skiers - Epidemiology and video analyses of head impact injury mechanisms DISSERTATION FROM THE NORWEGIAN SCHOOL OF SPORT SCIENCES • 2018 ISBN 978-82-502-0550-5 Errata Page Original text Type of correction Corrected Text number 39 However, the relative reduction in the Formatting However, the relative reduction in the proportion of head injuries was smaller than proportion of head injuries was smaller than anticipated (from 18% in 2002 to 15% in anticipated (from 18% in 2002 to 15% in 2011).(Sulheim et al., 2017) 2011) (Sulheim et al., 2017). 87 BAILLY, N., LLARI, M., DONNADIEU, T., Reference formatting BAILLY, N., LLARI, M., DONNADIEU, T., MASSON, C. & ARNOUX, P. J. 2016. Head MASSON, C. & ARNOUX, P. J. 2016. Head impact in a snowboarding accident. Scand J impact in a snowboarding accident. Scand J Med Sci Sports. Med Sci Sports, 27, 964–974. 88 CARUS, L. & ESCORIHUELA, M. 2016a. Reference formatting CARUS, L. & ESCORIHUELA, M. 2016a. Epidemiology of Feature-Specific Injuries Epidemiology of Feature-Specific Injuries Sustained by Skiers in a Snow Park. Wilderness Sustained by Skiers in a Snow Park. Wilderness Environ Med. Environ Med, 27(3), 415-20. 91 MCCRORY, P., MEEUWISSE, W., Reference formatting MCCRORY, P., MEEUWISSE, W., DVORAK, J., AUBRY, M., BAILES, J., DVORAK, J., AUBRY, M., BAILES, J., BROGLIO, S., CANTU, R. C., CASSIDY, BROGLIO, S., CANTU, R. C., CASSIDY, D., ECHEMENDIA, R. J., CASTELLANI, R. D., ECHEMENDIA, R. J., CASTELLANI, J., DAVIS, G. A., ELLENBOGEN, R., R. J., DAVIS, G. A., ELLENBOGEN, R., EMERY, C., ENGEBRETSEN, L., EMERY, C., ENGEBRETSEN, L., FEDDERMANN-DEMONT, N., GIZA, C. FEDDERMANN-DEMONT, N., GIZA, C. C., GUSKIEWICZ, K. M., HERRING, S., C., GUSKIEWICZ, K. M., HERRING, S., IVERSON, G. L., JOHNSTON, K. M., IVERSON, G. L., JOHNSTON, K. M., KISSICK, J., KUTCHER, J., LEDDY, J. J., KISSICK, J., KUTCHER, J., LEDDY, J. J., MADDOCKS, D., MAKDISSI, M., MADDOCKS, D., MAKDISSI, M., MANLEY, G. T., MCCREA, M., MEEHAN, MANLEY, G. T., MCCREA, M., MEEHAN, W. P., NAGAHIRO, S., PATRICIOS, J., W. P., NAGAHIRO, S., PATRICIOS, J., PUTUKIAN, M., SCHNEIDER, K. J., PUTUKIAN, M., SCHNEIDER, K. J., SILLS, A., TATOR, C. H., TURNER, M. & SILLS, A., TATOR, C. H., TURNER, M. & VOS, P. E. 2017. Consensus statement on VOS, P. E. 2017. Consensus statement on concussion in sport-the 5th international concussion in sport-the 5th international conference on concussion in sport held in conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. Berlin, October 2016. Br J Sports Med, 51(11), 838-847. 93 RICHARDS, D., CARHART, M., SCHER, I., Reference formatting RICHARDS, D., CARHART, M., SCHER, I., THOMAS, R. & HURLEN, N. 2008. Head THOMAS, R. & HURLEN, N. 2008. Head Kinematics During Experimental Snowboard Kinematics During Experimental Snowboard Falls: Implications for Snow Helmet Falls: Implications for Snow Helmet Standards. Standards. Journal of ASTM International, 5(6), 1-7. 94 SCHER, I., RICHARDS, D. & CARHART, Reference formatting SCHER, I., RICHARDS, D. & CARHART, M. 2006. Head Injury in Snowboarding: M. 2006. Head Injury in Snowboarding: Evaluating the Protective Role of Helmets. Evaluating the Protective Role of Helmets. Journal of ASTM International, 3(4), 1-9. II Table of contents Acknowledgements ........................................................................... V List of papers ................................................................................ VII Abbreviations ................................................................................ VIII Sammendrag .................................................................................. IX Summary ....................................................................................... XI Introduction .................................................................................... 1 Head injuries ................................................................................. 5 Sports-related concussion ....................................................................... 6 Severe sports-related traumatic brain injuries .............................................. 7 Literature search strategy ................................................................. 9 Epidemiology of head injuries in skiing and snowboarding ........................... 11 Recreational skiing and snowboarding ....................................................... 11 Epidemiology at the FIS World Cup level .................................................... 12 Causes of head injuries in skiing and snowboarding ................................... 12 Risk factors for head injuries in recreational skiers and snowboarders ................ 12 Head Injury mechanisms ........................................................................ 14 Detailed brain injury mechanisms vs gross head impact injury mechanisms ........... 14 Detailed mechanisms of brain injuries ....................................................... 15 Research approaches to describe head injury mechanisms in skiing and snowboarding ............................................................................... 18 Retrospective interviews, hospital records and accident reports ........................ 18 Video analysis .................................................................................... 25 Cadaver and dummy studies ................................................................... 28 In vivo measurements - Biomechanical wearables .......................................... 30 Mathematical modelling ........................................................................ 32 Summary of research approaches to describe head injury mechanisms ................. 34 Head injury prevention .................................................................... 35 Helmets ........................................................................................... 35 Helmet design .................................................................................... 35 Helmet testing ................................................................................... 36 Helmet standards ................................................................................ 37 III Helmet use and risk of head injury ........................................................... 38 Summary head injury prevention and helmets .............................................. 42 Aims of the thesis ........................................................................... 43 Methods ....................................................................................... 44 Injury registration (Papers I-IV) .......................................................... 44 Injury definition (Papers I-IV) ............................................................ 45 Exposure registration (Paper I) ........................................................... 45 Video aquisition (Papers II, III and IV) ................................................... 46 Video processing (Papers II, III and IV) .................................................. 47 Qualitative video analysis (Paper II) ..................................................... 47 Head impact injury reconstruction from broadcast video (Papers III and IV) ..... 48 Statistics (Papers I and II) ................................................................. 52 Error estimates (Papers III and IV) ....................................................... 52 Ethics ......................................................................................... 53 Results and discussion ...................................................................... 54 Epidemiology (Paper I) .................................................................... 54 Gross head impact injury mechanisms (Paper II) ...................................... 58 Head impact injury reconstruction from broadcast video (Papers III and IV) ..... 66 Methodological considerations ........................................................... 74 Implications for injury prevention ....................................................... 81 Conclusions ................................................................................... 84 Future research ............................................................................. 85 References ................................................................................... 87 Papers I to IV ................................................................................. 96 IV Acknowledgements This project is the result of great teamwork. I am truly thankful for the opportunity to do a PhD at the Oslo Sports Trauma Research Center and the Department of Sports Medicine at the Norwegian School of Sports Sciences. I have been surrounded by a fantastic team of very talented people. I would especially like to thank: Roald Bahr, MD PhD, professor, co-founder of the Oslo Sports Trauma Research Center, and my main supervisor. Your knowledge in the field of sports medicine research is outstanding, and I cannot believe how much I have learnt
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