Brainstem Injury – Understanding Levels of Injury and Therapeutic Approaches

Concussions often affect the outer tissue called the “cortex.” It’s the part most of us associate with “the brain.” However, when the injury involves twisting the head or neck, the brainstem is often involved. Brainstem injuries can have significant implications for an individual’s functioning and well-being.

This article explores the levels of brainstem injury and corresponding therapeutic approaches to enable fast and complete recovery.

Midbrain Injuries

A midbrain injury can profoundly affect an individual’s functioning and lead to various challenges. Let’s explore some specific impacts this type of injury can have:

1. Balance and Coordination

Damage to the midbrain can result in balance and coordination problems, including unsteadiness, dizziness, and increased risk of falls. Physical therapy can help with exercises to improve balance, coordination, and stability, reducing the risk of injuries related to balance deficits.

2. Vision Problems

The midbrain processes visual information and coordinates eye movements. Damage to this area can cause double vision, blurred vision, and difficulty focusing. The midbrain is responsible for controlling the size of the pupil, as well as looking up and down. Damage to this region can cause light sensitivity and issues in environments where the eyes move up and down (grocery store, or on the computer). Vision therapy includes exercises and strategies to improve visual function and eye movement coordination.

3. Sensory Processing Issues

The midbrain is vital for processing sensory information. Injury to the midbrain can disrupt sensory processing, causing deficits. Sensory integration therapy involves sensory-rich activities to retrain sensory processing pathways and improve function. This therapy exposes individuals to sensory stimuli to promote adaptive responses and reduce sensory aversions or sensitivities.

4. Motor Impairments and Abnormal Movements

Motor impairments from midbrain injuries include muscle weakness, spasticity, and involuntary movements like tremors or dystonia. Physical therapy aims to improve muscle strength, coordination, and range of motion. Occupational therapy helps individuals adapt to their impairments and find alternative strategies for daily living activities.

5. Cognitive and Emotional Effects

Midbrain injuries can lead to cognitive and emotional changes, including difficulties in attention, memory, and mood regulation. Cognitive rehabilitation and psychological support from therapists can help individuals cope with these challenges.

Pons Injuries

A pons injury can have significant implications on various aspects of an individual’s functioning due to the critical role this structure plays in relaying signals throughout the brain and body. Let’s explore the specific impacts that a pons injury can have:

1. Motor Deficits

The pons are a crucial pathway for sending motor signals. Damage can cause motor deficits, which physical therapy aims to address through exercises and functional tasks to improve motor function and help individuals regain independence in daily activities.

2. Facial Nerve Dysfunction

Remember that the pons houses vital cranial nerve nuclei, including the facial nerve (cranial nerve VII). Damage to the pons can lead to facial nerve dysfunction, causing facial weakness or paralysis (facial palsy). This can affect facial expressions, eye closure, saliva and tear control, and taste sensations on the affected side.

Rehabilitation may involve facial exercises, electrical stimulation, and speech therapy to improve muscle tone and overall facial function.

3. Sleep Regulation Disruptions

The pons also regulate sleep-wake cycles, including REM (rapid eye movement) sleep. A pons injury can result in changes in sleep patterns, including difficulties falling or staying asleep, excessive daytime sleepiness, or abnormal sleep cycles.

Sleep hygiene practices, behavioral changes, and medications prescribed by sleep specialists can help manage sleep-related issues and promote healthy sleep patterns.

4. Sensory and Cognitive Implications

The pons act as a relay station for motor and non-sensory functions. Damage to this area can indirectly affect sensory processing and cognitive functions. For example, a pons injury can disrupt sensory information in the brain, leading to issues with body perception. Cognitive training techniques can address cognitive problems following a pons injury.

Medulla Injuries

1. Respiratory Difficulties

The medulla controls breathing in several ways. Injury can cause irregular or shallow breathing, and people may need immediate medical intervention for breathing support. If the injury isn’t life threatening, simple breathing exercises to strengthen to diaphragm and improve output of the vagal system are also helpful.

2. Impaired Cardiac Function

The medulla regulates heart rate and blood pressure. An injury to this area can cause changes in heart rate, irregular heart rhythms, or blood pressure abnormalities. Continuous monitoring and appropriate treatments may be necessary to manage these issues and promote cardiovascular health.

3. Gastrointestinal Dysfunction

The medulla regulates digestion, gastric motility, and bowel movements. Injury to this region can cause constipation, irregular bowel movements, or disruptions in digestion. Dietary modifications, medication, and consultation with a gastroenterologist or dietitian can help manage these symptoms and promote healthy digestion.

The vagal system lives in the medulla, so adding therapies to improve its output can be helpful for GI dysfunction. Additionally, a comprehensive stool analysis is another good strategy to assess GI dysfunction after a medulla injury.

4. Autonomic Dysregulation

Injury to the medulla oblongata can lead to autonomic dysregulation, causing imbalances in the body’s normal automatic processes. This can result in abnormalities in temperature regulation, sweating patterns, pupillary responses, or skin blood flow.

Management may include environmental adjustments, medications, or specialized therapies guided by specialists to address these dysfunctions and improve well-being. Tilt table testing, advanced blood panels and exercise testing are all helpful to assess medullary function post injury.

Therapies for a Midbrain Injury

1. Physical Therapy

Physical therapy is crucial for individuals with midbrain injuries as it helps them regain optimal movement, balance, and coordination. Therapists use balance training, proprioceptive exercises, and gait training to improve stability and walking ability. They also address any visual or sensory impairments resulting from the injury to enhance motor function and maximize independence.

2. Occupational Therapy

After a midbrain injury, occupational therapy plays a crucial role in helping individuals regain the essential skills needed for daily living. Highly skilled therapists provide personalized plans, adaptive techniques, and effective strategies, empowering patients to improve their independence and quality of life.

3. Eye Movement & Visual Therapy

Following a midbrain injury, visual impairments such as double vision, difficulty tracking objects, or problems with eye movements may occur. Vision therapy exercises, which involve targeted exercises and techniques administered by professionals, aim to improve eye coordination and visual tracking and resolve visual issues.

Functional Neurologists and vision therapists commonly use these forms of exercise. Exercises in the vertical plane, convergence, divergence, and accommodation are especially helpful for the midbrain.

Therapies for a Pons Injury

1. Speech Therapy

Speech therapy is vital for individuals with pons injuries, aiding in overcoming speech and swallowing difficulties. Also known as speech-language pathologists, these providers use various techniques to address dysarthria, which causes slurred or unclear speech due to reduced facial muscle control.

Therapy may involve exercises to improve articulation, strengthen facial muscles, and enhance speech clarity. Additionally, therapists help with swallowing difficulties using strategies and techniques to improve swallowing safety.

2. Functional Neurology

Functional neurology can play a crucial role in helping a person’s injury. These specialists assess brain functions and challenges resulting from the injury and develop personalized interventions using eye movement exercises, vestibular rehabilitation, balance training, and sensorimotor integration therapies to improve neurological function and enhance overall recovery.

Recovery tools like vagal nerve stimulators and low level laser therapy are also used speed up recovery and ensure the rehab isn’t too intense. This can help individuals regain optimal function and restore their quality of life after a pons injury.

3. Respiratory Therapy

After sustaining a pons injury, the patient requires specialized interventions to address respiratory impairments. Respiratory therapists are crucial in improving lung function, offering breathing exercises, muscle training, and education on breathing techniques and devices.

Their interventions help individuals enhance lung function and breathing capacity and maintain respiratory health. Simple exercises that challenge breathing muscles are also helpful in cases where damage isn’t as severe.

Therapies for a Medulla Injury

1. Swallowing Therapy

Medulla injuries can affect swallowing, leading to difficulties. Swallowing therapy, led by speech-language pathologists, aims to improve safety through exercises, posture adjustments, and dietary modifications. These personalized interventions enhance the ability to eat and drink safely.

In less severe cases, exercises that activate the soft palate of the mouth are helpful to restore proper function of the muscles that help you swallow normally.

2. Cardiac Monitoring

The medulla regulates autonomic functions like heart rate and blood pressure. Thus, following an injury, autonomic issues may occur. Continuous monitoring of vital signs is crucial for detecting and managing abnormalities promptly. This allows healthcare professionals to provide the proper cardiac support.

The term “dysautonomia” is commonly used to describe issues in this area. A tilt table test, or exercise tolerance are commonly used to assess the extent of autonomic dysfunction.

3. Rehabilitation Interventions

Physical, occupational, and brain based therapies are essential for individuals with medulla injuries to maintain functional abilities and maximize independence. Physical therapy focuses on range of motion, strength, and mobility.

Occupational therapy provides strategies and adaptations to enhance independence in daily activities. Functional Neurology focuses on the targeted activation of affected areas to regain their function and strength.

Brainstem Injuries Are Unique and Require Specialized Treatments

Brainstem injuries present unique challenges due to the critical functions controlled by these areas. Because of this, specialized therapeutic approaches are needed for each area, such as physical therapy, occupational therapy, speech therapy, and functional neurology.

A well balanced, integrated plan is crucial for helping individuals recover and improve their quality of life after a brainstem injury. Understanding the details of a brainstem injury and available therapies is essential for providing the best possible care and supporting recovery and rehabilitation.

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*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Thus, patients are advised to consult their medical provider or primary care physician before trying any therapies at home.