Agriculture can be a risky business. Equipment, chemicals, livestock and infrastructure such as grain bins or manure pits are just a few of the dangers that farmers interact with on a daily basis. Other, perhaps less obvious dangers include slippery surfaces, ropes and cords that can cause trips and falls, hard corners or edges that can deliver a blow to the head or sharp objects that can pierce and injure.

Underlying all of the above hazards is the risk of traumatic brain injury (TBI). But how often do farmers think about the risk of TBI? What happens when a brain injury occurs? And how do those who suffer from TBI continue to farm?

Dr. Ivette Ruiz became a small farmer after suffering a TBI while preparing to deploy to assist those impacted by Hurricane Isaias in 2020. She slipped and hit her head on three trees. Thinking nothing of it, and in a hurry to bid goodbye to her family and depart for the disaster zone, Ruiz didn’t at first realize that she had suffered a serious brain injury.

“I just wiped the blood off my head and kept on moving. My primary goal at that time was not my head,” she said.

She soon became dizzy, had some speech difficulties and started to feel ill. A trip to the emergency room was only the first step in diagnosing and treating her injuries. Her recovery from TBI remains ongoing. She is still participating in multiple forms of therapy and suffers from the effects of her TBI with physical, cognitive and emotional impairments.

“That’s where my life changed forever. I went from a very dark place where I wanted to commit suicide to choosing to live and have life over what was happening to me,” she said.

Today, she advocates for those with disabilities in agriculture and founded her business, Healing by Growing Farms (HGB Farms), to advance awareness of TBI in agriculture, empower farmers who have suffered TBI and promote therapeutic agriculture for anyone experiencing social justice issues and trauma.

Using her skills in disaster management, healthcare, humanitarian relief, social justice and education, along with her own experience with TBI, HBG Farms utilizes experiential farming for healing. HGB Farms sponsored the first Northeast Disability and Agriculture Conference in 2023.

Ruiz recently presented a webinar for the Food Animal Concerns Trust, addressing the farming community’s risks of TBI, methods of prevention, recognition of symptoms and explored resources for assisting farmers with TBI-related disabilities.

The effects of traumatic brain injury aren’t always immediately noticeable. See your doctor after any head injury to be safe.

TBI Risks & Symptoms

“In agriculture, there’s a whole bunch of ways that someone can get hurt,” Ruiz said: getting kicked or head-butted by livestock; tractor rollovers; being hit in the head by heavy equipment or other objects; brain injury via chemical exposure; brain injury from piercing with a sharp object; and trips and falls due resulting in head injuries.

For those who have already experienced one TBI, avoiding another incident can be made more difficult due to lingering damage and symptoms from the previous injury. Adapting to job requirements following a TBI is both preventative of a new TBI and a necessary step in recovery.

The increased risk of depression and suicide in farming may partially be related to central nervous system dysfunction, which can occur with exposure to toxins as well as from damage due to physical impacts on the brain, she said. Suicidal ideation is common in agriculture and can be augmented when a farmer has had a TBI. Farmers in general have increased risks of anxiety and depression and a 46% greater chance of suffering from dementia, she said.

Furthermore, the severity of the TBI does not necessarily correlate with the long-term complications. Mild injury temporarily affects brain cells, and serious brain injury includes bruising, bleeding and torn tissues.

Symptoms of TBI are not always noticeable immediately after an injury, and they can continue to plague those with TBI for many years. Physical, cognitive, behavioral and emotional changes can and do occur. People suffering from TBI may not notice the changes themselves, but others will often see these changes.

Physically, a decrease in eyesight, lack of awareness, neck or back pain, whiplash, numbing or tingling sensations, disorientation and falling can occur. Those with brain injuries often have difficulty with vomiting, nausea and digestive issues, as well as with temperature regulation (frequently being too hot or cold). Cognitive changes include memory lapses, reduced ability to pay attention, speech impairment, inability to foresee consequences and less ability to adapt to busy environments. Mood changes, aggression, impulsivity and frustration are often present in those who have experienced TBI.

“If any of you have ever hit your head … and have experienced any of these, my advice would be seeing a doctor,” Ruiz said.

TBI Prevention & Protection

Realizing that farming itself is a risk factor for TBI is a first step. Paying attention to the immediate environment to see and, if possible, remove hazards is a necessity. Putting tools away and not leaving sharp and heavy objects in the environment can reduce injury risk.

Slowing down when performing tasks and focusing on the job at hand can go a long way in preventing many accidents which can result in TBI. Having the correct equipment and tools for the job at hand is another protective factor. Assessing potential hazards prior to beginning each chore can reduce risk.

Adequate lighting, stable footing and wearing the correct protective clothing for the environment is imperative. Wearing goggles to protect the eyes can prevent brain injury from piercing through the eye.

Ruiz suffered a second brain injury which could have been prevented if she had worn a helmet, as her physician advised. Wearing a helmet to complete farm chores is the best way to protect oneself from a brain injury (and highly recommended). Several members of the webinar audience shared that wearing helmets while working on the farm had saved their lives.

Those who have already had a TBI will suffer significant setbacks in their recovery with any further brain injury. Sometimes, the person will lose all of the improvements they have gained since the initial TBI. Other times, it escalates the problems that still exist.

“It sets you back,” Ruiz said. “When you have a brain injury of any type, each time you have a brain injury, the condition gets worse. And the symptoms get worse.”

The National AgrAbility Project has resources available to assist farmers with managing TBI symptoms while continuing to farm (at agrability.org/s=brain+injury). Prioritizing tasks, setting alarms as reminders, taking frequent breaks, eliminating distractions and managing fatigue are all important aspects of coping following TBI.

An awareness of TBI risks which exist in agriculture, knowledge of the means of protecting people on the farm from those risks and adapting the farm to better meet the needs of someone with a TBI are all important factors in keeping farmers healthy and helping them to continue to farm effectively and safely.

Editorial note: It is not harmful – and in fact is helpful – to ask a person directly if they are having thoughts about suicide. Nationwide, dial 988 for the National Suicide Hotline for immediate assistance 24/7.

by Tamara Scully