Diffuse Axonal Injury

Overview

Diffuse Axonal Injury (DAI) is a serious type of traumatic brain injury (TBI) that occurs when the brain is rapidly shifted inside the skull, causing damage to the brain’s white matter. This microscopic injury disrupts the connection between nerve cells, leading to a wide range of physical, cognitive, and behavioural impairments.

At The Royal Buckinghamshire Hospital, we offer structured inpatient neurorehabilitation for adults recovering from moderate to severe DAI. Our multidisciplinary approach supports long-term recovery through physiotherapy, occupational therapy, psychology, and 24/7 nursing care.

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What Causes Diffuse Axonal Injury?

DAI typically results from acceleration-deceleration forces that cause the brain to move back and forth inside the skull.

Common causes include:

• Road traffic collisions
• Falls from height
• Assault or violent shaking
• Sport-related head trauma
• Blast injuries (e.g. military trauma)

Unlike focal injuries, DAI affects multiple areas of the brain — particularly the corpus callosum, brainstem, and midbrain. The injury often occurs without a direct blow to the head and may not always be visible on standard CT scans.

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Symptoms of DAI

Symptoms depend on the severity and location of axonal disruption. Many patients with DAI experience loss of consciousness at the time of injury.

Common Symptoms Include:

Cognitive Impairments

• Memory problems
• Reduced attention and concentration
• Slowed information processing
• Poor judgement and reasoning

Motor & Physical Effects

• Weakness or loss of coordination
• Balance difficulties
• Fatigue
• Impaired fine motor control

Behavioural & Emotional Changes

• Agitation or impulsivity
• Apathy or withdrawal
• Irritability or mood swings
• Loss of emotional regulation

Speech & Communication

• Slurred speech
• Word-finding difficulties
• Reduced social awareness in conversation

Disorders of Consciousness (in severe cases)

• Prolonged coma
• Vegetative state or minimally conscious state
• Difficulty with wakefulness or responsiveness

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Diagnosis

DAI is diagnosed through a combination of clinical examination and imaging:

• MRI brain scan – sensitive to shearing injuries in white matter
• CT scan – may be normal in mild cases
• Glasgow Coma Scale (GCS) – used to measure level of consciousness at injury
• Neuropsychological assessment – to evaluate cognitive function post-injury

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Rehabilitation at The Royal Buckinghamshire Hospital

We provide comprehensive neurorehabilitation for individuals recovering from DAI. Each programme is personalised, goal-oriented, and delivered by a consultant-led multidisciplinary team.

Services Include:

Physiotherapy

• Mobility and balance retraining
• Strength and endurance building
• Spasticity management (if present)
• Functional independence training

Occupational Therapy

• Activities of daily living (e.g. self-care, dressing)
• Cognitive rehabilitation strategies
• Environmental adaptations and assistive devices
• Community reintegration and return-to-work planning

Speech and Language Therapy

• Language and communication recovery
• Cognitive-communication therapy
• Swallowing assessments if required

Neuropsychology

• Mood and behavioural management
• Memory and executive functioning support
• Emotional adjustment and coping strategies

Specialist Nursing

• 24-hour care for complex medical needs
• Medication and seizure monitoring
• Nutrition and continence support

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Who We Support

We admit adults (18+) who:

• Have a confirmed diagnosis of DAI or severe TBI
• Are medically stable but functionally impaired
• Require inpatient rehabilitation for cognitive, behavioural, or physical recovery
• May also require support with prolonged disorders of consciousness

Call 01296 678800 or enquire online to discuss a referral.

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Why Choose The Royal Buckinghamshire Hospital?

• Expertise in moderate and severe traumatic brain injury
• Consultant-led multidisciplinary team
• Therapy delivered up to 7 days per week
• On-site neuropsychology and family support
• Quiet, private environment ideal for recovery