August 2007
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August 27
Michael had some pool time this weekend. He gave many smiles and seemed to enjoy it. It breaks my
heart for him to be in this condition, but I could not help but think how fortunate I am to have him. Not a
day goes by that I do not think about the gift that Deputy Jeff Morgan gave to me.
August 25
Elizabeth and her boss, Pat, came by last week to see Michael. Pat was very positive about Michael and offered a few
suggestions that we will implement. Michael had some pudding this weekend when Jennifer, the ST, visited. He
swallowed well and had no problems.
School started yesterday and Michael had a good first day.
Gotta run.
August 14
Not many things get to me anymore, but this one touched me deeply. A couple of friends of mine,
Jennifer and Warren, are showing their support for Michael by putting the name of the website on their
race car. That in itself got to me, but this excerpt from their email about brought tears to my eyes; I must
be getting old.
"........ August 2004, you were cracking jokes (as usual) and Michael was having a great time being around
you. I was thinking to myself, Michael is not hanging around with his dad; Michael is hanging around with
his best friend. What a great thing to be able to share between father and son. After viewing the website
and reading much of the material I see nothing has changed, Michael still has both his loving dad and his
best friend."
August 9
Status Quo here. Michael slept about 12 hours last night to make up for the 3 hours he got the night
before. I never know what effect Ambien will have on him. It either makes him sleep or it has the opposite
effect and makes him active. It did not make him sleep the night before.
He has had some pool time lately, but has not had occupational or speech therapy this week. He will,
however, have speech on Sunday.
I'm sure that by now everyone has heard this story:
Near-Vegetative Man Partially Recovers from Brain Injury, Recites Pledge of Allegiance
Deep-brain stimulation "jump-starts" a man's brain six years after he suffered a severe head trauma
A 38-year-old man who had been barely conscious for six years can now speak to his family, eat on his own, brush his own hair and
teeth and even recite part of the Pledge of Allegiance.
Last year, six years after suffering brain damage in an assault, the man began showing dramatic improvement during deep-brain
stimulation, a breakthrough therapy that involves sending electrical pulses to a specific brain region. The new treatment was first
administered in 2005, researchers report this week's issue of Nature.
"[I thought], 'What could we lose?'" the man's mother said during a telephone press conference this morning, explaining why she
accepted doctors' offer to try out the new therapy on her son. She also detailed the trials of caring for someone in a near-vegetative
state, which included signing a "do not resuscitate" form soon after his 30th birthday and the inability to take her son out of his
managed care facility even on a nice day (for fear he would aspirate, drawing liquid into his lungs).
But life improved dramatically after physicians used the new treatment. "My son can now speak, eat and watch a movie without falling
asleep," she said. "The most important thing is he can say 'mommy' and 'pop'. I still cry when I see my son, but they are tears of joy."
Deep-brain stimulation, essentially a pacemaker for the brain, has previously been used to treat Parkinson's disease and to monitor
neural activity in epileptics; it is now being tested in clinical trials for use in patients who suffer from obsessive-compulsive disorder and
clinical depression.
According to the study's lead author Nicholas Schiff, a neurologist and neuroscientist at the Weill Cornell Medical College in New York
City, the man was the perfect candidate for a deep-brain stimulation trial, because he was at the higher end of the spectrum of minimally
conscious states, exhibiting minor language capability. "[These patients] show that the intrinsic brain systems may be there," he said at
the press briefing, "and that they may be potentially restored."
Joseph Giacino, study co-author and a neuropsychologist at the New Jersey Neuroscience Institute in Edison, said that prior to the trial,
the patient "tended to keep his eyes closed almost all the time." He could perform simple movements, "[but] at no point along the
way…was he able to communicate in a reliable manner"—rarely speaking.
In this case, the doctors targeted neurons in the thalamus for treatment. This midbrain structure has come to be known over the past 10
to 20 years to exert some control over global sensory function, communicating with the cerebral cortex, which Schiff called "the
principle computing area of the brain," and the basal ganglia, another midbrain structure that is key to controlling movement.
During a 10-hour operation (performed by study co-author Ali Rezai, a neurosurgeon at Cleveland Clinic), electrodes were placed with
millimeter precision on the central lateral nucleus of the man's thalamus to target the nerve cells there. "Immediately [after the surgery],
the patient's level of arousal and alertness improved," Rezai says. Giacino adds that the man's eyes were open and he could turn his
head to look at whomever was speaking to him.
The physicians turned off the deep-brain stimulation over the next 50 days to isolate its effects—making sure the sudden improvement
was not from the surgery alone. The team then began an 18-week period of tuning the electric pulses to get the best therapeutic effects,
followed by alternating phases during which the deep-brain stimulation was turned on and off to allow doctors to measure its efficacy.
Giacino said there were other gradual improvements beginning around postsurgery day 145. (The advances were most pronounced when
he was receiving the pulses, but also persisted when the therapy was not being administered.) The patient began to talk, first mouthing
single words and then progressing to speaking short phrases audibly. He still has significant memory lapses where he cannot remember
the activities of the previous day, but is very good at off-the-cuff reasoning.
"The most compelling change I've seen," Giacino noted, detailing an event that took place within the past six weeks, is that "he was able
to say the first 16 words of The Pledge of Allegiance.
In addition, the man, who now receives 12 hours of therapy daily (to mimic his sleep–wake cycle), can now feed himself as well as brush
his teeth and hair and drink from a glass, rather than being nourished through a feeding tube. Due to extreme atrophy (from lack of use)
of his limbs, however, his motor skills are very belabored. The doctors are prepping him for so-called release of tendons surgery that
should enable him to increase his upper-body strength. (It is uncertain whether he will be able to walk again.)
There is always hope.
Take care,
Dave
