Anoxic Injury: Causation, Care, Post-Acute Rehabilitation and Outcomes

Generally and Causation

An anoxic injury is one that results from the brain’s total deprivation of oxygen. In general, if the brain cannot get oxygen for four minutes, brain cells start to die.

Any anoxic injury is catastrophic and requires prompt acute care and innovative post-acute rehabilitation. Anoxic injury can result from a variety of causes, including:

• Asthma
• Smoke or carbon monoxide inhalation
• Poisoning
• Brain tumors
• Heart attacks
• Drowning
• Compression of the trachea. A common cause of tracheal compression is a motor vehicle accident (MVA) that results in a neck or trachea injury preventing normal breathing and hence, inadequate oxygen intake.

Broad Effects of Anoxia

Physically, anoxic injury causes physical problems, performance in areas of executive function, vision, and in many other respects. In severe cases of anoxia, the individual may be in a stupor or comatose for periods ranging from hours to days, weeks or months. Seizures, myoclonic jerks and neck stiffness may occur. If the individual’s respiratory and cardiovascular systems can be supported properly during the acute care stage of treatment recovery may happen, but whether or not it does depends on the severity and extent of the injury.

As recovery proceeds, a variety of psychological and neurological abnormalities may appear, persist for a time or may improve. Mental confusion, personality regression, parietal lobe syndromes, amnesia, hallucinations, memory loss and persistent myoclonus may also occur. The parietal lobe of the brain is involved with processing and integrating taste, temperature, and touch. Myoclonus refers to sudden, involuntary jerking of a muscle or group of muscles. Myoclonic twitches or jerks usually are caused by sudden muscle contractions, called positive myoclonus, or by muscle relaxation, called negative myoclonus.

If the cerebral anoxia is mild, the following problems are likely:

• Concentration
• Attention
• Coordination and short-term memory deficits that may get worse with time
• Lightheadedness
• Dizziness
• Increased breathing rate and sweating
• Diminished field of vision

If the anoxia becomes worse, such as, by the delay in starting acute care, the following symptoms may manifest themselves:

• The skin may turn blue, especially the lips
• Brief jerks of the limbs
• Seizures, which can advance to a coma.

The nerve cells of the brain crave oxygen, and when deprived, there can be catastrophic results. The degree of damage correlates with the amount of time that the brain is deprived of oxygen. Particularly susceptible to damage from the lack of oxygen are these areas of the brain, with the corresponding physical and neurologic implications:

• Cerebral cortex, including the parietal and occipital lobes, and the hippocampus, all important to memory
• The basal ganglia and the cerebellum, both critical to the control of movement.
• Cerebral anoxia may also cause brain swelling. Swelling can add to the damage, by squeezing off smaller blood vessels and interrupting the local blood supply.
• Severe anoxic injury can cause damage to the hypothalamus and pituitary gland. Damage to them can lead to insufficient or to increased release of hormones.In turn, this can result in a disruption of the body’s ability to maintain a stable internal environment (homeostasis). In the early stages, this can cause a condition called neurogenic diabetes insipidus.

Acute Care

The acute care rendered to an individual who has sustained an anoxic injury depends upon the cause of the injury. For example, if it resulted from a stroke, the individual would be treated for a stroke. If it resulted from a crushed trachea, measures would be taken to open it to permit oxygen to access the brain and measures will probably be taken to keep the individual cool to prevent additional brain damage (deprivation of oxygen causes the temperature to rise).

Long-Term Effects of Anoxic Brain Injury

The long-term results of anoxic brain injuries depend mainly on the degree to which permanent brain injury occurred and to what part(s) of the brain. If the injury is mild, localized or short-lived, the individual may return to a near-normal status. This is especially true if there was rapid and effective acute care followed by the type of expert and innovative post-acute rehabilitation such as that furnished by NeuLife Rehab in Mount Dora, Florida.

Among the long-term consequences of anoxic injury that can result and that require the clinically-relevant services of NeuLife Rehab include:

• Limb weakness and disturbances of movement, balance and coordination. These include rigidity, spasticity, tremor, involuntary writhing and jerky movements.
• Loss of visual function referred to as cortical blindness.
• Memory function
• Disturbances of speech and language function may occur because of damage to areas of the brain involved in the production and articulation of speech, finding the right words and understanding language. Spoken and written communication may both be affected.
• Damage to the frontal lobes may lead to disturbances in executive function – the ability to think and reason, to synthesize and integrate complex information and make considered judgments and decisions about what to do in a particular situation. These skills underlie the ability to plan for the future in a sensible way, as well as to function effectively in work and social settings.
• Frontal lobe injury may produce changes in personality, including irritability, poor tolerance of frustration, impulsiveness, and impairments in social perception and conduct. There may be apathy and lack of insight, as well as intermittent agitation and mood swings, or more sustained periods of depression.
• Occasionally, severe anoxic injury can cause damage to the hypothalamus or pituitary gland, which can lead to a variety of hormonal problems.

Post-Acute Rehabilitation

Innovative post-acute rehabilitation of an individual having sustained an anoxic injury must be conducted by a multidisciplinary team of specialists. The goal is to return the individual to his or her maximum level of independence consistent with his or her physical and mental abilities. Among the team members include professionals expert in speech therapy, occupational therapy, physical therapy, recreational therapy, and the use of adaptive equipment.

When an individual becomes a Client of NeuLife Rehab in Mount Dora, Florida, he or she undergoes an independent functional evaluation administered by a multidisciplinary team of professionals that may consist of:

• Board Certified Neurologist
• Board Certified Behavior Analyst
• Board Certified Physiatrist
• Neuropsychologist
• Psychologist
• Board Certified Psychiatrist
• Speech Language Pathologist/Cognitive Therapist
• Physical Therapist
• Occupational Therapist
• Nurses
• Certified Rehab Counselor

From the results of the independent functional evaluation, the professionals of NeuLife Rehab formulate a Client Goal Plan. The Client Goal Plan guides the clinically relevant services delivered by NeuLife Rehab. The Client Goal Plan guides the cognitive, psychiatric, neurologic, psychological and neuropsychological therapy of the Client. The goal of NeuLife Rehab’s innovative post-acute rehabilitation is the attainment for our Clients of independence to the fullest extent that his or her physical and mental abilities permit.

NeuLife Rehab in Mount Dora, Florida consistently provides the highest standard of care in the delivery of clinically relevant services to achieve successful, sustained outcomes and exceed the expectations of all persons served.

Proper and timely post-acute rehabilitation that may determine the difference between disability and independence is what NeuLife refers to as the “platinum post-acute period” —  the crucial window following acute care that is needed to nurture the whole person to health with specialized, clinically relevant services.

NeuLife Rehab’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting, therapeutic environment where caring staff encourage, assist and support each Client so that he or she may achieve specific goals. NeuLife Rehab believes personal philosophy is equally as important as goals to increase function and independence.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with Traumatic Brain Injury
(TBI), Spinal Cord Injury (SCI), Amputations, Burns and other Catastrophic Injuries and Challenging Diagnoses.

2725 Robie Avenue

Mount Dora, Florida 32757