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BRAIN INJURIES: NEW TECHNIQUES FOR BRIGHTER FUTURE
Brain-injured must be taught new ways to think – the old thought pathways are blocked forever.
Thomas Kay directs research at the Research and Training Center on Head Injury and Stroke at New York University (NYU) Medical Center in Manhattan. He says that the amount of damage can affect a patient’s thinking and emotional changes. A severely injured patient often looks and sounds different, with jerking movements, unclear speech, peculiar gestures, and odd facial expressions.
Yehuda Ben-Yishay directs the head trauma program at NYU’s Rusk Institute for Rehabilitation Medicine. He points out that brain trauma cuts across many intellectual functions. The patient’s attention may wander. He may not coordinate reasoning with action; even if he finds the solution to a problem, he cannot easily carry it out. He cannot formulate goals either at work or in daily life. He may not even be aware he has memory problems.
Dr. Ben-Yishay’s group offers a 20-week program to teach the brain-injured how to think and act. For 5 or more hours a day, the patients solve thinking problems, with both pencil and paper and with computer. Patients also do public speaking?under pressure?so they later can interact with bosses and others without inappropriate behavior. After the training, 63 percent have been able to earn a living.
In 1984, Chris Willner of North Miami Beach, Florida, then an accountant, was driving her car when another hit her broadside. Upon waking up after 2 weeks in a coma, she couldn’t speak, write, or remember things. She walked with a limp.
“Dr. Ben-Yishay’s program gave me a fresh start,” says Mrs. Willner, now working again as a secretary. “I was lost, but they taught me how to remember things and to have more confidence in my abilities. Now I can handle my house, my son. I am pretty darn close to how I was before the accident.”
Research points to some inspiring advances. For example, electric stimulation of sperm ejaculation has enabled paralyzed husbands to become fathers. Women whose sex organs are unaffected by their injuries can have babies normally. Karen Silver Karlin of Huntington, New York, had her neck broken in a car crash in 1979. Later she had a trouble-free pregnancy.
Another exciting development is computer-driven electrical stimulation, given directly to leg and thigh muscles. This treatment enables paraplegics to walk. Dr. E. Byron Marsolais of the Veterans Administration Medical Center in Cleveland has developed a system that lets paralyzed patients walk on flat ground and on stairs.
Dr. Marsolais inserts 48 electrodes under the skin and into muscles. A computer controlled by a hand-held device sends electrical signals into the muscles, forcing them to contract in just the right sequences to produce a walking motion.
The system still needs work to make it operate more smoothly, slim its bulk, design an implantable one, and reduce its cost. More than 100 scientists and engineers have worked on it.
Researchers also stimulate the diaphragm, the large muscle in the abdomen that pumps air in and out of the lungs. They help patients breathe by activating the paralyzed diaphragm to contract. The Food and Drug Administration has approved a device for this function.
Engineers are also working on an electrical stimulator to help patients empty paralyzed bladders.
Biologists are still testing transplants of animal fetal tissue to reestablish the broken nerve connections. Fetal tissue grows rapidly and could help injured nerves before they die.
At the Medical College of Pennsylvania in Philadelphia, scientists partially have healed spinal cord injuries in rats by transplanting nerve tissues from rat fetuses into the spinal cord.
Across the nation, scientists are hard at work trying to make paralyzed bodies respond and to lift the victims from their wheelchairs.
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