The Infinite Mind; No. 27; Rewiring the Brain; Part 2

I'm Dr. Fred Goodwin, and we're talking about rewiring the brain today on The Infinite Mind, produced by Lichtenstein Creative Media in association with WNYC. Gaylord Hospital in Wallingford, Connecticut, was founded at the turn of the last century as a sanatorium for patients with tuberculosis, among its more famous patients were writer Walker Percy and playwright Eugene O'Neill. After World War Two, antibiotics made the treatment of TB much easier, and the hospital became a rehabilitation facility for people with a variety of ailments. Today, Gaylord is a leader in therapy for people recovering from stroke and other traumatic brain injuries. The Infinite Mind, even Newberg files this report towards me more. OK, now take your legs off the bed. The right leg got to help lift like. Hey, very nice, right? Yeah. Our hope is that everyone isn't going to get cured necessarily. It's not here for a cure, but here to gain as much back into

their life in the control that they have in their life here. I caillaud So that's the most rewarding and exciting part, is that people in general get better. Karen King is a nurse at Gaylord Hospital. Every day she and her colleagues work with people who have suffered physically and psychologically debilitating injuries. The patients are trying to regain or compensate for abilities they have lost. Dr. Elise Cyclic is medical director of the acquired brain injury division at Gaylord Hospital. She outlines some of the challenges they face. There's usually a multitude of things that happen with this patient population as a result of either a brain injury or stroke, difficulties with memory, difficulty with sequencing events. In other words, how to get dressed. They physically might be able to do it, but they don't know how to have their brain direct their limbs to do what they're supposed to do in order to go through the motions of dressing in the morning, washing themselves up even the

motor abilities themselves, getting up and walking. You may have the physical ability to do it, but the mental ability is often impaired. There you go. Now, with your stuff, I want you to put three apples with your left hand and the bag is a bag before patients can tackle the world outside the hospital, they come here to Easy Street. Easy Street is a simulated town located just off Gaylord's main exercise room, complete with a miniature bank, a diner and a grocery store. There's even a traffic signal and a sidewalk newspaper box. Survivors of brain injury and stroke practice such real life tasks as ordering from menus and writing checks. They can get behind the wheel of a real, though stationary car and work on driving using a computer simulator. Gaylord's facilities even include a nine hole golf course for those who want to get back to their game. And how about box office?

Harold Bennett is practicing grocery shopping. Great. Photographing more that fast with you? I don't think you can actually put everything back into a Michel. Again, I'm not patient therapy supervisor here or what I was just doing with Harold was an activity in Easy Street, which is a simulated grocery store, which really worked on his balance, at the same time working on his left arm, having to reach items with his left arm. So we find the best way to work on things is doing the tasks that you're going to be doing rather than just, you know, lifting a weight 10 times. You actually reach for something that you would do at home. Well, I noticed that a lot of things that I take for granted involves quite a bit of things, you know, grabbing, walking, lifting, turning around and sitting down, walking up to the shop and just things that we all take for granted.

Most of us probably take for granted our ability to speak, but many people who suffer brain injury or stroke lose that ability, at least for a time. Mr. Bennett was among the few patients at Gaylord who was able to speak with us. Debra is a speech therapist at the hospital. Speech therapy is is a deceptive term because it's not just speech. Sometimes it's cognition, depending on the injury. If someone's had a right sided stroke, we tend to work on attention and memory and reasoning, problem solving. If it's a left sided stroke, we tend to work on language, understanding of language, speaking, reading, writing, math, cognition and physical therapy remain the basis of rehabilitation and Gaylord. But there are many promising new developments for people with brain injury and stroke. In June, researchers at the University of Pittsburgh Medical Center transplanted neuron type cells into the brain of a 62 year old stroke survivor. They hope the cells will help repair her damaged brain, and the new drug TPA

can help some patients if administered within three hours after a stroke. Dr. Cyclic. Certainly over the last couple of years, there's been a lot of excitement as far as the treatment of stroke, new and exciting medications that are coming out regularly that potentially can improve the cognitive abilities of patients, not only with stroke, but also with brain injuries. And we're constantly trying to assess which ones work with different patient populations we now have at our access medication that can be given in the acute environment to try to minimize the residual neurologic deficits that these patients experience. And that's been the first time in the history of treating this patient population that there is a medication that can be given to a certain discrete sector of the stroke population that seem to benefit in the long term. Whatever the method of treatment, the goal remains the same. Again, Dr. Cyclic, you can work hard and achieve

independence for a patient so that they can get up in the morning and take care of themself and make sure that they have their three meals a day and participate with their family within the four walls of their home. But often, if you're not successful in attaining independence, for that patient to reintegrate themselves back into the community, back into their vocational and educational interests and desires, you may have failed in successfully rehabilitating the patient. One of the most important components of rehabilitation is psychological in nature. Health care professionals must pay great attention to the emotional state of patients and of their family and friends. At Gaylord, efforts are made to link the injured with support groups. It's not unusual for relatives or friends to be at a patient's side during daily therapy. Dr. Sulick explains how important this is to the process of recovery. A patient that has a supportive family and friend group surrounding them at the time and after their stroke consistently does better than

the patient that does. Day new drugs are surgical procedures may transform the treatment of brain injury and stroke, most TB patients no longer need long periods of inpatient care. And some day the same may be true for those who survive traumas to the brain. If that day comes, rehabilitation hospitals like Gaylord will have to transform themselves yet again. But until then, they will continue striving to meet their goal, returning people to full and independent lives for the infinite mind. I'm even Newberg. You can reach Gaylord Hospital in Wallingford, Connecticut, by calling one 800 six for rehab, that's one 800 six four seven three four two two. Our next guests are treating stroke and head injury in an unusual environment, the equivalent of six feet under the ocean. They're using a hyperbaric chamber, the kind normally used to treat divers for decompression sickness. Dr. Jon Mader is professor of internal medicine and

chief of the Marine Division at the University of Texas Medical Branch at Galveston. Also joining us is Kevan Corson, a former Navy SEAL diver who is technical and safety director of the hyperbaric program at TMB. Welcome, gentlemen, to The Infinite Mind. Thank you. Thank you. Kevan, let me ask you first. I think most of our listeners know what a hyperbaric chamber is and how it was developed. But could you sort of describe the facility? What does it actually look like to put it in real layman's terms, a hot water tank, this placed on its side? OK, what we do is we have a large opening at one end that can accommodate stretchers and gurneys. And with case of our facility, our patients can walk in and stand up inside our chamber. Once again, inside, it's completely enclosed cylinder. And once we shut the doors without a pressurized chamber here, anywhere from 16 feet of saltwater to two hundred and fifty feet. Dr. Mader, the mechanism of hyperbaric just explain that to our listeners. Basically, what we're trying to do with hyperbaric is to increase the oxygen tension

first in the bloodstream and then that translates to the tissue, both abnormal and injured tissue. If we can increase the oxygen tension in injured tissues, then we can allow new blood vessel formation as it relates to improved wound healing. And also it can keep tissue that's poorly oxygenated alive and it keeps it from sustaining further damage. Are there any downsides to that? I think the downside is that some people are susceptible to oxygen toxicity and by that I mean CNS oxygen toxicity. And on occasion we can have some seizures in patients that we're treating. That really translates out into maybe one or two seizures per year. And we do about 4000 treatments per year at UTB. So it's not common, but it does occur. Could you give us a few cases of of head injuries? You've you've treated are these mostly from automobile accidents or what?

Yeah, these have been mainly from automobile accidents. And actually we treated five patients on a Muthee Foundation grant and these patients were three and a half years out and were really pretty stabilized. We treated them with 80 hyperbaric treatments and we saw them improved fairly markedly in cognitive function, speech function and to a lesser extent, motor function. Can you give me a particular example? I've seen I remember when I worked in a hospital before, you know, you deal with these people that had chronic brain injuries and it was often very, very discouraging. What I'm going to do is have Kevan describe one of our chronic head injury patients since he was really intimately associated with these patients. OK, Kevan. Well, so basically, first of all, what we've got to look at is, as you well know, the injured area of the brain, once you damage that, that those cells, that they will never come back. But if we look at it much like a black and blue where they have the the ecchymosis or the blacking part of the center and then the leeching or

the yellowish area around it, sometimes two to three fold is the size, the original insult. What would the brain injury what happens is that area or that particular area, the brain shuts down. It doesn't utilize glucose metabolism. And when that happens, it doesn't send or receive neurological impulses with the increase of hyperbaric oxygen. What we try to do is see at one point six atmospheres absolute. That's the optimal glucose metabolism level for that area or that particular area of the brain. So 60 percent more than normal? Yes, sir. If we can get that area to wake back up and start utilizing glucose, then it starts to receive neurological impulses. And as we all know, we don't use as much of our brain as we think we do. Just to give you an example, we've had a couple of patients. One of them is a pediatric patient that I'd like to talk to you about was transferred from us from Texas Children's Hospital in Houston. How old? He was not eight years old, sir. Eight years. When he got to us, he was in a Glasgow coma scale of seven. And what does that mean? Basically, he was in a coma state. He just had deep tendon reflexes to pain only when he got to

us. The neurological people at Texas Children's Hospital asked if we could do anything for him. And this was kind of a last ditch effort because they were in great belief that he had plateaued. And this is where we would sit for the rest of his life. He'd be a vegetable. Yes. So basically what happened with this patient is we started treating him in a hyperbaric facility and at forty two dives, he was 42 days die. What does that 40 to hyperbaric treatments. Excuse me. We call our treatment a dove here at 42 treatments. He was coming to us in the morning and receiving. And going back to school that afternoon, going back to school, going back to school, we have had that happen with a majority of our pediatric patients. That's amazing. With the pediatric, there's more chance for the neuroplasticity, more the brain can actually adapt more easily because it's younger. Yes, exactly. And parties do tend to bounce back a little bit more. So you had this kid who was essentially in a coma, unresponsive to anything other than pain. You had this kid walking again, going to school,

which meant he was hearing and speaking and and having cognitive thinking, memory and everything. Yes. So he didn't miss a beat. As a matter of fact, from from time of injury to time back to school, which I believe was about two and a half months. But that should have been on the front page. Well, sir, it was down here, if I might add. We had an article that came out in July's parent magazine of another motor vehicle accident. This little child was a hit and run vehicle. And we basically had the same type of patient presentation. And again, he got dramatically better. Now, tell us again how the actual treatment is done. You have this eight year old kid who's in a coma. He's on a gurney or a stretcher. What are you wheel him into the chamber? Yes, sir. Our chamber here at the university has a complete critical care unit capabilities. Inside the chamber, we can see patients from both a hemodynamic and pharmacological standpoint, also cutaneous patient defibrillator if

necessary. So we had this patient in our chamber. We had him on ventilator support, not as a whole body go in the chamber. Yes, sir. The whole body goes inside the chamber. And then what we do is we pressurize the chamber with normal air with twenty one percent oxygen, much like we're breathing right here. Then once they get down to treatment depth, if he's intubated, we hook them up to one hundred percent O2 through the endotracheal tube. Or if he's not intubated, then we put on what's called either a do could or a Scott mask and then they get the one hundred percent oxygen through and directly into their lungs then. Yes, sir. And how long does that last and how long do you do it? One hour, sir. At one point, six atmospheres absolutive six and a half feet. Dr. Mayder, what's your sense of what's going on in these stages of of recovery? It's hard to know, but I think that there's several different mechanisms going on. We talked about one mechanism is as you increase your oxygen tension, then your fiberglass starts laying down collagen and you can get some increase blood vessel growth and angiogenesis.

So some of it could be on a vascular mechanism. So actually, growth of these smaller little little arterial blood supply we call arterials, they are actually growing more into the tissue. Right. The other issue, of course, is what Mr. Coarsen talked about with just idling neurons where that these are not dead tissues, but they're below the level of oxygen allowing function. So as you increase the oxygen tension, this area starts functioning. And the other interesting mechanism that we're still trying to evaluate comes out of the University of Pennsylvania with Steve Thum. Basically, the host of cells tend to bind to damaged blood vessels and release all their toxic particles like the defense is going going over. And so hyperbaric prevents that. And so you cut down on the local inflammatory response, which then may aid the body and allowing it to heal itself. We've treated 30 patients in our studies and we've had improvement in twenty eight of those 30 patients.

But we still need to and some have improved more than others. When you're dealing with head injuries or stroke, if you get any improvement, as far as I'm concerned, that's a success. Where do you think this is going to go in the future? I think that hyperbaric will probably continue to slowly increase as we get better and better data. Right now, we're using it for maidenly wound healing and some difficult infectious disease problems as we get more data with stroke and also myocardial infarction. I think that you you may see the growth grow quite a bit in the next several years. So I think it's a growing field, but one that is that newer, more and more research is required. So both heart attacks and stroke, which are two of our big killers. Right. And again, there are studies going on to evaluate the effect of hyperbaric after myocardial infarction and especially using the thrombolytic agents, plus hyperbaric.

So that is ongoing also. So these are the agents that actually the enzymes that can actually chew up the blood clot? That is correct. OK, well, look, this has been fascinating. And I really appreciate both of you, Dr. Mader and Mr. Carson. I appreciate you very much. Appearing on The Infinite Mind. Thank you very much. Thank you, sir. You can reach Dr. Mader and Kevan Coarsen at the University of Texas Medical Branch hyperbaric facility, Galveston, Texas, seven seven five five five. And we want to repeat the toll free number for the National Stroke Association, one 877 six five three seven and the Brain Injury Association, which is one 800 four four four six four four three. Log on to our award winning Web site at w w w dot the Infinite Mind dot com. For more information about anything you hear on this show, you can reach us toll free at one 888 three five Overmind to be a caller on a future program.

That's one eight three five oh six four six three. And finally this week, commentator John Hockenberry reflects on the idiosyncrasies of the human computer. In my experience, it's not about the wiring, it's about the software, what's that thing down there? She's got a puzzled look on her face. She rocks back and forth on her stomach, on her back. She flails and seems surprised by all the commotion she herself has caused. But she can't quite place it. Huh? I don't know what you did on your summer vacation, but my wife and I brought twin girls into the world. Actually, my wife was more involved in the actual bringing part. In any case, they are here with us now. And as we gaze mesmerized parents down or up or sideways at them, they are focused on another set of issues. There's the getting of those eyes to work. Oops, they rolled back in my head again. There's the matter of these little pink hands.

What do they do? Finally these puffy things down below my waist. I can move myself forward, but I'm not getting anywhere. Frustration, a whimper than an all out bellow. I see these two girls thinking, what is this body for anyway? My two daughters limbs are perfectly formed. So perfect that you don't want to get daddy started here. OK, but even as perfection, they don't work. Not yet. For Zoe and Olivia, movement has nothing to do with their fine, delicate hardware. Right now it's a software question as they grunt and squirm and push and notice and push some more, they are defining what their limbs will do. They will decide based on what makes the most sense and I suppose what they see other people doing around it. And there's a wide range of definition here, especially in this family. For instance, I can't use my legs for walking because of a long ago spinal cord injury, but I use my legs all the time. The keyboard I'm typing on is resting on them right now.

In fact, my lap is a terrific baby bed. When these girls look up at me resting on their backs, their heads on my knees and legs, I think not even an Olympic sprinter could make better use of them. I look down at the same hardware you might have, even though an injury made me incapable of walking. What's really different about me is my software. What I think of as legs doesn't involve walking just like my daughters right now. That will change, of course, looking at these little babies struggling to make sense of leg, even as their legs are right, they're formed and containing all the wiring, everything necessary to walk. It is clear that walking is not a hardware issue. What we feel as legs and walking is a complicated software interface. It is this this component that is adjustable, this component open to fine tuning. In fact, even people whose legs have been amputated all together retain the software of their use. Feeling phantom limb, Agnese, even when there are none.

Perhaps Zoe will race bicycles. Olivia perhaps will chop wood. Either way, they have legs. Surely if Zoe and Olivia did not even ever try to walk, they would still have legs. The mind is he has this unique capability from the initial and somewhat arbitrary conditions of physiology. The mind creates the software and defines the person. What these brand new girls have uniquely as humans. Besides, a somewhat hysterical, doting daddy is what we all have the record of choices of how we use our physical hardware. Life is the software of consciousness. I can't help thinking that there is something arbitrary about so many of the physical details we think of as wired at the factory. We spend so much time trying to fix wiring. We miss the software. Sometimes we aren't wires. In the 23 years since I last walked, the definition of my legs has changed. Even repairing the so-called wiring won't alter my new software.

Looking down at my daughters, looking up at me and flailing their goofy legs uselessly, I whisper, Hey girls, you'll figure it out. Don't worry about the wiring. Right now, it's all in the software. For The Infinite Mind, I'm John Hockenberry. John Hockenberry is heard weekly on The Infinite Mind. Next week on The Infinite Mind, front page headlines, talk shows, news reports, all focusing on one question. Are people with mental illness more violent discharge? Patients who abused alcohol or other drugs were much more violent than other people in their neighborhoods. But discharge patients who didn't abuse alcohol or other drugs, in fact, had the rate of violence is no different than other people in the neighborhood. We've assembled the best minds on the subject. Join us next week on The Infinite Mind. Each week we explore the new frontiers of the infinite mind right here on this

public radio station. I'm Dr. Fred Goodwin. Thank you for joining me on this journey. If you have a comment about the infinite mind or would like to be a caller on an upcoming program, please call us toll free at one 888 345000 Mind. That's one eight three five oh six four six three. The executive producer of The Infinite Mind is Bill Lichtenstein. The show was produced by June Peebles, production manager Tamira Burgess, Associate Producer Eva Newberg Technical Direction by Gregory Seaton, Development and Outreach. Dan Miner with Kitaura Sawyer. Original Music Art Labriola special thanks to Ceder Reiner and Elizabeth Alvarado intern Chris Thoracic Legal Services, David Lubell, Accounting Services Akerman and Associates webmaster John Groll announcer Catina Kailin for a copy of this program called Birrell's Transcripts at one 800 777

text. That's one 877 seven eight three nine eight. You can visit our award winning Web site at the Infinite Mind dot com underwriting for this week's The Infinite Mind comes from the National Institute of Mental Health, the National Institute of Drug Abuse, the National Institute of Alcohol Abuse and Alcoholism, the Sage Foundation, and in the form of an unrestricted educational grant from Eli Lilly and company support also provided by Glaxo Wellcome Inc. in the form of an unrestricted educational grant. Additional support provided by the Harris Foundation and Helen Stern. Special thanks to listeners like you for providing additional support. This program was produced in association with WNYC New York and the New York Foundation for the Arts. The Infinite Mind is a nonprofit production of Lichtenstein Creative Media, Inc.. Copyright 1998.