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Brain Stem Injury Recovery & Rehabilitation

The term brainstem refers to a composite substructure of the brain. It includes the midbrain, the pons and the medulla. It may also include the cerebellum and parts of the interbrain.

Injury to the brain stem is so severe because it is similar to the motherboard of a computer being disrupted or destroyed. The brain stem, controls consciousness, respiratory (breathing), heart rate, ocular (eye) movement, dilation and contracture of the pupils in response to light/darkness, swallowing and facial movement and all neurological signaling from the brain to various muscle groups. The brain stem literally controls all that we do and how we process the things that we do each day.

Rehabilitation from brain stem injury often occurs in phases. Much will depend on the extent of the injury and if severe cerebral edema (brain swelling) occurred and for what length in time it did so. Spasticity will also be evaluated. Spasticity is increased muscle tone which results in whole or in part from the disruption that has occurred between the brain and the muscles. These muscles are prone to spasms and obscure random reflexes.

Phase one of rehabilitation will be done in a hospital or specialty care rehabilitation facility. These facilities begin intensive therapy specifically designed to recover as much physical and occupational ability as possible. They will also work to decrease the level and severity of the spasticity of muscles and teach adaptive measures to address activities of daily living (like transferring from bed to a wheelchair, or how to safely get into or out of a bathtub). During this time, your healthcare team will also assist the injury victim’s family with preparation for homecoming by education on adaptive needs and equipment.

Phase two of the rehabilitation process is dependent on if the injury patient will be going home or to an Extended Nursing Facility (ECF). At this point in recovery, some patients are able to transition to vocational training programs to teach new manners of being gainfully employed and how to work safely and functionally around any lingering deficit. Just because the injury survivor is home, however, do not feel that all challenges are over. Home care presents unique challenges of its own. Difficulty with complex processing of information, maintaining emotional awareness and ability to control emotions becomes frustratingly difficult and commonplace for brain stem injury survivors. This frustration and inability to measure its response can subsequently impact the family dynamics. During this time it is also common for the brain stem injury patient to suffer setbacks of one kind or another. It may be difficult or overwhelming for him/her to grasp the change that has taken place in livelihood and/or career direction. The patient and his/her family will require a great deal of support in providing care at home during this time, as many of these issues do not present during intensive inpatient stays but are readily present once discharged to home.

In the most severe cases, however, where the brain stem injury has caused a total lack of awareness to time or place, 24-hour care in a skilled care nursing facility may be necessary. The best option in weighing this decision is to consult with your neurologist and neurosurgeon for resources and support to make the best decision possible.

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