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Understanding Brain Stem Damage: Effects, Treatments, and Recovery

medical illustration of brain highlighting the brain stem damage

Of the various types of brain injuries possible, brain stem damage is by far the most life-threatening. The brain stem is home to the most basic life functions, and the resulting damage can be devastating.

However, it is possible for a person with a brain stem injury to at least partially recover by using the brain’s natural plasticity.

Here’s everything you need to know about brain stem damage, including the steps you must take to recover.

Use the following links to jump ahead to certain sections:

What Is the Brain Stem?

brain anatomy showing location of brain stem damage

Located at the base of the skull directly above the spinal cord, the brain stem is perhaps the most important region of the entire brain. It is responsible for all the functions that keep you alive and aware of your surroundings.

The brain stem comprises three distinct sections:

  • Midbrain. At the top of the brain stem rests the midbrain. This structure plays a large role in muscle movement, particularly eye movement.
  • Pons. Below the midbrain lies the pons. The pons acts as a bridge between the cerebellum and spinal cord and helps control your balance, among other things.
  • Medulla. Finally, at the bottom of the brain stem is the medulla.The medulla is in charge of essential life functions, such as breathing, heart rate, and swallowing.

Not only does the brain stem control vital bodily functions, it’s also the link between the spinal cord and the rest of the brain. For example, the cerebral cortex sends information through the brain stem. This means that brain stem damage can affect other functions besides the ones found in the brain stem.

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Effects of Brain Stem Damage

Fortunately, brain stem damage is rare.

Most brain stem injuries are a result of swelling from other brain injuries. Swelling can push the brain stem against the skull and cause damage.

You can also damage the brain stem if you suffer a diffuse axonal injury that tears the brain cells in the pons or medulla.

Brain stem injuries cause serious problems and require intensive treatment. Below are some of the most common effects of brain stem damage.

1. Coma

man in deep coma from brain stem damage

The brain stem houses a network of neurons called the reticular activating system (RAS), which helps a person wake up. When the brain stem is damaged, the RAS is compressed and can cause a coma.

Most comas will last until the swelling goes down. After that, a person will usually pass through three stages of consciousness before finally becoming alert.

These stages are:

  • Vegetative state. Eyes may open and shut but the person cannot respond in a meaningful way, like squeezing your hand.
  • Minimally conscious state. Person can respond by blinking or smiling but falls in and out of consciousness.
  • Confusional state. Person is awake and aware but does not have full control over their behavior.

The faster the person progresses through these stages, the higher their chances of making a full recovery will be. For example, patients who reach a minimally conscious state within three months have a high likelihood of regaining full consciousness compared to those who are still in a vegetative state after 12 months.

2. Locked-In Syndrome

Sometimes, the brain stem is severely damaged and patients cannot move anything except their eyes. Doctors call this condition locked-in syndrome.

When a patient has locked-in syndrome, they possess normal intelligence, reasoning skills, and can hear everything going on around them. They just cannot communicate.

They are, quite literally, locked into their bodies like a prison.

There is no treatment for locked-in syndrome, and most people do not regain movement, although some have.

Instead, supportive care is the best option for these patients. There are also computer programs that track eye movement and help the person speak artificially.

3. Swallowing Problems

old man with swallowing problems talking to doctor after brain stem damage

Not all brain stem injuries lead to coma or paralysis. Instead, some can cause swallowing problems, such as dysphagia.

While the brain stem is not the only part of the brain in charge of swallowing, it plays a significant role in automatic swallowing and the gag reflex. This means that people with brain stem injuries are at a greater risk of choking on their own saliva.

Fortunately, you can treat most swallowing problems with swallowing exercises for dysphagia. A speech therapist is the most qualified professional to help you overcome dysphagia.

4. Respiratory Problems

The medulla controls your breathing by sensing the level of carbon dioxide (CO2) in the blood and adjusting your respiratory rate in response.

However, a damaged medulla cannot detect how much COis in the blood. As a result, it doesn’t know how much air the body still needs. That’s when breathing problems can arise.

The most common respiratory problems after brain stem damage include:

  • Hyperventilation: Breathing too much too fast
  • Hypoventilation: Breathing too little too slow
  • Apneustic breathing: Problems exhaling air
  • Apnea: Lack of breathing

5. Sensory Problems

Problems with sensation and balance can also affect people with brain stem damage.

That’s because, as mentioned above, the brain stem serves as a bridge between the spinal cord and the rest of the brain.

If this bridge is broken, then the body cannot receive messages from the brain. As a result, you can experience numbness and muscle weakness.

Treatment for Brain Stem Damage

Close up of doctor holding patient's hand

To treat brain stem damage, you must address the symptoms. The most effective way to do this is to trigger neuroplasticity, your brain’s natural healing mechanism.

Because of neuroplasticity, your brain can form new neural pathways. These pathways allow undamaged portions of the brain to take over functions controlled by damaged ones. It does this in response to repetition.

Therefore, the more you practice an action, the more you will reinforce those neural pathways. And the stronger those pathways are, the easier the activity will become.

This principle applies to every type of brain damage, even brain stem damage. There are several therapies you can take part in to engage neuroplasticity and recover function. We will discuss the most important ones in the sections below:

Physical Therapy

After a brain stem injury, the connection between the brain and muscles can become damaged or destroyed. Fortunately, engaging the brain’s neuroplasticity can allow a person to rebuild those neural connections.

There are a few interventions a physical therapist might use to accomplish this. These include:

  • Passive range-of-motion exercises. If your muscles are too weak or stiff to move on their own, your PT can move them for you. Just having someone else do the motion is often enough to stimulate the brain and rekindle the neural networks that help you move. 
  • Electrical stimulation. E-stim sends electrical impulses directly into the targeted muscle through electrodes placed on top of the skin. These impulses can stimulate the nerves enough to start the neural repair process.
  • Task-specific exercises. These exercises are the best way to engage neuroplasticity. All it really means is that, if you want to improve an ability, you must practice that action directly. For example, to improve your walking skills, therapists will have you practice proper walking motions.

The more you activate your muscles through physical therapy, the more skills you can hope to recover.

Occupational Therapy

While physical therapy is concerned with teaching you how to rebuild your physical strength, occupational therapy (OT) looks at the specific skills you need to regain independence.

During an OT session, you will practice many important activities to improve your independence after brain stem damage. Some areas of your life an occupational therapist can help you with include:

  • Self-care
  • Home management
  • Recreation
  • Social skills
  • Cognitive functioning

To help you regain these skills, an occupational therapist will teach you both restorative and compensatory strategies. Restorative techniques help you relearn how to perform an activity the way you did before your brain injury. Compensatory tactics, on the other hand, help you find an alternative way of doing a task.

Of the two techniques, restorative techniques are more permanent and functional solutions. Therefore, occupational therapists prefer to focus on restorative techniques whenever possible.

Speech Therapy

Finally, to improve your swallowing, you must take part in speech therapy.

A speech therapist can walk you through the various TBI speech therapy activities available, and show you exactly what you need to do to retrain your brain and regain swallowing skills.

They can also help you with cognitive or communication skills that sometimes are impaired after brain stem damage, such as the ability to listen, pay attention, and respond appropriately.

All of this makes speech therapy a vital part of brain stem injury rehabilitation.

Continuing Brain Stem Damage Rehabilitation at Home

To ensure the best recovery from brain stem damage, you should practice your home exercises every day after therapy. If you struggle with memory problems, have your therapist write you a home exercise sheet to help you remember exactly how to do them.

There are also home therapy devices, such as FitMi, which walk you through exercises in a fun and engaging manner. These devices can help you stay motivated in a way that hand-out sheets do not.

Practicing your exercises every day will keep your brain stimulated and can help you recover from brain stem damage that much quicker. 

Brain Stem Damage: Conclusion

Without a doubt, brain stem injuries are more debilitating than other brain injuries. However, even with brain stem damage, it is possible to improve skills such as swallowing or breathing.

There’s no such thing as a hopeless case. As several severe brain injury recovery stories show, the brain is a remarkably adaptable organ, and with the right treatment and enough perseverance, you might just surprise yourself by how much you can recover.

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