When an athlete suffers a blow to the head that results in temporary confusion or changes in perception (for example, double vision), we often say he has “had his bell rung.” The analogy is apt; what has happened in those cases is that the brain has been violently tossed around inside the skull, much like the clapper of a bell. In the not-too-distant past, such incidents were often treated as if they were not serious. But the experience of athletes in contact sports like football, as well as the experience of military veterans, has shown that the long-term effects of these types of injuries can be serious indeed.
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Another thing we’re learning is that these injuries are not limited to athletes or active-duty servicemembers. Other workers are also at increased risk of this type of injury together with its long-term health effects.
Here’s what you need to know about the potential long-term health effects of concussions and what activities can put workers at the greatest risk.
Minor TBIs, Major Health Issues?
“Concussions” actually go by many names—they may be diagnosed as “mild head injuries,” “minor head injuries,” or “closed head injuries.” However, in light of the fact that they are a form of traumatic brain injury (TBI)—in the same category as skull fractures and gunshot wounds to the head—they are increasingly referred to as “minor traumatic brain injuries” (MTBIs). Major traumatic brain injuries have long been recognized as a cause of permanent personality changes, but, until recently we did not fully understand both major and minor TBIs can also increase the risk of other health issues.
When it is not given adequate time to recover from a MTBI—for example, when an athlete is sent back onto the field despite being dazed and confused—the brain may suffer additional injury. Individuals who suffer one or more MTBIs are now believed to be at increased risk of a number of health conditions, including:
- Chronic traumatic encephalopathy (CTE). CTE is a progressive, degenerative brain disease that has been identified in former players from the National Football League (NFL), boxers, and professional wrestlers, as well as in military veterans. Symptoms of CTE include memory issues, depression, difficulty controlling impulsive or aggressive behavior, impaired judgement and balance, and gradually increasing dementia. Because the symptoms are similar, CTE has sometimes been misdiagnosed in the past as Alzheimer’s or Parkinson’s disease.
- Post-traumatic stress disorder (PTSD). Studies in active-duty Marines and Marine veterans have shown that suffering a TBI during deployment, whether major or minor, was the strongest single predictor of post-deployment PTSD.
- Epilepsy. An increased risk of epilepsy in individuals who suffered major or minor TBIs was first noted in veterans of World War II and the Korean War. The same link was seen in a study of more than 250,000 veterans of the wars in Iraq and Afghanistan that was published in 2015.
- Alzheimer’s disease and other forms of dementia. A study of 188,000 older veterans found that veterans who had suffered TBIs had a 60% greater risk of developing Alzheimer’s disease or other forms of dementia. Some, but not all, of these may have actually been misdiagnosed cases of CTE.
- Suicide. Veterans who have suffered TBI are 55% more likely to commit suicide.
Workers at Risk
But just how much of a concern are MTBIs outside the military and professional contact sports?
Between 2004 and 2013, the Canadian Center for Occupational Health and Safety (CCOHS), Canada’s equivalent of the National Institute for Occupational Safety and Health (NIOSH), saw a 371% increase in lost-time claims for work-related concussions. CCOHS doesn’t believe that workers were suddenly suffering more concussions; rather, awareness and reporting had increased. In other words, workers have probably been suffering higher rates of concussions on the job than were being recorded, but, in many workplaces, they weren’t recognizing that they were injured.
The Veterans Administration has found that, outside of military settings, the highest risk of MTBI occurs as a result of:
- Assaults
- Falls
- Automobile accidents
- Sports injuries
According to NIOSH, construction workers suffer the greatest percentage of work-related concussions, as a result of falls. There are more fatal and nonfatal traumatic brain injuries in the construction industry than in any other U.S. industry. Between 2003 and 2010, traumatic brain injuries of all types accounted for 24% of all occupational fatalities and 25% of all construction deaths.
Tomorrow we’ll look at how to identify MTBIs, and how to ensure that workers fully recover from them.