The Federal Motor Vehicle Safety Standard (FMVSS) 207 “specifies strength requirements for automotive seats and their attachment assemblies, so as to minimize the possibility of their failure by forces acting on them as a result of vehicle impact.”

While this standard helps to regulate how well a seat structure performs in an accident, it has failed to significantly decrease injuries and fatalities due to seatback failure. Alyssa’s story is one of many such devastating tales.

The Insurance Institute for Highway Safety lists 2006 as their most recent year of fatality statistics. There were 1,327 deaths caused by rear impact motor vehicle accidents. The majority of fatalities were under the age of 25, with crashes causing one of every three injury-related deaths among children under 13.

Of these numbers, it is unclear exactly how many death were a result of seatback failures, but what is clear is that auto crashes are a significant cause of life ending or altering injuries in children. What is tragic is the lack of governmental oversight, or seemingly interest, in how often seats fail with catastrophic results.

We have numerous reports on air bag related injuries, but no hard data on seat failures and the resulting injuries. A study for The Los Angeles Times by Keith Friedman, an auto safety researcher, analyzed 72 rear-end collisions using a government database of tow-away crashes, found that from 1988 to 1997 1,800 backseat passengers were injured or killed by seat failures.

What we need are more researchers willing to invest the time into this important subject. Data on which cars have a history of seat collapse and which ones are best known to withstand a rear impact needs to be better available to the public. This topic isn’t a new one - auto safety engineers have been issuing warnings on this subject since the 1950s.

The FMVSS 207 was adopted back in 1968 and other than adding vans, trucks and buses in 1972, there hasn’t been an update in its standards since. FMVSS 207 requires that a seat back be capable of handling an impact of 270 foot/lbs. Now compare that number to the 6,000 lbs. of force that seat belts are required to withstand before failure. Why would the seat only need to be four or five percent as strong as the seat belt?

The National Highway Traffic Safety Administration (NHTSA) is well aware of the problem and in 1996 actually admitted that the current standard was inadequate…this didn’t lead to any changes, only further recognition of the problem in 1997 and 1998. One of the reasons they are dragging their heels is over the concern that stiffer seatbacks will lead to more incidents of whiplash.

Compare a whiplash injury with a traumatic brain injury (TBI) that leads to permanent disability or death - which one would you chose?

For now, research into the car you own or are looking to buy is the best offensive you can take to keep you and your passengers safe. One Website with some information, though not nearly enough regarding seat failures, is Safecar.gov. Until we see higher seatback safety standards, we will continue to hear of tragic stories such as Alyssa’s. We need to write to NHTSA, to our local government and to our automobile manufacturers. These issues need to be resolved for the safety of all vehicle occupants.

The importance of the vehicle seat’s role in automobile accidents shouldn’t be overlooked, yet it often is. If you run an Internet search, you will find numerous stories on collapsed seat backs, faulty restraint systems and inadequate load bearing ability - all manufacturer-related issues that have contributed to injury or death in automobile crashes.

One area of concern that is overlooked more than most is that of wheelchairs used in lieu of standard seats in vehicles. For those with disabilities, the act of transferring from a wheelchair to a car seat is often difficult and thus prohibitive. Instead, they often choose to purchase a van or other vehicle with the capacity to hold a wheelchair. Either the back seats are removed or the front passenger seat is in order to create a space for the wheelchair.

Vehicles can be modified to allow room for the wheelchair and the addition of special restraints to offer protection in an accident. While these restraints are tested for strength and comfort, they don’t give the wheelchair the same protective properties as originally equipped manufactured seats would.

Keeping in mind that a stock seat is still no guarantee that the person riding in or near it will be safe in an accident, the idea of a wheelchair providing the same degree of protection is faulty. They simply aren’t built to act as car seats. They haven’t been created to withstand the load placed on them and the occupant during a wreck nor to optimize the protective abilities of the restraints.

A common cause of injury during an accident is seat back failure - when the seat is unable to bear the increased load from the force of the impact added to the weight of the occupant, causing it to collapse. The two most common types are either a failure of the seat to maintain an upright position and the deformation of the actual structure. This usually happens after a rear impact that propels the vehicle forward the person backwards, creating strain on the back of the seat. There have been thousands of life-altering traumatic brain injury (TBI) or spinal cord injury (SCI) cases from these failures.

Properly manufactured seats should be able to bear this additional load as well as prevent the occupant from coming into contact with the vehicle’s interior, but too often they don’t measure up.

Now picture a wheelchair encountering those same circumstances. This chair is designed for comfort, ease of transportation and maneuverability - not impact resistance. The Subcommittee on Wheelchairs and Transportation (SOWHAT) has been pushing for better wheelchair standards, ones that will protect a passenger during motor vehicle transportation. They call for an emphasis on “design requirements, test procedures, and performance criteria” that will provide the necessary stability, restraint and strength.

SOWHAT’s earlier efforts in the 1990s to have ANSI, the American National Standards Institute, approve WC-19-Wheelchairs Used as Seats in Motor Vehicles has been approved, but it does not address every issue or concern posed, most notably it does not cover protection from rear impacts or rollovers.

To find out how you can better protect yourself or the wheelchair user in your life, check out the Ride Safe online brochure. They provide step by step instructions on how to best secure a wheelchair and its occupant while in a motor vehicle. They also list tips for selecting a wheelchair and tiedown equipment.

Top Three Things to Know for New Brain Injury Patients

The time following a brain injury can be confusing, overwhelming, and emotional. There are three things that new brain injury patients should be aware of to help them through this difficult time.

1. You Are Not Alone

Every year 1.4 million people in the United States seek medical care for traumatic brain injury. Survivors should be willing to ask for—and receive—help from family, friends, and other loved ones when needed. Support groups, resources, and the survivor’s medical team are all there to help the patient navigate the time following traumatic brain injury. If the patient is not able to advocate for himself or herself, caregivers should be willing to call on the medical team, support groups, and other resources for help.

2. There are Different Types of Treatment and Rehabilitation

Survivors should be aware that there are a variety of types of treatments and rehabilitation available, depending upon individual needs, as well as where they are in the recovery process. No two treatment and rehabilitation programs are the same. Instead, they are individualized based on the location and severity of the injury. The goal of treatment and rehabilitation is to restore as much function to the survivor as possible. The plan should be to focus on the particular issues the survivor faces, and to structure therapies accordingly.

3. Recovery Will Be a Challenge

There’s nothing easy about recovery, and the new brain injury patient should realize this. As a matter of fact, without the many “challenges” that go hand-in-hand with recovery, the brain can’t rewire itself. While recovery can be extremely frustrating—with the gains offset by steps backward—perseverance, patience, and celebrating all forward progress, no matter how small, can keep the survivor in a positive frame of mind.

This week’s resource is the Center for Disease Control and Prevention’s (CDC) teen driver fact sheet.

The CDC says that motor vehicle accidents are the leading U.S. cause of teen deaths, accounting for more than one in three deaths. This site has some valuable information such as the size of this problem, who is at risk, risk factors and how to prevent these accidents.

They include a section specifically for traumatic brain injury (TBI), citing 1.4 million cases a year in the U.S. alone.

For more information and additional resources, visit the CDC fact sheet.

Remember that feeling of invincibility that you had as a teenager? For most of us, that feeling is almost unrecognizable now that life has caught up with us and we are aware of just how delicate life can be.

Dr. Najma Ahmed, the assistant director of trauma at St. Michael’s Hospital in Toronto, Canada, says that this feeling of invincibility is preventable. “Teenage drivers have the highest rate of injury and death from motor vehicle crashes of any demographic group in Canada,” says the Canadian Press, and most of these teens are oblivious to their danger.

Dr. Ahmed says “It’s my job, our job to save them.” With a new program at St. Michael’s, she is hoping to do just that. A study of 260 adolescents found that when teens met with their peers who had sustained paralysis or another such life altering injury, they were most likely to alter their attitude and behavior in regards to taking the risk of damage or death seriously.

Dr. Ahmed is promoting the ThinkFirst Injury Prevention Strategy for Youth (TIPSY) at St. Michael’s, a program that takes teens to see first hand what can happen to them. Some of the situations included visiting young victims of accidents in the ICU unit, a situation that worked to bring the intended point home.

Researchers are hoping that programs such as this will spread as parents begin to realize the importance of prevention. Traumatic brain injuries (TBI) or spinal cord injuries (SCI) are just some of the life changing results of a teen driving too fast and losing control of their car.

With early education, such as is given through TIPSY, the researchers at St. Michael’s hope to greatly minimize these traumatic situations as more youth leave behind the idea that “it can’t happen to me”.

As summer sports season starts to wane and fall rests on the horizon, we’d like to remind everyone of the need to deck kids out in the proper safety equipment for their sport.

According to the Cincinnati Children’s Hospital Medical Center, an estimated 4.4 million kids between the ages of five and 18 are treated in emergency rooms each year for sports related injuries. The use of some simple protective gear will go a long way to help minimize harmful effects.

Helmets help to prevent concussions which can be caused by a blow or jolt to the head in sports such as football, baseball and softball. Children are resilient, and often will be up and running around shortly after an injury, so it’s important to check them for signs of dizziness, feelings of being faint or lapses in memory. All of these symptoms are indicators of a potential concussion.

Dr. Divine, the director for the center, stressed in a recent Medical News Today article the need for “coaches, trainers and parents to be observant of head injury symptoms because athletes may not report them…of utmost importance, athletes younger than 18 who have any post-blow-to-the-head symptoms affecting their thought process should not return to the same practice, game or contest and be evaluated by a physician prior to return to play.”

Youthful energy sometimes runs too high - resulting in fistfights, brawls, scuffles…and this energy isn’t limited to teenagers. Whether boxing for entertainment or out of anger, people need to be aware of how much damage a simple-seeming punch can cause.

Whatever the impetus, one hit to the wrong place can cause serious, permanent damage. An impact to the head can have unseen consequences, with memory problems and impaired cognitive functioning showing up long after the initial incident. It’s not just the force of hand to head that’s dangerous, it’s also the fall that the person may take after being knocked about.

A 2007 study from the American Academy of Neurology, tittled Does Amateur Boxing Cause Brain Damage?, focused on brain damage indicators such as high levels in cerebrospinal fluid (CSF) of neuronal and glial markers in the brains of amateur boxers. They found that there was four times the level in boxers compared to healthy non-athletes.

Considering that boxers make a living at a sport where the head is regularly impacted, this study has some potential application. There are a variety of opinions and even studies that try to either prove or disprove the lasting effects of a concussion - whether or not it can cause permanent brain damage. As with most topics we discuss here, we aren’t stating that this scenario is the absolute “for sure” one, but that prevention makes a world of difference.

You may not typically be an angry person, but perhaps the knowledge that one strong punch or even slap can cause brain damage will stay your hand when you are close to losing it. Perhaps bringing awareness of the potential for life-long damage will encourage youth to think twice before engaging in “friendly” boxing. Awareness - it’s a start!

Image from Beavis and Butthead.

Bicycle helmet studies - how seriously can you take them? We are aware that there are contradictory studies that benefit both those for and those against the use of helmets, and each one states that its conclusions are the right ones. Knowing of these biases, how can you determine whether wearing a helmet will benefit you or not?

Ignoring case-control studies, where those with head injuries are compared to cyclists without, and anecdotal evidence, we are left with the actual hard research regarding a helmet’s ability to protect your head in a crash.

Helmets are designed to handle crash energy - when your helmet sustains an impact, the foam crushes decreasing the energy and extending the time in which your head stops moving forward. This reduces the impact force to your brain. A good helmet won’t shatter or break, and a great one will be made with foam that can stiffen or yield depending on the degree of impact.

The goal is for the foam to be thick enough that it won’t bottom out on impact, but not so thick that it contributes to neck strain. The rounded shape isn’t just to fit to your head, its to help reduce impact even more by easily skidding when it comes into contact with the pavement.

Helmet safety standards have been created to make sure that your helmet can be used as the manufacturer intends. The American Society for Testing Materials (ASTM) is the most commonly referred to standards organization today and publishes on a variety of sport helmets. They have impact tests, strap tests, coverage requirements, as well as performance standards for different temperatures and weather conditions. Check out the Snell Memorial Foundation site for detailed bicycle helmet standards or the US CPSC.

These standards include most of the following tests. Impact testing drops a headform wearing a helmet onto an anvil…the anvil will be in a variety of shapes, each one fit the particular test. The amount of shock that the headform sustains is measured and these measurements determine how well the helmet protected it. Some impact tests drop weights onto the helmet or an attempt is made to penetrate the helmet with a sharp, heavy object.

These same tests, among others, are carried out when the helmet is wet, hot, cold, dry, etc. The strap is tested as well, by being yanked either by a machine or by the attachment of a weight. This is done to measure how much it stretches or if it breaks.

Now, short of donning a helmet and riding your bike into a deliberate crash scenario, you will have to take this research along with the countless studies both advocating for and against helmet use and make up your own mind.

Helmets have been created to lower your risk of brain damage, not prevent it, not guarantee a complete recovery after a crash. They can help you to enjoy your time riding, knowing that in addition to taking careful stock of your surroundings and using safe riding habits, you are doing everything in your power to help prevent a traumatic brain injury.

It is of course, your choice.

An unusual path to brain damage:

In the news these last few days have been versions of a story about a woman who suffered brain damage from a detox diet she was on. The British woman, Dawn Page, was taking a nutritionist’s advice and ingesting large amounts of water while cutting back on salt intake.

The resulting sodium deficiency caused an epileptic fit that lead to permanent brain damage. Page was given a settlement by the nutritionist’s insurance company, but that didn’t exactly make up for the memory damage, speech difficulties and loss of concentration that Page now lives with.

This story is a good example of how important it is to make sure you are taking advice from a registered and thoroughly trained professional. Not only that, but following up someone’s advice with research of your own to make sure that there is some validity to the information is equally important.

It’s easy for people to assume that because someone lables themselves a nutritionist or doctor or herbalist, etc., that they are automatically trustworthy. In our culture we tend to take “professionals” on faith, figuring that they wouldn’t lie to us as they are in the health profession.

One thing to remember is that sometimes they aren’t lying, such as seemed to be the case with Page’s nutritionist, Barbara Nash. From all accounts, Nash believed what she was selling and most likely it was ignorance on her part that caused her to prescribe a detox program that was so dangerous. This is why doing your own research to back up what you have been told is so important.