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Brain Stem Injury Recovery Signs: Recognizing Positive Neurological Responses

doctor checking male patient for brain stem injury recovery signs

Brain stem injury is one of the most devastating traumatic injuries possible. These injuries can cause problems with motor functioning and in severe cases can result in paralysis, coma, and even death.

But although brain stem injuries are serious, recovery is still possible. You’re about to learn what these injuries involve and what some early signs of recovery from brain stem injury look like.

What is the Brain Stem?

Located at the base of the skull, directly above the spinal cord, the brain stem is perhaps the most pivotal region of the entire brain. It is responsible for all the basic functions that keep you alive, such as:

  • heart rate
  • respiratory function
  • blood pressure
  • reflexes such as swallowing and coughing

Not only does the brain stem control vital bodily functions, but 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 injury can impair many other functions besides the ones the brain stem has direct control over. In fact, if no signals can pass through the brain stem into the spinal cord, the person could become effectively paralyzed.

This explains why most brain stem injury patients fall into a coma after their injury.

Coma After Brain Stem Damage

The brain stem houses a network of neurons called the reticular activating system, which helps a person wake up from sleep. When the brain stem becomes damaged or swollen, this system gets compressed, causing the patient to fall into a coma.

Most comas will fade once the swelling goes down. After that, a person will usually pass through three stages of consciousness before finally waking up. These stages are:

  • Vegetative state. Eyes may open and shut but the person cannot respond meaningfully.
  • Minimally conscious state. The person can respond by blinking or smiling but falls in and out of consciousness.
  • Confusional state. The 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 will be of making a full recovery. For example, patients who reach a minimally conscious state within three months have a higher likelihood of regaining full consciousness than those who are still in a vegetative state after 12 months.

There are also certain early signs that a person may be emerging from their coma and might recover from their brain stem injury. We’ll discuss those recovery signs below.

Brain Stem Injury Recovery Signs

Doctor checking man for brain stem injury recovery signs.


Most brain stem injury patients who recover will display a certain pattern of signs. These signs indicate preserved brain function

For example, the presence of neurological reflexes is often an excellent sign of possible recovery. Some neurological signs that doctors look for in brain stem injury patients include:

  • Pupillary reactivity. The doctor will shine a light on the patient’s eyes. If the pupils shrink in response, then their brain stem is intact.
  • Oculocephalic response. When the person’s head is turned to the left, their eyes should turn the opposite direction, to the right.
  • Eye deviation. Both pupils should be looking straight ahead. If one pupil is looking up and the other is looking down, that is a sign of serious brain stem damage.
  • Gag reflex. The person should gag or cough if a cotton swab or endotracheal tube is placed down their throat.

The presence of these reflexes is an excellent sign of recovery from brain stem injury. While the person might still have a long way to go before they regain full consciousness, these signs indicate that their brain stem is still intact.

With that said, the initial absence of these reflexes does not always indicate a poor recovery. Some patients who have no brain stem reflexes when they arrived at the hospital go on to make a functional recovery.

But in general, the more reflexes the person has, the better their chances of achieving a good recovery.

Tips for Interacting with Someone with a Brain Stem Injury

Even though they can’t respond right now, try to talk to your loved one as normally as possible. Not only will it let you stay more connected to them, but it might even help the person recover.

One study found that familiar sounds, such as a loved one’s voice, improved responsive signs in people with brain stem injury.

And many patients who emerge from their comas report that they heard what people in their room were saying. So keep talking to them and telling them about your life. You never know how much it might help.

Promoting Brain Stem Injury Recovery

young adult grandson visiting grandpa in hospital, giving him high five

Once the person regains consciousness, they should begin therapy immediately. Treating a brain stem injury will be the same as treating any other type of brain injury: you’ll need to address the symptoms.

For example, if the person struggles with swallowing, speech therapy exercises can help them regain that strength. They will just need to do enough exercises to trigger neuroplasticity, the brain’s natural healing mechanism.

With neuroplasticity, the brain forms new neural pathways. These allow undamaged portions of the brain to take over functions previously 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, including brain stem injury.

Recognizing the Signs of Brain Stem Injury Recovery

Brain stem injury is a serious condition. However, this condition is not hopeless.

Encouraging signs that point to brain stem injury recovery include certain reflexes such as pupil reactions and oculocephalic responses.

Another good sign of recovery is if they reach a minimally conscious state within the first six months after injury. However, there are people who recover after 12 months in a vegetative state.

If and when your loved one does finally regain consciousness, they will need your help to recover. Try to encourage them to take part in physical and cognitive therapy as early as possible.

These activities are excellent ways to engage neuroplasticity and kickstart their brain’s healing process.

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