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Concussions in the Workplace

Following the release of the movie Concussion on December 25, 2015, long term effects of concussions on the brains of former NFL players was brought to light. Although concussions sustained at the workplace may not occur as dramatically or as regularly as those sustained during high contact sports such as football and hockey, they should still be taken seriously and managed accordingly. Common mechanisms from which a worker may sustain a concussion are items falling from above, head contact with an inanimate object, fall from the same or elevated level and motor vehicle collisions (Kristman et al., 2008; Colantonio et al., 2010; CCOHS, 2013). However, it is still possible to sustain a concussion from an indirect force causing shearing to the brain within the skull. A common example of this is whiplash during a motor vehicle accident. Although the head has not sustained direct contact, the force of the impact and subsequent movement of the head and neck result in the brain being jostled within the skull and ultimately may result in a concussion.

What is a Concussion?

According to the Sport Concussion Assessment Tool (SCAT3), a resource used by medical professionals such as athletic therapists, a concussion is “a disturbance in brain function caused by a direct or indirect force to the head.” Concussions may occur as a result of an acceleration, deceleration, or rotational force to the head or other body parts such as the neck, back or buttocks. This can be a force of the body hitting an object or an object applying the force to the body. The force causes a shaking of the brain within the skull, which then causes what are called shearing forces to the brain resulting in disruptions of brain connections, on either the same side or opposing side of the brain (Prentice, 2011). Many describe this injury as a “bruise to the brain” or a “brain bleed.”

Symptoms

Concussion signs and symptoms include but are not limited to a new onset of one or more of the following:

• Headache (or a sensation of pressure in your head)
• Loss of consciousness
• Nausea or vomiting
• Dizziness
• Seeing stars or lights
• Blurred or double vision
• Slurred speech
• Balance problems
• Sensitivity to light and/or noise
• Difficulty concentrating
• Difficulty remembering
• Confusion, drowsiness, and an incoherent thought process (CCOHS, 2015)

Despite what some people may think, on average only 10% of concussions actually result in a loss of consciousness (Prentice, 2011; Harmon, 2013). If returned to sport or work too early, individuals are in danger of suffering from second-impact syndrome (SIS), which is the rapid swelling and bleeding of the brain when a second head injury occurs before the initial head injury was fully recovered. In severe cases, the brain tissue can begin to swell. Since the brain cannot escape the rigid confines of the skull, severe swelling can compress the brain and its blood vessels, limiting the flow of blood (American Association of Neurological Surgeons, 2016). SIS can result in mental disability or death. This is why concussion recovery should be taken seriously.

Prevention

There are many ways to prevent the common causes of concussion in the workplace, of which many companies have already taken the necessary considerations in order to decrease the chances of injury.
Precautions include:

• If a job requires wearing a hard hat, make sure it’s appropriate to the job, properly fitted, and in good condition .
• Remove tripping hazards. Make sure walkways and work spaces are free of clutter, cords, puddles of water, or anything else than can cause a slip, trip, or fall.
• Use of proper signage to alert employees of wet surfaces .
• Keep shelves and other storage areas clean and organized.
• When storing items, place the heaviest objects on the floor or the lowest possible shelving.
• Wear the proper type of safety footwear to prevent falls if you work in slippery, icy or other types of rugged terrain.
• Do not stand on chairs, desks or tables, but rather use an appropriate step stool, access platform, or ladder to avoid falls
• Use caution when working from heights. Know how to use fall protection and fall restraint equipment.
• Report all unsafe conditions to the nearest supervisor (CCOHS, 2015).
• Practice proper management of previous and current concussions.

Recovery Process

Return-to-work planning should be based upon careful evaluation of symptoms and neurocognitive status by a trained professional. To help facilitate recovery from concussion, workers may initially need to reduce both physical and cognitive exertion. Rest is key (CCOHS, 2013). Once symptoms have resolved a step-by-step return to work/sport protocol which should be followed. The use of a SCAT3 (Sport Concussion Assessment Tool) is recommended for return to play/work and an example template is listed below:

Step 1: Light Aerobic Activity
• Activities: Exercise bike, walking, stretching or light jogging
• Do not exceed 30-45% of your heart rate max
Please note: step 1 should not begin until the worker has been free of concussion symptoms for 24 hours

Step 2: Light Exercise
• Activities: Light weights, balance exercises
• Do not exceed 40-60% of your heart rate max

Step 3: Moderate aerobic exercise
• Activities: All form of strength exercises, running, high-intensity stationary biking and dynamic balancing exercises
• Do not exceed 60-85% of your heart rate max

Step 4: Job specific training
• Activities: Job specific activities/lifting: e.g. If your job requires you to lift 75 lbs, begin by lifting 80% of that weight. If your job requires you to climb flights of stairs, ladders, use of machinery or equipment, etc., try those activities to ensure concussion symptoms do not return.
• Do not exceed 80% of your heart rate max

Step 5: Full job performance with full exertion

What can SureHire do to help?

SureHire recognizes the importance of proper healing time frames for injuries such as concussions. Candidates who participate in SureHire’s Fitness to Work program and disclose previous or current concussions will be assessed by qualified Medical Assessors to determine if their concussion is fully healed and safe for them to participate in Critical Strength and Mobility (CSM) testing. Critical Strength and Mobility Testing is 30-45 minutes of job-specific lifting to confirm that the candidate possesses the necessary strength and conditioning to safely work at the job they are applying for. All lifting is closely monitored by our medical staff to ensure that proper lifting technique is demonstrated. Testing is immediately ceased if a candidate is at risk of injury.

By ensuring proper healing for head injuries and concussions SureHire can help reduce the chance of incidents on the jobsite such as second-impact syndrome or injuries incurred as a result of lingering concussion side effects. For more information on SureHire’s Fitness to Work testing, please click here.

Sources

CCOHS. (2013). Heads-Up: What you need to know about concussions in the workplace [Online]. Available from: http://www.ccohs.ca/newsletters/hsreport/issues/2015/05/ezine.html [Accessed: Sept 15, 2015]

Colantonio, A., Mroczek, D., Patel, J., et al. (2010). Examining occupational traumatic brain injury in Ontario. Canadian Journal of Public Health 101(2). S58- S62.

Concussion Patient Information. (2016). In American Association of Neurological Surgeons. Retrieved September 1, 2016, from http://www.aans.org/patient%20information/conditions%20and%20treatments/concussion.aspx

Harmon, K. G., Drezner, J., Gammons, M., et al. (2013). American Medical Society of Sport Medicine Position Statement: Concussion in Sport. Clinical Journal of Sport Medicine 23(1). 1-18.

Kristman, V. L., Cote, P., Van EERD, D., et al. (2008). Prevalance of lost-time claims for mild traumatic brain injury in the working population: Improving estimates using workers’ compensation databases. Brain Injury Journal. 22 (1). 51-59.

Prentice, W. E. (2011). Principles of athletic training: A competency-based approach. 4th Ed. The McGraw-Hill Company.

Sport Concussion Assessment Tool- 3rd edition. (2012, November). In Shift Concussion. Retrieved August 13, 2016, from http://www.shiftconcussion.ca/wp-content/uploads/2013/10/SCAT3.pdf