STEP 2: Concussion Live Course - November 5-6, 2024, in San Diego, CA-Case Discussion: Risk Factors of Special Populations (Injured Worker)

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A 50-year-old male forklift operator presented for evaluation following an unwitnessed fall at work two months ago, which resulted in a concussion. Initially assessed in the ER with negative imaging, he was subsequently cleared to return to work by occupational medicine after physical therapy, although he has been unable to resume work due to persistent symptoms. These include headaches, dizziness, balance disturbances, sleep issues, sensitivity to light and sound, numbness, confusion, memory problems, and vision disturbances.<br /><br />The patient's medical history reveals diabetes, prior concussions, headache disorder, anxiety, depression, ADHD, and sleep disorders. He is covered by worker's compensation and has additional insurance through Blue Cross. Despite receiving support from his family and consulting an attorney, he has not pursued litigation.<br /><br />The evaluation included neurocognitive testing, which showed partial recall ability and challenges with physical coordination. Physical examination indicated problems such as reduced cervical range of motion, muscle tenderness, and balance issues, evident through a positive Romberg test.<br /><br />The clinical assessment diagnosed him with a concussion, post-traumatic headaches, sleep, vestibular, and vision impairments. The treatment plan involves starting Amitriptyline, ongoing physical therapy focusing on cervical spine issues, and potentially referring him to neuropsychology and vision therapy if needed. Additionally, understanding worker's compensation complexities, including resources and state regulations, is emphasized.<br /><br />This case illustrates the multifaceted nature of concussion recovery, the need for comprehensive evaluation, and the potential challenges in navigating healthcare and compensation systems. Critical teachings include considering employment factors, job satisfaction, and possible secondary gain or psychosocial issues affecting recovery, as well as recognizing state-specific nuances in health resources and medication availability.

Asset Subtitle

Lori M. Grafton, MD

Keywords

concussion

post-traumatic headaches

vestibular impairments

vision disturbances

worker's compensation

neurocognitive testing

physical therapy

Amitriptyline

occupational medicine

psychosocial issues