Reported work-related concussions increasing, says researcher

Traumatic brain injuries have garnered a lot of attention recently in sports media, but they are a real issue in non-athletic workplaces as well and instances are on the rise, according to Angela Colantonio, senior scientist at the Toronto Rehabilitation Institute at the University of Toronto.
“What about the average worker, the civilian worker? There’s less attention on the person who say, for instance, falls from a skylight. A lot of people are concerned about the physical injuries and often that brain injury is missed,” she said, speaking at the Institute for Work and Health in Toronto on Tuesday.

Traumatic brain injuries are a major cause of death and disability globally and they are more common than breast cancer, HIV-AIDS, spinal cord injury and multiple sclerosis combined, Colantonio said. According to the Public Health Agency of Canada, traumatic brain injuries will be the most prevalent neurological condition by 2031.

In Ontario, 7.3 per cent of all traumatic brain injuries are work related, and traumatic brain injuries contribute to almost half of the work-related traumatic fatalities, Colantonio has found in her research.

Upon examining workers’ compensation board reports, Colantonio also found there is an increased trend in number of concussion cases that are being reported. For example, in Ontario, 80 per cent of brain injuries filed to the Workplace Safety and Insurance Board were for concussions versus 50 per cent prior to 2010.

“We think this is largely due to the fact there is increased awareness around this,” she said. “We do see some people are informed what’s going on in the sports world are thinking about it based on what they’ve learned from coaching their kids hickey teams or soccer team and they’ve brought it into the workplace.”

Traumatic brain injuries are commonly caused by falls, motor vehicle crashes and being struck by an object.

“You don’t have to hit your head to get the effect. With whiplash injury, your brain joggles in between the hard skull,” said Colantonio.

Colantonio and her colleagues are also researching work-related traumatic brain injury due to assault.

“There’s increased attention now to violence in the workplace in terms of the mechanism of injury.”

The highest mortality rates from work-related traumatic brain injuries are in agriculture, forestry, mining and fishing/trapping. Transportation and storage see high rates of severe injuries form traumatic brain injuries, outside of fatalities. Manufacturing accounts for a high percentage of mild brain injuries.

If an individual sustains a traumatic brain injury, there are a laundry list of potential consequences, including: cognition (memory, judgment, communication); movement ability (strength, co-ordination, balance); sensory (vision, hearing, tactile); and social relationships.

“One of the challenges of this population is no two brain injuries are alike. It really reflects who people are, their age, whether they’ve had other injuries, pre-existing conditions and also depending on what area of the brain is affected,” said Colantonio.

The most common persistent symptom Colantonio and her colleagues see at the Toronto Rehabilitation Institute after an individual sustains a work-related traumatic brain injury is headache, followed by mood, anger, frustration as well as problems with memory, concentration and thinking. Dizziness, lack of sleep and fatigue are also reported.

To ensure individuals return to work after a traumatic brain injury, they need appropriate job modification. This clocked in as the third most important facilitator for returning to work, followed by support from family and friends and good treatment, according to a survey conducted by Colantonio and colleagues.

The neuro-cognitive accommodation required after a brain injury is something that makes it unique from physical injuries.

“There’s a real art (to accommodation),” said Colantonio. “It’s difficult because it requires a very tailored approach to not only the person’s issues but also where they are returning to and the kind of support they need.”

Workplace commitment to health and safety was also cited as an important factor.

One of the return to work challenges is that the legitimacy of the injury may be questioned.

“For instance, people look fine,” said Colantonio. “Brain injury is often called an invisible disability… and it can be a stigmatizing condition that can have negative effects on one’s career.”

As a best practice, individuals who sustain a brain injury should be encouraged to take time off work and rest, she said.

When it comes to prevention, employers should ensure training is universally provided to all employees and brain education may also help prevent work-related brain injury.