Why helmets don't prevent concussions -- and what might | David Camarillo

譯者: Conway Ye 審譯者: May Cheung

The word concussion evokes a fear these days more so than it ever has,

現在聽到腦震盪這詞 比起以往更加恐懼，

and I know this personally.

這是我親身的經驗。

I played 10 years of football,

我打美式足球已經有十年了，

was struck in the head thousands of times.

頭部被擊中數千次。

And I have to tell you, though, what was much worse than that

不過我想告訴你， 比起這事還有更糟的，

was a pair of bike accidents I had where I suffered concussions,

就是兩次被單車撞致腦震盪，

and I'm still dealing with the effects of the most recent one

這件事近期仍然影響我日常生活，

today as I stand in front of you.

幸好今日我可如常站在你們面前。

There is a fear around concussion

對於腦震盪仍然圍繞著恐懼，

that does have some evidence behind it.

因為背後確實有些證據。

There is information that a repeated history of concussion

還有一些資訊顯示重複腦震盪

can lead to early dementia, such as Alzheimer's,

可能會導致早期老年癡呆症， 例如：阿茲海默症，

and chronic traumatic encephalopathy.

以及慢性創傷性腦病變。

That was the subject of the Will Smith movie "Concussion."

威爾‧史密斯主演的《震盪效應》 就是談論那樣的主題。

And so everybody is caught up in football and what they see in the military,

大家都以為只有打美式足球 或服役才會得到，

but you may not know

可能你未必知道

that bike riding is the leading cause of concussion for kids,

對於兒童來說騎單車 是引致腦震盪的主要原因，

sports-related concussion, that is.

即運動導致的腦震盪。

And so another thing that I should tell you

還有另一件事我應該告訴你，

that you may not know

可能你未必知道，

is that the helmets that are worn in bicycling and football

騎單車也好，踢美式足球也好， 都必須配戴頭盔，

and many activities,

還有其他戶外運動亦需要配戴，

they're not designed or tested

由於現時的運動頭盔 並沒有仔細設計或進行測試，

for how well they can protect your children against concussion.

故此難易保護兒童防止腦震盪發生。

They're in fact designed and tested

實際上在設計及測試方面

for their ability to protect against skull fracture.

應要有預防及保護頭骨骨折的能力。

And so I get this question all the time from parents,

所以每時每刻， 我都從家長那兒得到這個問題，

and they ask me,

他們問我：

"Would you let your own child play football?"

「你會讓你的孩子踢美式足球嗎？」

Or, "Should I let my child play soccer?"

或問：「我應該 讓我的孩子踢足球嗎？」

And I think that as a field,

我認為在這個領域，

we're a long way from giving an answer with any kind of confidence there.

要找到明確答案 的確還有很長的路要走。

So I look at that question from a bit of a different lens,

所以我從稍微不同的角度 去看這條問題，

and I want to know, how can we prevent concussion?

我想知道，我們應如何預防腦震盪？

Is that even possible?

真的有可能嗎？

And most experts think that it's not,

大多數專家認為這是不可能的，

but the work that we're doing in my lab

不過在我的實驗室進行的研究，

is starting to reveal more of the details around concussion

開始揭示更多與腦震盪有關的細節，

so that we can have a better understanding.

讓我們有更好的理解。

The reason we're able to prevent skull fracture with helmets

我們之所以配戴頭盔來預防頭骨破裂

is because it's pretty simple. We know how it works.

就是因為這個方法很簡單。 我們知道頭盔的作用。

Concussion has been much more of a mystery.

可惜腦震盪仍然充滿著謎團。

So to give you a sense of what might be happening in a concussion,

為了讓大家知道 腦震盪是怎麼發生的，

I want to show you the video here

我想在這裡放個影片，

that you see when you type into Google,

你到 Google 搜尋

"What is a concussion?"

「什麼是腦震盪？」就會看到。

The CDC website comes up,

美國疾病管制與預防中心的 網站會跑出來，

and this video essentially tells the whole story.

這段影片講得很完整。

What you see is the head moves forward,

現在留意這個頭部向前移動，

the brain lags behind,

大腦先向前撞到，

then the brain catches up

然後大腦再向後傾

and smashes into the skull.

並撞向頭骨。

It rebounds off the skull

再從頭骨反彈，

and then proceeds to run into the other side of the skull.

然後繼續撞到另一邊的頭骨。

And what you'll notice is highlighted in this video from the CDC,

這段由疾管中心提供的影片 有強光打亮的地方，

which I'll note was funded by the NFL,

我要先申明一下這是由 國家美式足球聯盟贊助的，

is that the outer surface of the brain,

是大腦表面的四周，

where it was to have smashed into the skull,

就是撞擊到頭骨的地方，

looks like it's been damaged or injured, so it's on the outer surface of the brain.

看起來像已受損或受創， 所以是打亮在大腦表面周邊。

And what I'd like to do with this video

我給大家看這段影片，

is to tell you that there are some aspects that are probably right,

是想告訴你某些觀點可能是對的，

indicative of what the scientists think happens with concussion,

表明這是科學家認知的腦震盪成因，

but there's probably more that's wrong with this video.

不過這段影片的錯誤部分 大概比較正確的還多。

So one thing that I do agree with, and I think most experts would,

有一件事我與大多數專家都認同的，

is that the brain does have these dynamics.

就是大腦的確有這樣的動態變化。

It does lag behind the skull

確實大腦會比頭骨慢，

and then catch up and move back and forth and oscillate.

再向前繼而前後擺動。

That we think is true.

我認為這是事實。

However, the amount of motion you see in the brain in this video

然而，從影片中 可以看到大腦擺動次數，

is probably not right at all.

但這點可能沒根據。

There's very little room in the cranial vault,

在大腦與顱頂之間的空間極小，

only a few millimeters,

只有幾公厘，

and it's filled entirely with cerebral spinal fluid,

而且完全充滿腦脊髓液，

which acts as a protective layer.

這角色就是要充當保護層。

And so the brain as a whole probably moves very little inside the skull.

因此整個大腦在頭骨內移動得很少。

The other problem with this video

這影片內另一個問題

is that the brain is shown

是大腦在移動時，

as a kind of rigid whole as it moves around,

是以一塊堅硬的整體顯示，

and that's not true either.

而事實並非如此。

Your brain is one of the softest substances in your body,

你的大腦是你的身體上 最柔軟的物質之一，

and you can think of it kind of like jello.

你能想到的它有點像果凍。

So as your head is moving back and forth,

所以當你的頭部來來回回移動，

your brain is twisting and turning and contorting,

你的大腦就會扭來扭去、 旋轉和扭曲，

and the tissue is getting stretched.

及組織會被拉長。

And so most experts, I think, would agree

所以我想大多數專家都會同意

that concussion is not likely to be something that's happening

腦震盪不太可能像這樣子

on this outer surface of the brain,

發生在大腦表面周邊，

but rather it's something that's much deeper

而是更深層、

towards the center of the brain.

接近大腦中心點。

Now, the way that we're approaching this problem

現在，用我們的方式 去解說這個問題，

to try to understand the mechanisms of concussion

嘗試去理解腦震盪的機制，

and to figure out if we can prevent it

搞清楚我們是不是可以預防，

is we are using a device like this.

我們使用類似這個的設備。

It's a mouthguard.

這是一個牙套。

It has sensors in it that are essentially the same

牙套上有一個感應器，

跟你手機上的東西的本質是相同的：

that are in your cell phone:

accelerometers, gyroscopes,

加速度計，陀螺儀，

and when someone is struck in the head,

當有人頭部被擊中，

it can tell you how their head moved

這個裝置可以告訴你 他們的頭部是怎樣移動的，

at a thousand samples per second.

每秒產生一千個樣本。

The principle behind the mouthguard is this:

該牙套背後的原理是這樣的：

it fits onto your teeth.

它套牢在你的牙齒上。

Your teeth are one of the hardest substances in your body.

你的牙齒是身體最堅硬的物質之一。

So it rigidly couples to your skull

所以它牢牢的連接到你的頭骨，

and gives you the most precise possible measurement

並為你提供最精確合適的測量

of how the skull moves.

頭骨是如何移動的。

People have tried other approaches, with helmets.

大家嘗試過其他的方法， 如配戴頭盔。

We've looked at other sensors that go on your skin,

或利用其他放在皮膚上的感應器，

and they all simply move around too much,

但是它們很容易移動，

and so we found that this is the only reliable way

所以我們發現，牙套感應器 是唯一可靠的方法

to take a good measurement.

取得最好的測量方式。

So now that we've got this device, we can go beyond studying cadavers,

我們現在有了這個設備， 就不用再用屍體作研究，

because you can only learn so much about concussion

因為你想更了解腦震盪， 研究屍體能得到的很有限，

from studying a cadaver,

and we want to learn and study live humans.

所以我們想從活生生的人中研究。

So where can we find a group of willing volunteers

可是要去哪裡找一群志願者，

to go out and smash their heads into each other on a regular basis

定期去敲他們的頭部，

and sustain concussion?

並要持續腦震盪？

Well, I was one of them,

對吧，我就是他們其中之一，

and it's your local friendly Stanford football team.

這是你們本地超友善的 史丹福大學美式足球隊。

So this is our laboratory,

這是我的實驗室，

and I want to show you

我想展示給你們看

the first concussion we measured with this device.

我們用這裝置進行了 第一次腦震盪測量。

One of the things that I should point out is the device has this gyroscope in it,

我想特別指出這裝置是利用陀螺儀

and that allows you to measure the rotation of the head.

來測量頭部旋轉情況。

Most experts think that that's the critical factor

因為大多數專家認為 這就是關鍵因素，

that might start to tell us what is happening in concussion.

能告訴我們腦震盪是如何形成。

So please watch this video.

請先觀看這段影片。

Announcer: Cougars bring extra people late, but Luck has time,

評述員︰ 美洲獅遲遲才帶人來， 但盧克仍有時間，

and Winslow is crushed.

可惜與溫思勞撞到正面。

I hope he's all right.

我希望他沒事。

(Audience roars)

（影片中觀眾怒吼）

Top of your screen,

請留意螢光幕上方，

you'll see him come on just this little post route,

他跑球門線 (post route) 衝過去，

get separation, safety.

被撞到彈開了，安全得分。

Here it comes at you in real speed. You'll hear this.

現在用正常的速度播給大家看。 你會聽到這個。

The hit delivered by --

撞擊是由──

David Camarillo: Sorry, three times is probably a little excessive there.

大衛卡馬里奧：對不起， 撥三次實在有一點過分。

But you get the idea.

但你看到了。

So when you look at just the film here,

你只要看著這個影片，

pretty much the only thing you can see is he got hit really hard and he was hurt.

你唯一能注意到的事情 就是他真的被撞得很慘和受傷。

But when we extract the data

但當我們從他戴的牙套提取資料時，

out of the mouthguard that he was wearing,

we can see much more detail, much richer information.

我們可以看到更詳細、 更豐富的信息。

And one of the things that we noticed here

我們在這裡注意到一件事，

is that he was struck in the lower left side of his face mask.

就是他被撞擊到面罩左下方。

And so that did something first that was a little counterintuitive.

這在第一時間造成了 有點不合常理的反應。

His head did not move to the right.

他的腦部沒有移動到右邊。

In fact, it rotated first to the left.

事實上，腦部先轉動到左邊。

Then as the neck began to compress,

然後隨著頸部開始受壓，

the force of the blow caused it to whip back to the right.

由衝擊力引致腦部迅速撞回右邊。

So this left-right motion was sort of a whiplash-type phenomenon,

這個左右移動很類似 車禍撞擊後頸部扭傷的現象，

and we think that is probably what led to the brain injury.

我們認為就是這樣導致了腦部受傷。

Now, this device is only limited in such that it can measure the skull motion,

由於，這種裝置只局限於 測量頭骨移動，

but what we really want to know is what's happening inside of the brain.

所以我們真的很想知道 在大腦內究竟發生了什麼變化。

So we collaborate with Svein Kleiven's group in Sweden.

故此我們在瑞典， 與斯韋恩·凱文的研究小組合作。

They've developed a finite element model of the brain.

他們已經發展出 一套有限元法去探討大腦。

And so this is a simulation

這是一種模擬狀態，

using the data from our mouthguard from the injury I just showed you,

研究數據主要來自傷者的牙套資料， 就是從剛才這段影片上看到的，

and what you see is the brain --

從這片段你可以看到大腦──

this is a cross-section right in the front

這是大腦橫切面，

of the brain twisting and contorting as I mentioned.

正如我所提及的大腦有扭曲及變形。

So you can see this doesn't look a lot like the CDC video.

你們現在看到的 與疾控中心的影片完全不同。

Now, the colors that you're looking at

現在，你看到的顏色

are how much the brain tissue is being stretched.

代表有多少腦組織被拉長了。

And so the red is 50 percent.

紅色代表 50% 。

That means the brain has been stretched to 50 percent of its original length,

就是指大腦被拉長程度 比起原來的長 50%，

the tissue in that particular area.

就是該特定區域的組織。

And the main thing I want to draw your attention to is this red spot.

我請大家特別注意這個紅點。

So the red spot is very close to the center of the brain,

紅點非常接近大腦中心，

and relatively speaking,

相對來說，

you don't see a lot of colors like that on the exterior surface

在外層表面並沒看到 太多類似的顏色，

as the CDC video showed.

並不像疾控中心的影片中顯示的。

Now, to explain a little more detail

現在，為了進一步解釋

about how we think concussion might be happening,

我們認為發生腦震盪的原因，

one thing I should mention

有一件事我必須要提及

is that we and others have observed that a concussion is more likely

就是我們和其他人已經觀察到，

腦震盪比較容易發生於 被撞時頭部往旁邊轉的情況。

when you're struck and your head rotates in this direction.

This is more common in sports like football,

前後轉比較常見於美式足球，

but this seems to be more dangerous. So what might be happening there?

但是這樣轉似乎更加危險。 所以可能的原因是什麼呢？

Well, one thing that you'll notice in the human brain

有件事你會注意到，

就是人類的大腦 的確與其他動物不同，

that is different than other animals

is we have these two very large lobes.

我們有兩個非常大的額葉。

We have the right brain and the left brain.

我們有右腦和左腦。

And the key thing to notice in this figure here

請留意圖中最關鍵的事情，

is that right down the center of the right brain and the left brain

就是右腦與左腦的中間位置

there's a large fissure that goes deep into the brain.

有一個大裂縫深入大腦。

And in that fissure, what you can't see in this image,

那裂縫，你不能在此圖片中看到，

you'll have to trust me,

請相信我，

there is a fibrous sheet of tissue.

有一片纖維組織。

It's called the falx,

稱為大腦鐮，

and it runs from the front of your head all the way to the back of your head,

大腦鐮從你的腦前額開始 一直延伸到後腦，

and it's quite stiff.

而且很硬。

And so what that allows for is when you're struck

所以這會使大腦在受到撞擊時，

and your head rotates in this left-right direction,

你的大腦左右旋轉的情況下，

forces can rapidly transmit right down to the center of your brain.

這個撞擊力會迅速傳遞 直到你的大腦中心。

Now, what's there at the bottom of this fissure?

那麼，裂縫的底部究竟有什麼？

It's the wiring of your brain,

就是你大腦內的線路，

and in fact this red bundle here at the bottom of that fissure

事實上裂縫底部一束束的紅色線

is the single largest fiber bundle

就是腦部最大的神經纖維束，

that is the wiring that connects the right and left sides of your brain.

聯繫左右兩側大腦的主要路徑。

It's called the corpus callosum.

被稱為胼胝體。

And we think that this might be

我們認為這可能是

one of the most common mechanisms of concussion,

最常見的腦震盪機制，

and as the forces move down, they strike the corpus callosum,

當撞擊力向下移，便會撞擊胼胝體，

it causes a dissociation between your right and your left brain

會引致左右腦之間分離，

and could explain some of the symptoms of concussion.

這樣可以解釋某些腦震盪的症狀。

This finding is also consistent of what we've seen

調查結果發現與我們

在之前提到的腦疾病中 見到的一致，

in this brain disease that I mentioned, chronic traumatic encephalopathy.

慢性創傷性腦病變。

So this is an image of a middle-aged ex-professional football player,

圖中是一位中年人的腦部， 他是前職業美式足球運動員，

and the thing that I want to point out is if you look at the corpus callosum,

你看看他的胼胝體，我想指出一點，

and I'll page back here so you can see the size of a normal corpus callosum

先回到這頁，你可以看到 正常的胼胝體的大小，

and the size of the person here who has chronic traumatic encephalopathy,

及這位中年人的胼胝體大小， 他有慢性創傷性腦病變，

it is greatly atrophied.

萎縮得非常厲害。

And the same goes for all of the space in the ventricles.

所有腦室的空間也是如此。

These ventricles are much larger.

這些腦室非常大。

And so all of this tissue near the center of the brain

因此，這類靠近大腦中心的組織

has died off over time.

隨著時間慢慢死亡。

So what we're learning is indeed consistent.

與我們研究的確實一致。

Now, there is some good news here,

不過在這裡還是有好消息的，

and I hope to give you a sense of hope by the end of this talk.

我希望透過這次演說 帶給你們有希望的感覺。

One of the things that we've noticed,

我們注意到一件事

specifically about this mechanism of injury,

特別是這種傷害的機制，

is although there's a rapid transmission of the forces down this fissure,

雖然那種撞擊力會 快速傳輸到這裂縫處，

it still takes a defined amount of time.

仍然需要一定的時間來傳送。

And what we think is that if we can slow the head down just enough

我們的想法是， 如果我們可以讓頭慢一點，

so that the brain does not lag behind the skull

大腦便不會落後於頭骨，

but instead it moves in synchrony with the skull,

相反與頭骨同步移動，

then we might be able to prevent this mechanism of concussion.

我們也許能夠防止這種腦震盪發生。

So how can we slow the head down?

但如何將頭部慢下來？

(Laughter)

（笑聲）

A gigantic helmet.

一個巨大的頭盔。

So with more space, you have more time,

因此你有更多空間，更多時間，

and this is a bit of a joke, but some of you may have seen this.

這有點像開玩笑， 但你們可能有人已經看過這個。

This is bubble soccer, and it's a real sport.

這是泡泡足球，也是運動的一種。

In fact, I saw some young adults

事實上，我看到一些年輕人

playing this sport down the street from my house the other day,

在我家中附近的街道玩這運動，

and as far as I know there have been no reported concussions.

並就我所知 沒有發生過腦震盪的報導。

(Laughter)

（笑聲）

But in all seriousness, this principle does work,

但嚴肅地說，這個原則確實有效，

but this has gone too far.

不過這的確有點過頭。

This isn't something that's practical for bike riding or playing football.

對於騎單車或踢足球來說 這個不太實用。

And so we are collaborating with a company in Sweden called Hövding.

因此，我在瑞典與一家名為 Hövding 的公司携手合作。

Some of you may have seen their work,

你們當中可能已經看過他們的產品，

and they're using the same principle of air to give you some extra space

他們使用同樣充氣的道理， 讓你有額外的空間

to prevent concussion.

去預防腦震盪。

Kids, don't try this at home please.

小朋友請勿在家中嘗試。

This stuntman does not have a helmet.

這個特技演員並沒有戴頭盔。

He instead has a neck collar,

他用了頸圈代替，

and this neck collar has sensors in it,

他的頸圈有一個感應器，

the same type of sensors that are in our mouthguard,

與我們用在牙套上的感應器相同，

and it detects when he's likely to have a fall,

在他跌倒的情形下便可檢測到，

and there's an airbag that explodes and triggers,

有個氣囊會爆發和打開，

the same way that an airbag works in your car, essentially.

基本上與你車上的安全氣囊一樣，

And in the experiments we've done in my lab with their device,

這個實驗早已在我的實驗室完成了，

we found that it can greatly reduce the risk of concussion in some scenarios

我們發現利用氣囊技術 可以大大減少腦震盪的風險，

compared to a normal bicycle helmet.

相對於正常的單車頭盔。

So it's a pretty exciting development.

的確進展令人興奮。

But in order for us to actually realize the benefits of technology

為了讓我們真正實現氣囊技術的好處

that can prevent concussion,

以防止腦震盪，

it needs to meet regulations.

仍需要符合法規。

That's a reality.

這是現實。

And this device is for sale in Europe

這設備在歐洲銷售，

but is not for sale in the US, and probably won't be any time soon.

但不在美國發售， 可能暫時還不會開賣。

So I wanted to tell you why.

我想告訴你們原因。

There are some good reasons and then there are some not so good reasons.

有一些好的理由， 也有一些不太好的原因。

Bike helmets are federally regulated.

單車頭盔由聯邦政府監管。

The Consumer Product Safety Commission has been given jurisdiction

消費者產品安全委員會 有司法管轄權

to approve any bike helmet for sale,

批准任何單車頭盔出售，

and this is the test they use.

這是他們用的測試法。

This is back to what I was telling you at the beginning about skull fracture.

回顧我開始時講述的頭骨骨折。

這種測試就是在做這個。

That's what this test is for.

And that's an important thing to do.

這件事很重要。

It can save your life, but it's not sufficient, I would say.

這可以挽救你的生命， 但我會說還是不夠。

So for example, one thing this test doesn't evaluate

舉個例子，這種測試沒有評估

is it doesn't tell you is that airbag going to trigger

那氣囊會不會

at the right time and place, and not trigger when it doesn't need to?

在適當的時間和地點爆開， 不要的時候也不會亂打開？

Similarly, it's not going to tell you

同樣地，這也不會告訴你

is this helmet likely to prevent concussion or not?

這個頭盔到底能不能防止腦震盪？

And if you look at football helmets, which aren't regulated,

如果你去看美式足球頭盔， 他們的頭盔不受規範，

they still have a very similar test.

仍然有類似的測試。

They're not regulated by the government, anyway.

反正他們也不受政府監管。

They have an industry body, which is the way most industries work.

他們有協會，絕大部分行業都這樣。

But this industry body, I can tell you, has been quite resistant

但這個協會，我可以告訴你， 非常不願意更新標準。

to updating their standards.

所以在我的實驗室，

So in my lab, we are working on not only the mechanism of concussion,

我們不僅在研究腦震盪的機制，

but we want to understand how can we have better test standards?

還想要瞭解如何有更好的測試標準？

And we hope that the government can use this type of information

我們希望政府 可以使用這種類型的資訊

to encourage innovation

鼓勵創新，

by letting consumers know

好讓消費者知道

how protected are you with a given helmet.

頭盔保護你的程度是多少。

And I want to bring this back finally to the original question I asked,

最後我想帶回來這原來的問題，

which is, would I feel comfortable letting my child play football

就是我可以很放心的 讓我孩子踢美式足球

or ride a bicycle?

或騎單車嗎？

And this might be just a result of my own traumatic experience.

從我自己的創傷經歷中得到這答案。

I'm much more nervous about my daughter, Rose, riding a bicycle.

我更緊張我的女兒露斯騎單車。

So she's a year and a half old,

在她一歲半時，

and she's already, well, wants to anyway, race down the streets of San Francisco.

她已經做好準備， 隨時在舊金山街道上比賽。

This is the bottom of one of these streets.

這是一條街的盡頭。

And so my personal goal is to -- and I believe this is possible --

所以我個人的目標是 ──我相信這是可能的──

is to further develop these technologies,

再進一步發展這些技術，

and in fact, we're working on something in my lab in particular

事實上，我們正在努力， 特別是我的實驗室，

that really makes optimal use of the given space of a helmet.

如何最佳使用頭盔有限的空間。

And I am confident that we will be able to,

我很有信心將來我可以，

before she's ready to ride a two-wheeler,

在露斯要準備騎單車時，

have something available

有一樣可以用的東西

that can in fact really reduce the risk of concussion

不但能真正減少腦震盪的風險，

and comply with regulatory bodies.

還符合政府的法規。

And so what I'd like to do --

所以這就是我想做的──

and I know that this is for some of you of more immediate nature,

我知道這對你們某些人更直接，

I've got a couple years here --

我已經在這裡好幾年了──

is to be able to tell parents and grandparents when I'm asked,

就是當有父母和祖父母問我時，

it is safe and healthy for your children to engage in these activities.

能回答說你的孩子參加的運動 是安全和健康的。

And I'm very fortunate to have a wonderful team at Stanford

我非常慶幸我在史丹福大學 有一個令人讚嘆的團隊

that's working hard on this.

為這份工作努力。

So I hope to come back in a few years with the final story,

我希望能在幾年後回來 告訴大家結局，

but for now I will tell you,

但現在我會告訴你，

please don't just be afraid when you hear the word concussion.

當你聽見腦震盪 這個名詞請不要害怕。

There is hope.

這裡仍然有希望。

Thank you.

多謝。

(Applause)

（掌聲）