What Workers Have to Lose: An Introduction to Traumatic Injuries of the Brain and Their Effects Traumatic Brain Injury (TBI) Toolkit Kentucky Occupational Safety and Health Surveillance (KOSHS) Program February 2019

Objectives Define ‘Traumatic Brain Injury’ (TBI) Review TBI statistics for general population Review work-related TBI statistics Review different areas of the brain, their functions, and what may be affected if damaged

Disclaimer The purpose of this presentation is to highlight different areas of the brain and discuss how an employee may be irreparably affected by a traumatic brain injury. While much is known about the brain, it remains one of the most powerful and mysterious creations in nature. New discoveries are made every year that help us fine-tune our understanding of what the brain does and what it can accomplish.

What is a Traumatic Brain Injury? Traumatic brain injury (TBI) is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness[1]. Simply put, TBI is a disruption in normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.

TBI Statistics Traumatic brain injuries are a leading cause of death and disability in the United States, accounting for 30% of all injury deaths. TBI was diagnosed in more than 282,000 hospitalizations and 2.5 million emergency department visits. Every day, 153 people in the United States die from TBI injuries. Falls accounted for 47% of all TBI-related emergency department visits, hospitalizations, and deaths in the United States[2].

Leading Causes of TBI Deaths in the Workplace 7,300 TBI deaths occurred in the United States from 2003-2008. The majority of TBI deaths were due to: Motor Vehicle Crashes (31%) Falls (29%) Assaults and Violent Acts (20%) Contact with objects/equipment (18%) Construction, Transportation, and Agriculture/Forestry/Fishing industries recorded nearly half of all occupational TBI deaths over this time span[3].

Workplace TBI in Kentucky In 2016 in Kentucky, there were 405 emergency department visits for work-related, non-fatal TBI. Total cost for those injuries was $1,966,820. In the same year in Kentucky, there were 63 hospitalizations for work-related, non-fatal TBI Total cost for those injuries was $5,263,390. Workers who were admitted to the hospital for a work-related TBI missed an average of 6 days of work[4].

The Human Brain as a Whole One of the largest and most complex organs in the human body. Brain Is command center for the human central nervous system. Separated into two halves called ‘cerebral hemispheres’. Receives input from sensory organs and sends output to muscles.  Brain is protected by the skull, and cushioned by cerebrospinal fluid. This watery fluid is produced by special cells in the four hollow spaces in the brain, called ventricles[5].

Areas of the Brain Frontal Lobe Motor Cortex Somatosensory Cortex Parietal Lobe Occipital Lobe Temporal Lobe Medulla Oblongata Cerebellum

Areas of the Brain – Frontal Lobe What it Does Considered our emotional control center and home to our personality. If Damaged Problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior may all be affected[6]. Image 1

Areas of the Brain – Motor Cortex What it Does Motor cortex sends signals to muscles telling them to make a movement[7]. If Damaged Ability to make voluntary movements may be affected. Image 2

Areas of the Brain – Somatosensory Cortex What it Does Processes sensations from the body. If Damaged Ability to process touch, pain, and temperature may be affected[8]. Image 3

Areas of the Brain – Parietal Lobe What it Does Vital for sensory perception including management of taste, hearing, sight, touch, and smell. If Damaged Ability to process language, count how many objects you see, and coordinated movements of hands, arms, and eyes may all be affected[9]. Image 4

Areas of the Brain – Occipital Lobe What it Does Responsible for processing visual information from the eyes. If Damaged Ability to assess distance, size, and depth may be affected, as well as identifying familiar faces or objects, and determining color properties of items in visual field[10]. Image 5

Areas of the Brain – Temporal Lobe What it Does Play a key role in forming memories and hearing. If Damaged Forming visual and long-term memories may be affected. In addition, ability to feel hungry or thirsty, or ability to produce speech may be compromised[11]. Image 6

Areas of the Brain – Brain Stem What it Does Considered to be most important part of the brain. Regulates involuntary functions such as heart rate, blood pressure, and breathing[12]. If Damaged Ability to swallow, walk, or move certain muscles may be affected. In many cases, damage to medulla will result in severe strokes and eventually death. Image 7

Areas of the Brain - Cerebellum What it Does Coordinates voluntary movements resulting in smooth and balanced muscular activity. If Damaged Ability to maintain balance and equilibrium may be affected. Damage may also prevent the body from performing fine motor skills, such as reaching, grasping, and keeping upright[13]. Image 8

Sources [1] https://emedicine.medscape.com/article/326510-overview [2] https://www.cdc.gov/traumaticbraininjury/get_the_facts.html [3] https://www.ncbi.nlm.nih.gov/pubmed/21665064 [4] http://www.mc.uky.edu/kiprc/programs/tbi-surveillance/reports/TBI2016Report.pdf [5] http://www.neurosurgery.pitt.edu/centers-excellence/neurosurgical-oncology/brain-and-brain-tumors/brain-and-spinal-cord [6] https://www.neuroskills.com/brain-injury/frontal-lobes.php [7] https://www.sciencedirect.com/topics/neuroscience/primary-motor-cortex [8] https://www.neuroscientificallychallenged.com/blog/know-your-brain-primary-somatosensory-cortex [9] https://www.spinalcord.com/parietal-lobe [10] https://www.spinalcord.com/occipital-lobe [11] https://www.spinalcord.com/temporal-lobe [12] https://www.neuroscientificallychallenged.com/blog/know-your-brain-medulla-oblongata [13] https://www.sciencealert.com/cerebellum-human-brain-neuroscience-discover-new-role-behaviour-reward-response

Photo Sources Title Image – https://commons.wikimedia.org/wiki/File:Cerebrum_lobes.svg Image 1 - https://commons.wikimedia.org/wiki/File:Frontal_lobe_-_anterior_view.png Image 2 - https://upload.wikimedia.org/wikipedia/commons/7/70/Postcentral_gyrus_3d.png Image 3 - https://commons.wikimedia.org/wiki/File:Precentral_gyrus_3d.png Image 4 - https://ipfs.io/ipfs/QmXoypizjW3WknFiJnKLwHCnL72vedxjQkDDP1mXWo6uco/wiki/Parietal_lobe.html Image 5 - https://commons.wikimedia.org/wiki/File:Occipital_lobe_-_lateral_view.png Image 6 - https://upload.wikimedia.org/wikipedia/commons/4/4a/Temporal_lobe_-_lateral_view.png Image 7 - https://commons.wikimedia.org/wiki/File:1311_Brain_Stem.jpg Image 8 - https://commons.wikimedia.org/wiki/File:Cerebellum.png

Questions? Concerns? Michael.turner1@uky.edu 859-257-5839 http://www.mc.uky.edu/kiprc/koshs/index.html