How Many Fingers? Identifying Minor Traumatic Brain Injuries

Many industries are paying increased attention to the potential health effects of minor traumatic brain injuries (MTBIs), which were once called “concussions.” The long-term health effects of these injuries were first observed in military servicemen and veterans and in professional athletes, but they can occur in any industry and are common in construction. Risk factors for MTBIs include assaults, falls, and automobile accidents.

Identification of MTBIs and an opportunity to fully recover from them are critical to the prevention of long-term health effects. Here’s how to identify an MTBI and ensure that workers recover fully without reinjuring themselves.

Recognizing MTBIs

It’s important to recognize that not all MTBIs result from identifiable blows to the head. Although a direct blow to the head (usually resulting from slips and trips, car accidents, assaults, or falls from height), is the most common cause of an MTBI, it can also be caused by jolts, sudden stops, or other sudden, violent incidents. For example, members of the military have suffered major and minor TBIs as a result of exposure to bomb blasts. The bouncing and twisting of the brain as it is shaken rapidly back and forth inside the skull is what causes the physical damage to the brain tissue.

Workers and supervisors should know to suspect a concussion whenever a worker suffers any loss of consciousness, no matter how brief. A concussion that results in a loss of consciousness is considered a “critical injury”; it is potentially life-threatening, and the worker should receive medical attention. Workers who are dazed and confused or who suffer brief amnesia should also be immediately evaluated for possible traumatic brain injury.

Other concussion symptoms may show up days or even weeks after the traumatic event, so it is important to continue to monitor workers. Delayed symptoms vary but can include:

• Headache (or a sensation of pressure in the head)
• Forgetfulness or difficulty concentrating
• Sleeplessness or otherwise unexplained fatigue
• Sensitivity to light and/or noise
• Blurred or double vision; seeing stars or lights
• Dizziness
• Nausea
• Depression or anxiety

Some symptoms are serious enough that the individual should be taken immediately to the emergency room. Call 911 if a coworker cannot be awakened, and seek medical attention if he or she experiences:

• Worsening headaches
• Ongoing vomiting
• Slurred speech
• Balance problems, weakness, numbness, or clumsiness
• Confusion, drowsiness, or incoherence
• Increasing restlessness or agitation
• One pupil larger than the other

Treating MTBIs

Concussions have until recently been treated as if they are not really serious, especially if symptoms are mild. Athletes and others who’ve “had their bell rung” are encouraged to shake it off, pull themselves together, and keep playing. But, we are learning that this can be a dangerous response; if the brain is not permitted time to recover, if it is reinjured before it fully heals, or if a person suffers multiple concussions, MTBIs increase workers’ long-term risk of degenerative brain disease, epilepsy, dementia, and suicide.

Because of the potential for long-term, progressive damage, it is more important than ever that MTBIs be identified quickly. Most people who suffer an MTBI will recover fully within a few days, but some may have symptoms that linger for months. MTBI symptoms that last for more than 3 months are called “post-concussion syndrome.” Those individuals may need longer follow-up care and monitoring.

When a worker has suffered a concussion, appropriate recovery and follow-up care include:

• Companionship. Symptoms of an MTBI can develop over days or weeks and can become very serious, including lapsing into unconsciousness. Individuals who have suffered an MTBI should not be left alone.
• Activity restriction. Because MTBIs affect brain function, including alertness, judgment, and decision making, individuals who have suffered one should not drive a car or operate heavy machinery until they are cleared by a qualified medical professional.
• Avoiding reinjury. Individuals who are recovering from an MTBI should avoid any activity, including contact sports or hazardous work, that could result in reinjury before the brain is fully recovered.
• Rest. Recovering workers should get plenty of sleep and take it easy when they are not sleeping. They should pay attention to their own energy levels and not push themselves.
• Reduced stimulation. An MTBI is a brain injury, so it’s important to let the brain rest. An environment that is quiet, with minimal distractions, is best for recovery.
• Reduced demands on cognition. Workers should do one thing at a time while they are recovering rather than trying to multitask or manage multiple demands (such as multiple projects or deadlines). Strategies such as writing things down can help with short-term memory issues.
• Avoiding drugs. Recovering workers should avoid alcohol and other drugs and should only take medications that have been prescribed or approved by a qualified medical professional during recovery.

Tomorrow we’ll look at when and how workers who have suffered an MTBI can safely return to work.