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