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Diffuse Axonal Injury Recovery: Causes, Symptoms, and Methods for Rehabilitation

Everything you need to know about diffuse axonal injury recovery

Diffuse axonal injuries are generally a severe type of traumatic brain injury. Fortunately, through neuroplasticity, it is possible to encourage recovery in the areas of the brain that were affected to regain abilities you may have lost.

To help through your diffuse axonal injury recovery, we’re covering everything you need to know about these injuries, including the most effective treatment approaches.

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Causes of Diffuse Axonal Injury

Diffuse axonal injury occurs when the brain quickly moves inside the skull as a result of a traumatic injury, like a car accident. As the brain repeatedly hits against the inside of the skull from the force of the injury, the long connecting fibers in the brain, known as axons, can tear and potentially cause severe damage.

Doctors call this type of injury axonal shearing. The tearing of the axons disrupts the messages that neurons send, leading to a loss of function.

Because most diffuse axonal injuries result in microscopic tears, damage can be difficult to detect with imaging.

Any strong shaking, quick acceleration, or blunt injury can lead to axonal shearing. Some of the most common causes of diffuse axonal injury include:

  • Car accidents
  • Sports injuries
  • Falls
  • Domestic abuse

The severity of the traumatic event is related to a higher potential for axonal shearing.

Symptoms of Diffuse Axonal Injury

symptoms of diffuse axonal injury can be devastating

The primary symptom of diffuse axonal injury (DAI) is loss of consciousness. For example, if the event causes a significant amount of head trauma and subsequent damage to the axons, the individual could fall into a coma.

Not everyone with a DAI will lose consciousness, though. The other symptoms of this injury include common traumatic brain injury symptoms, such as:

  • Confusion
  • Severe headaches
  • Nausea and vomiting
  • Cognitive problems
  • Loss of speech

Another secondary effect of DAI is a condition called dysautonomia. Dysautonomia refers to a malfunction of the autonomic nervous system which controls unconscious bodily functions like heart rate, digestion, and breathing.

Symptoms of dysautonomia can include fatigue, low blood pressure, dizziness, and anxiety attacks.

Measuring the Severity of a Diffuse Axonal Injury

Doctors will consider a variety of factors when determining the severity of a diffuse axonal injury.  He or she may also choose to rate the severity of injury using the Glasgow Coma Scale (GCS).

The Glasgow Coma Scale is a simple tool that gauges the severity of a TBI and can be used to predict an individual’s prognosis.

The scale consists of 15 points total that measure various functions such as eye-opening, motor function, and verbal response. A higher the score indicates more function, which means a greater likelihood of a positive prognosis.

Positive Signs of Recovery from Diffuse Axonal Injury

Most patients who recover display a certain pattern of signs after a DAI. These signs are usually a positive indication of working brain function.

For example, the presence of neurological reflexes is often viewed as an positive sign of recovery. Some neurological signs that doctors look for in patients after DAI include:

  • Pupillary reactivity. The doctor will shine a light on the patient’s eyes. If the pupils shrink in response, then the brain stem is working.
  • Oculocephalic response. When the person’s head is turned to the left, their eyes should turn the opposite direction, to the right.
  • Gag reflex. The person should gag or cough if a cotton swab or medical tube is placed down the throat.

Presence of these reflexes is a positive sign of recovery and prognosis.

Neuroplasticity and DAI Recovery

A diffuse axonal injury can affect many areas of the brain at the same time. This can make DAI injuries more difficult to treat than other traumatic brain injuries that only affect one area at a time.

Your recovery from DAI depends on the severity of the injury itself. For example, those who regain consciousness within two weeks have a relatively mild injury and can have a good chance of making a full recovery.

In the more severe DAIs, recovery is difficult to predict. However, regardless of the severity of the injury, it is possible to regain function due to the brain’s natural ability to heal itself.

This natural healing mechanism is known as neuroplasticity. Neuroplasticity occurs when the brain uses healthy functioning nerve cells to form neural connections with the areas of the brain that were affected.

Since a DAI causes problems with communication between neurons, a significant aspect of diffuse axonal injury recovery involves activating neuroplasticity to reform those neural connections.

Effective Methods for Diffuse Axonal Injury Recovery

man using crutches to learn how to walk during diffuse axonal injury recovery

One of the most effective ways to recover after a diffuse axonal injury is to utilize the principle of neuroplasticity.

During the first few months after a diffuse axonal injury, the brain is highly susceptible to neural changes, known as a heightened state of plasticity. One way to take advantage of this is to engage and participate in therapy.

This is why it’s so important to start rehabilitation as soon as possible after your injury. For the best results, try to incorporate the following therapies into your diffuse axonal injury recovery plan:

1. Physical Therapy

A main goal of physical therapy during recovery from DAI is to regain control over your nerves and muscles.

After a DAI, the connection between the brain, nerves, and muscles are impaired, or damaged. Fortunately, participating in physical therapy can engage the brain and promote neuroplasticity, which is important to recover the areas of the brain that were affected.

There are a number of interventions a physical therapist might use to accomplish this, such as:

  • Transfer training. Your PT can reteach you how to stand or sit safely, get in or out of a car, or maneuver in the tub/shower.
  • Functional electrical stimulation (FES). FES sends electrical impulses to weakened muscle through an electrode that is placed on top of the skin. Combined with functional activities, like walking or stair climbing, these impulses can stimulate the nerves and hopefully improve muscle strength.
  • Task-specific exercises. These exercises are the best way to engage neuroplasticity. Task-specificity means, if you want to improve a skill, 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 after diffuse axonal injury.

2. Speech Therapy

If your diffuse axonal injury has affected your ability to speak or swallow, begin speech therapy right away. The earlier you can receive treatment, the less likely it is that your speech disorders will last.

A speech therapist can walk you through the various TBI speech therapy activities available, and show you the steps you must follow to regain speech and language skills. Even if you have no visible speech disorders, speech therapy can also help you with the more delicate aspects of communication that you might struggle with after a DAI.

For example, you might need to relearn how to match your voice pitch and volume with others, which a therapist can teach you. They can also help you with cognitive-communication skills such as the ability to listen and respond appropriately.

In addition, speech therapists can teach you various social communication skills that you might lack after DAI, such as learning how to begin and end a conversation. All this makes speech therapy a vital part of diffuse axonal injury recovery.

3. Occupational Therapy

man in wheelchair ironing shirt on ironing board

While physical therapy shows you strategies on how to regain your physical mobility, occupational therapy (OT) looks at specific skills you need to regain independence in your home, work environment, or community.

During an OT session, you will practice many important activities that will directly improve your independence. Some areas of your life an occupational therapist can help you with include:

  • Dressing
  • Bathing
  • Personal hygiene
  • Managing your finances
  • Sorting your prescriptions
  • Social skills
  • Cognitive functioning

To help you regain these skills, an occupational therapist will teach you both restorative and compensatory strategies:

  • Restorative techniques encourage you to perform an activity the way you did before your brain injury.
  • Compensatory tactics, on the other hand, help you find an alternative way to accomplish the same tasks.

Whenever possible, all therapists prefer to focus on restorative techniques.

Learning How to Recover From Diffuse Axonal Injury

Diffuse axonal injury is a serious condition and can be one of the most debilitating types of traumatic brain injuries.

But as with all brain injuries, the key to making a good recovery lies in activating neuroplasticity through therapeutic exercises.

The brain is a remarkably adaptable organ, and even if it’s been heavily damaged, there is always the potential for improvement. By persevering with physical, occupational, and speech therapy, you can have a real hope of making a functional recovery.

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Independance, motivation and hope!

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Sharat’s review of FitMi home therapy, 10/10/2020

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