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Supporting Workers Following a Concussion or Traumatic Brain Injury

Construction workers suffer more nonfatal and fatal traumatic brain injuries (TBIs) than any other occupation. Out of all fatal TBIs in the workplace, one quarter of them happen on construction jobsites.

LIUNA General
and LHSFNA Labor
Armand E. Sabitoni

Traumatic brain injuries occur after sudden head trauma. Falls from heights and at ground level, incidents involving vehicles and other “struck-by” incidents are only some of the many ways that construction workers can experience a TBI while on the job. Even when TBIs aren’t fatal or are milder, as is often the case with concussions, the impact on workers’ health can still be serious, hidden and long-lasting.

“Traumatic brain injuries pose a high risk to the physical safety and mental well-being of LIUNA members,” says LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “Taking a head injury seriously when it first occurs can lessen the long-term impacts on workers’ health and help workers return to work successfully.”

Taking steps to prevent TBIs in the first place is critical. Supervisors should also be trained to recognize concussion signs and symptoms so workers can receive prompt treatment if a TBI does occur.

TBIs, Depression and Mental Health

In addition to physical symptoms, TBIs are also linked to depression, with the highest risk among older adults, men and people with previous brain injuries. The construction industry currently skews older, mostly male and is made up of many military veterans and former high school and college athletes who are more likely to have a history of concussions.

“Between 25 percent and 50 percent of TBIs will be followed by major depression in the first year after the event,” said Cary Gunther, M.D., Ph.D., who is board-certified in neurology, psychiatry and brain injury medicine. “Loss of independence, changes in relationships and financial burdens that arise after head trauma all contribute to this risk.”

Rates of anxiety disorder and obsessive-compulsive disorder double after a TBI. PTSD and the emergence of substance abuse disorders are other possible outcomes. In addition to the neurological changes that happen in the brain, risk for depression is heightened by social isolation and being unable to participate in normal activities that bring enjoyment or reduce stress.

There’s a clear link between TBIs and increased risk for suicide, with people who die by suicide being twice as likely to have previously suffered a TBI. We already know mood disorders, PTSD and substance abuse disorders are associated with increased risk for suicide, and that construction workers have the highest rate of suicide among all occupations. These overlapping risk factors provide even more reason to prevent TBIs and ensure workers receive treatment and adequate support during the recovery process.

Prompt and Proper Treatment

TBIs can range in severity from mild to moderate or severe. However, all TBIs should be taken seriously. Workers who suffer a TBI at work should be immediately removed from the job until they are evaluated by a medical professional trained to assess TBI symptoms.

Depending on the severity of the injury, this evaluation may include a neurological exam, CT scan, MRI or other testing. Treatment for TBIs varies based on severity. For mild TBIs, physical and mental rest for a couple of days may be enough to resolve symptoms. More serious TBIs may require hospital care, surgery, rehab and additional follow-up appointments. In all cases, counseling in conjunction with medical treatment can help reduce stress and aid recovery.

Recovery Protocols and Return to Work Programs

TBI symptoms don’t always present themselves immediately and can occur days or weeks after the initial injury. Because of this, the CDC recommends multiple evaluations to assess for TBI symptoms and workers’ cognitive status following the incident. Once a TBI is diagnosed and symptoms are present, restricting work tasks may be necessary to aid in the recovery process.

Construction employers can support workers following a TBI by working in tandem with treating physicians to coordinate care and provide accommodations that support recovery. This could include:

  • Gradually building up to a full workload, frequent breaks throughout the workday or performing tasks that aren’t as physically or mentally strenuous during the initial days or weeks following a return to work.
  • Monitoring for continued symptoms that may signal the need for adjusting the return to work timeline or additional treatment during the recovery process. Supervisors should be trained on TBI symptoms so they can recognize and understand what a worker is experiencing. For example, fatigue is an almost universal symptom of TBI. This lack of energy could easily be confused for laziness or lack of motivation without education about TBI symptoms.
  • Encourage workers to report new or ongoing symptoms and provide resources that support workers’ mental health as well. Emphasize that recovery from a TBI is a gradual process that takes time.

Most importantly, employers should recognize that treatment and recovery for a TBI are not one-size-fits-all. Ensuring workers get prompt care following a TBI and supporting them throughout the treatment and recovery process can help reduce the long-term impact of TBIs on workers’ physical and mental health.

[Nick Fox]

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