Diffuse Axonal Injuries: Definitions, Causes and Treatments
Diffuse axonal injury (DAI) is one of the most common, yet devastating, types of traumatic and catastrophic brain injury. The reason that the term “diffuse” is used is because an injury of this type affects a large area of the brain and, therefore, has a potentially broad effect on many brain functions. In contrast a “focal” brain injury affects a more specific (focused) portion of the brain and, therefore, a potentially narrower range of brain functions.
“Axonic” refers to axons. Axons are neural processes within the brain that permit neurons to communicate with each other. They promote consciousness and other aspects of normal brain activity. A diffuse axonal injury results in extensive lesions in tracts of the white matter of the brain, including the constituent axons, and is a traumatic brain injury in every sense. The white matter is brain tissue that actively affects how the brain learns and functions. It also modulates the distribution of action potentials within cells. The term “action potential” refers to electrical signals that are transmitted along nerve and muscle fibers. Action potentials are essential for the communication of information to, from and within the brain and act as relays and coordinators of communication between different brain regions. Therefore, DAI is one of the major causes of unconsciousness and persistent vegetative state after a head trauma[1]. Sometimes, DAI occurs at the junction of the white matter and the grey matter of the brain. The grey matter is the main processing center of the brain.
Coma is a frequent outcome of a DAI, with many individuals with severe DAI never regaining consciousness or full independence. Those who do wake up often remain significantly impaired, both in bodily and intellectual function and require residential services and supported living[2]. Some who have studied DAI believe that it can occur in numerous degrees of severities, with even a seemingly mild concussion constituting one level of DAI.
The cause of DAI is thought to be a rapid acceleration/deceleration process to the head, rather than a direct impact to it. This kind of traumatic brain injury frequently results from an auto collision (sometimes called “whiplash”), a fall or a similar occurrence that causes a shearing (stretching) to the axons. Although not a direct traumatic brain injury, it is an indirect one as it results in biochemical changes to the brain, usually in the temporal or frontal lobes of the brain. “Deceleration” is a term that is sometimes used in describing part of the causation of DAI, but it may be a misnomer. “Acceleration” is the common factor because deceleration is actually acceleration, but in the opposite direction of the initial movement.
Treatment for those individuals who survive DAI varies depending upon the severity of this kind of catastrophic brain injury. In an acute care facility, one of the major concerns is the stabilization of intracranial pressure. Techniques include craniotomies to directly relieve brain pressure, or shunts to ensure the proper drainage of cerebrospinal fluid (CSF). Both of these clinically relevant services are carried out under the careful supervision of a neurologist and neurosurgeon.
After acute care is rendered and the individual is stabilized, post-acute care consisting of rehabilitation, specialized rehabilitation and a range of neurorehabilitative services are needed. These require a specially developed, customized Client Goal Plan intended to achieve independence for the client to the fullest degree possible consistent with the individual’s physical and psychological needs and abilities.
The team of multidisciplinary professionals at NeuLife, including its team of neurologists, RNs and therapists are experts in the provision of innovative, clinically relevant services, including the development of a customized Client Goal Plan, and delivery of neurobehavioral and neurorehabilitative services. NeuLife’s goal is to provide post-acute rehabilitation to its clients to achieve the best possible outcome for its clients who have even the most difficult and challenging diagnoses.
NeuLife’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 he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve, for all of its clients, maximized, sustained outcomes that exceed the expectations of all persons served.
NeuLife, in Mount Dora, Florida, is a fully accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.
2725 Robie Avenue
Mount Dora, Florida 32757
[1] Wasserman J. and Koenigsberg R.A. (2007). Diffuse Axonal Injury. Emedicine.com
[1] Vinas F.C. and Pilitsis J. (2006). Penetrating head trauma. Emedicine.com
