A new survey suggests a large disconnect in Americans’ education around concussions and how to reduce the risk of them using helmets.

In the U.S., the prevalence of traumatic brain injuries (TBI), especially in sports, has been called a crisis. According to the Centers for Disease Control and Prevention (CDC), there were 64,362 TBI-related deaths in 2020 and 223,135 TBI-related hospitalizations in 2019 with more than 611 TBI-related hospitalizations and 176 TBI-related deaths per day.¹ In 2020, the CDC also reported that 7% of U.S. children suffered a TBI² and that each year in the U.S., about 3.8 million concussions occur from sports-related injuries.³

The survey, which was conducted by Nielsen, a consumer survey company, and commissioned by Mips, a helmet safety technology company, polled a representative sample of 1,000 Americans, split evenly between male and female, ranging 18 to 65 years old. All survey subjects have either bought a helmet in the past three years or plan to buy a helmet in the next six months for any of the following applications: cycling, rock climbing, horse riding, motorcycling, skiing, snowboarding, team sports and safety equipment.

Among the most significant findings of the survey is that 70% of American helmet buyers are unaware of the term rotational motion. Lack of understanding of rotational motion, a key contributor to TBIs, appears to correlate with Americans’ helmet purchasing decisions; seven out of 10 American helmet buyers did not consider at all how well the helmet protects against rotational motion when buying a helmet.

Rotational motion is a common cause for concussions and more severe brain injuries in oblique hits to the head. In most instances when you fall while moving and hit your head, you don’t hit your head in a straight 90-degree angle towards the surface. Instead, you often fall and hit your head at an angle, similar to how a tennis ball makes contact with the ground after being hit with a racket. When your head hits something at an angle, it typically exposes your head to rotational motion, which studies have shown can be more dangerous than linear motion.

Pioneer studies from the mid-20th century have shown that rotational motion is a key component in some traumatic brain injuries, such as concussions and diffuse axonal injury.^4,5,6 The rotational motion causes shearing of the brain tissue, which can cause traumatic brain injuries. After these pioneering studies, more recent studies have supported the prevalence of rotational motion in diffuse traumatic brain injuries.^7,8,9,10 Despite this evidence, today there are only two helmet testing standards that account for rotational motion (FIM and ECE22.06), both of which pertain only to motorcycle helmets in the EU.

The survey also found that about 40% of American helmet buyers have suffered a concussion in the past, 60% of which were not wearing a helmet at the time of the concussion. Additionally, comfort and fit are the most important criteria that Americans consider when purchasing a helmet, followed by perceived protection against head injuries, meeting specific safety regulations and price.

“Around the world, traumatic brain injuries (TBI) are often poorly understood,” said Peter Halldin, co-founder of Mips. “Improving safety and help[ing] increase education around TBIs — there is nothing more important to us than that. Think of a parent for example, when buying a helmet for their child, or you buying a helmet for yourself or a loved one. If people aren’t equipped with relevant information, how can they make informed decisions?”

Scientific Sources

1. Centers for Disease Control and Prevention. National Center for Health Statistics: Mortality Data on CDC WONDER. Accessed 2022. https://wonder.cdc.gov/mcd.html. 2. Centers for Disease Control and Prevention. Concussions and Brain Injuries in Children: United States, 2020. Accessed 2022. https://www.cdc.gov/nchs/data/databriefs/db423.pdf
2. University of Michigan Health, Neurosciences – Concussion in Athletes. Accessed 2022. https://www.uofmhealth.org/conditions-treatments/brain-neurological-conditions/concussi on-athletes-neurosport
3. Holbourn, A. H. S. (1943). Mechanics of Head Injuries. The Lancet, 9, 438–441. 5. Ommaya, A. K., Yarnell, P., Hirsch, A. E., & Harris, E. H. (1967). Scaling of Experimental Data on Cerebral Concussion in Sub-Human Primates to Concussion Threshold for Man. 11^th Stapp Car Crash Conference, 47-52.
4. Margulies, S. S., & Thibault, L. E. (1992). A Proposed Tolerance Criterion for Diffuse Axonal Injury in Man. Journal of Biomechanics, 25(8), 917–923.
5. Browne, K. D., Chen, X. H., Meaney, D. F., & Smith, D. H. (2011). Mild traumatic brain injury and diffuse axonal injury in swine. Journal of Neurotrauma, 28(9), 1747–1755. 8. Gennarelli, T. A., Thibault, L. E., & Ommaya, A. K. (1972). Pathophysiologic Responses to Rotational and Translational Acclerations of the Head. 16^th Stapp Car Crash Conference, 296–308.
6. Kleiven, S. (2007). Predictors for Traumatic Brain Injuries Evaluated through Accident Reconstructions. Stapp Car Crash Journal, 51, 81–114.
7. Kleiven, S. (2013). Why Most Traumatic Brain Injuries are Not Caused by Linear Acceleration but Skull Fractures Are. Frontiers in Bioengineering and Biotechnology, 1, 1–5.