Motor Vehicle Accident Rehabilitation
28 year old white female, MVA
by George von Hilsheimer
|J.A. experienced a motor vehicle accident (MVA) 10 years ago which killed her boy friend, and left her with severe head injury (skull completely cracked off around the entire circumpherence of the head) and with severe muscle spasms, limited speech, room temperature skin on right side and 10 degree deficit on left side. She had made no improvement in 9 years when she began training 23 Feb 1998. She trains at home after two weeks of training in the office separated by 4 weeks ending March 28.|
INITIAL OFFICE VISIT 23 FEB 98
E.A., the patient’s mother, states:
It had rained quite a bit the night J. got hurt. Her boy friend was driving a Chevette. The car hit a pond of water in the road and hydroplaned and hit a large car (an LTD).
The doctor told us that her brain went as far as it could in one direction and when she was hit in the other direction it went as far as it could in that direction. Her skull was cracked all the way around under the skin, there was a place across he forehead where the skin was open. One lung was punctured; there was a hole in her stomach. Her pelvis and right hip were broken in many pieces; there were broken ribs.
J. was carried from the hospital in Marianna to Tallahassee Memorial. They had to revive her twice on the way to Tallahassee. Life flight was not possible because of the weather. When I saw her she was not recognizible. She had so many cuts and scrapes over her body and she was so swollen. She was in intensive care for three weeks.
Every day the Neurosurgeon would tell us, well, she made it through the night we will see. They gave no hope to live, in fact they suggested to my husband that they unplug her and asked us to donate her organs. My husband said “J. is going to need all her parts.” She had a trach. for breathing and a feeding tube. The doctor said he was putting the tubes in permanent. After intensive care she stayed in the hospital 30 days. Then she went to extended care.
While J. was in intensive care she had all the therapy she could tolerate from therapist. We touched her and talked to her. I was convinced she would be all right. From extended care the staff tied to get us to put her in the nursing home upstairs there. My husband was told numerous times that she would not wake up..that we needed to face facts but we refused.
We carried her home while she was still in the coma. The neurosurgeon would not reccommend rehab until she woke. Of course, I guess that he thought that was not going to happen. The nursing staff at extended care were very nice to us but I still can see now how they looked at us when we left with her. At the time I did not understand why. They said if you need just call.
As we did not have a van we propped her up in the front seat. J. still had a feeding tube which we learned to use while she was in extended care. She had a catheter. She was so stiff it took both of us to change her. My husband got a hospital bed for her and I slept on a bed beside her. I burned incense for her to smell, I rubbed her and talked to her. I played music for her. Friends visited and talked to her.
We kept her for 7 weeks at home . She stared to open her eyes. I would tell her to stick out her tongue and she could get it to the edge of her lips. In all she was in the coma for over 4 months before she came all the way out. After she started to wake up the doctor told us we could look for a rehab center.
SEARCHING FOR HELP
My husband started calling. He got in touch with the head injury foundation and the insurance company. We carried her to Meiplex Rehab. in Bradenton, Florida. She stayed there from one year. My husband bought an old motor home that left a lot to be desired and stayed with her. He went every day. He would check the schedule and then go see if she was where she was supposed to be. Some staff admired him for this and some were less than pleased.
SEIZURES: TWO YEARS AFTER THE MVA
Two years after the accident she had the first seizure. It was life threatning. She did good somewhere about a year, I got the idea maYby she would be more alert if she came off the seizure medication. The doctor gradually took her off. The day after she took the last med. she went into seizures that lasted 2 hours. We have had to have her in the hospital several times since then but none so severe. About a month ago she stated having lot of petit mal seizures and an oocassional grand mal. The neurologist in Tallahassee has determined that the effects of Tegretol are no longer enough. He is trying Depokte now, last week she got over medicated on it and we all were uneasy. The dose was apparently too high.
THINGS WE DO FOR HER
We have tied her in the swimming pool, she enjoys that. She likes the hot tub. We take her to church and she takes part in Sunday School. She enjoys music. A friend of ours works with memorizing poetry. She enjoys being read to.
When J. got hurt my husband had been blind for two years diabetes. He went to a doctor in Tallahassee who had a reputation for off the wall treatment. He told him he might help or he might die I am still not exactly sure what the doctor did. My husband said “I am no good to my girl like this go ahead.” He got sight in one eye.
He had two heart attacks while J. as in Rehab. He went back to stay with her as soon as he could out of the hospital,which was before the doctor wanted him out. I had another daughter at home who was 14 at the time of the accident.
Her sister had a very hard heart about the accident, she was actually more realistic about J.’s condition than I was. Her sister got involved in some very bad stuff. She got mixed up with a man much older. We just did not have enough of ourselves left over for her. She by the grace of God got herself straightened out. She is married and has a 2 yr. old that is a joy to us all. J. named him.
Her sister will graduate as an RN this spring. She has been on the Dean’s list each semester.
My mother is 84 lives with us also. She can take care of a lot of her personal needs. She uses a wheel chair to get around. Sherry is a lady who has helped us for several years. She comes on Mondays and Tuesdays and stays all day and Friday nights. The friend who works with her comes every day. Both these people would be interested in helping with her therapy.
I am tired and I imagine you are. We have never stopped looking for help for her and trying different things.
Thanks for new hope”
COMMENTS BELOW ARE BY DR. VON HILSHEIMER, 1 MAR 98
E.A., of course, didn’t tell me about herself. After 6 days in the office I have come to know a remarkable woman, whose love for her daughter is solid and splendid. She worked for 30 or more years in a Sunland Center for severely retarded individuals. E.A. has seen all of J.’s problems over and over again in her work at Sunland.
As of 23 February when J. first appeared she had limited and markedly slurred speech which was unintelligible to most strangers. She tended to demand help by “Muuu Muuu”; however, she did occasionally form short sentences.
Her general disposition was sunny, but she had a temper before the MVA and now her temper is volcanic!!!
Mother insisted that there were continual seizures, but the neurologists consulted told her that J wasn’t having seizures, except when the big unmistakable grand mal seizures advertised their presence by severe convulsions.
J. was confined to a wheelchair and seemed to prefer to pull her head forward and down, although on demand she could straighten it, but she could not rotate her head, and spasms were markedly evident in her neck and shoulders as was marked spasticity.
There was a continual moderate tremor, especially evident in the left arm and hand, which were spastic but she had some voluntary control of the left hand.
The right hand and arm were markedly spastic, she could not manipulate the arm or hand and fingers. The arm did occasionally flail.
The legs are markedly spastic and the toes are extended, while she could stand supported for a brief moment, she could not put her feet flat and could not ambulate even with help. The right leg was more markedly impaired than the left and it has been icy cold to touch for 10 years.
J. is markedly willing and tries hard.
FIRST WEEK OF EXPOSURE TO NEUROTHERAPY
J. was cooperative and outspoken, her slurred pronunciation is readily learned and she is consistent in her phonation.
A 3 minute QEEG on the A620 Autogenic Systems device reading only C-3 demonstrated a marked spike at 2Hz (856 pW) with marked elevations at 1.5 (480), 2.5 (540), and 3 (350) Hz and at no other frequency (8 = 47, 17 = 13, 24 = 6).
Two 20 minute runs on the Neurocybernetics machine revealed marked seizure activity while she appeared to have nodded off. She demonstrated repeated narcoleptiform sleep. A burst appeared on the summary line and then storms of signals propagated across all three of the windows (Summary, Theta and low Beta). During several of these electrical episodes her attention could be fixed and she could respond verbally.
These were definitely not motor spasms nor artifacts, and all were signalled by a 100 usec burst in the summary line not visible in Theta or Beta. (I personally carried out the diagnostic and initial routines and most of the routine sessions).
A third machine, the F-1000 was used between the runs on the NC machine. It was apparent that the visual component of the F-1000 was better tolerated by J. and subsequent training was done on the F-1000. A second QEEG at C-3 was completed on 28 Feb, with results identical to the first run.
On each day, 23 thru 28 February (6 days) 3 training sessions were done on the F-1000 machine, except that on the 23rd 2 session were done on the NC machine and 1 on the F-1000 with one segment of evaluation on the A620; and on 25 and 28 February 4 sessions were completed on the F-1000. In 6 days 20 sessions were given on the F-1000, electrodes were placed at the mastoid crease and at Fp1, and training was given for reinforcement of 13-15 Hz, suppressing 4-7 Hz.
J. does not actually present a mastoid crease so the electrode is actually placed in the equivalent position 2 inches behind the center of the top of the right ear. The NC training sessions were at C-4/Fp1.
Observing markedly reddened ears (the color was sometimes not bilateral or not symmetrical bilaterally, the left ear being more vividly red), I dispensed DORIS RAPP’S book, IS THIS YOUR CHILD? and a quantity of material regarding keeping a food diary, food elimination, and food rotation. I encouraged the family to remember that despite the catastrophic brain injury, all the other systems of the body were working and could be deranged as well as the CNS.
In my experience, hypersensitivity to food chemicals (including organic chemicals produced in the food itself, e.g. salycilates in almonds – 10 almonds = 1 aspirin) frequently produces narcolepsy, and provokes epileptiform rage, frank seizures and other symptoms. Think of salycilates and hives (or hyperactivity); oxalic acid and vulvadynia; uric acid and gout (including gouty temper and gouty depression as a prodrome of gouty arthritis); and chemical diabetiform responses to foods without a high glucose index.
E.A. reported that J was content the first evening. J slept until 2 Am and then articulately requested “Mama come here.” She then talked volubly for about 2 hours when E.A. gave her a sleeping pill. E.A. states that this speech was remarkable and she had not heard such articulation nor volubility for 10 years.
J was alert and responsive by 9 AM at the office.
E.A. reported that on Wednesday morning (after 6 training sessions) J moved her right hand, she was able to move her thumb in and out completely, she could grasp with her right hand, and that she took a bottle of nail polish and held it in the right hand and took the cap off with her left hand.
J again spoke articulately for a couple of hours. She slept deeply and well from 9:30 to 4:30 am.
J demonstrated for me her new ability to put her chin to her chest and then rotate her head fully around her body 360 degrees. She can lift eher right arm to the top of her head, in fact she put a bottle on top of her head with her right hand, she can grasp with the right hand and voluntarily let go; she can bring the right arm into her chest and then stretch it out fully. The hand and arem are more pliable and less tense.
Her right leg and foot are warm; they have been cold since the MVA. She is able for the first time to move the toes on her right foot.
She has used appropriate conversational speech this week.
She used to yell and continue complaining inarticulatly when the family van bumped across railroad tracks and she ignores this stimulation now.
She woke up Tuesday morning and asked for her eye shadow. J had always made up before the accident, but never asks for it since the MVA.
J sat up on the right side of the bed, using her right elbow to help; she held on to her mother with her right hand; and with some assisance she pulled herself up to stand using only her right hand and arm.
On Wednesday morning, after 6 training sessions, she stood up, supported by a parent on each side of her and bore weight on her right foot which was flat to the floor and the foot did not spasm and was not in a tonic spasm when observed.
J has stopped bursting out with loud groans of alarm when someone comes close to her right foot. She has stopped this response even when they touch or bump the right foot.
On Friday some friends were visiting and J spit up a bit when they went out to eat. She was so embarrased that she hid her head. As her mother relates this event to me J states “I was mad at myself”. J has not noticed these events in the past. Now she wants control. She loudly states “I want control.”
After 6 days of observation and 20 training sessions, with two QEEG readings of 3 minutes activity at C-3.
It is interesting that J ‘s QEEG is just what Pavlov would have told us it would be, and the bar graph spikes at 2 Hz. This is a brain that is in a continual dynamic state of ‘seizure’ or marked inhibition.
J demonstrated marked change from 3 training episodes, two of which were on a device which appeared to stimulate episodes of epileptiform EEG activity.
After 20 sessions J demonstrated significant improvement in every dimension of emotion, cognition and muscular activity.
Daily neurotherapy in the form of training at C-3/Fz for 15-19 Hz activity, and at C-4/pz for 13-15 Hz activity.
In my considered professional opinion the F-1000 device manufactured by Focused Technology is the most cost effective device. However, it should be considered that there is evidence that a faster, more dynamically interacting system may provide marked improvement following the initial 90 days of training on the F-1000. The patient’s mother has been trained to deliver the therapy on an F-1000.
Daily EMG training which can be done at home, using the F-1000 (which is another reason for obtaining this machine first). J ‘s mother is a well experienced health care worker and is completely adequate to be trained in doing this work; however, another week of daily office visits will be required.
Daily training by temperature feedback.
Daily training by GSR or EDR feedback. The F-1000 can be configured to deliver all of these subsidiary modes of treatment.
Technical management of the device and delivery of the training is well within the capacity of the patient’s mother.
The patient’s marked sensitivity to food chemicals, and perhaps frank allergy to some foods, must be remarked and managed in order to maximize her rehabilitation.
The patient’s particular special nutritional needs as the victim of marked brain injury must be attended, and she should receive substantial supplementation as a direct result of her injury.
FOLLOW UP 4/24/98
Since the MVA J. has habitually tilted her head way over to the side, and now is holding her head almost normally in a straight position.
J.’s right hand (on 23 Feb completely spasmed and closed with no volitional movement) now opens and she can hold it almost completely straight.
E., J.’s mother, is now able to manage her physical care because J. is now able to assist with her arms and trunk movement and so E. can get her on to the floor alone.
Yesterday J. lifted her whole upper body from the floor twice (unique since 1988 MVA).
Last night she got into bed swinging her feet onto the bed with her legs bent (spasmed straight since MVA).
On the way home from the doctor’s office yesterday, for the first time in 10 years, J. asked for her parents to stop and get a pizza. There was no discussion of food going on at the time she spontaneously made the request.
J. began her training on 23 Feb 98. She is being trained daily, at home, by Quirk’s Sterman protocol (C3-C4, gFp1, 13 Hz)
PROGRESS REPORT ON 27 yr old 10 years post MVA, major brain injury
Last week J’S SISTER, Julie, graduated from Chipola Jr. College and received her RN.
E.A.’S REPORT ON HER DAUGHTER
J went to both graduations with no problem.
Although she has not tolerated long days since the MVA we were up until 10:00 both nights.
We sat close to the band the first night. Before she would get upset with a lot of noise. This time she recognized the song Do a Deer etc. and sang along with it.
She also recognized These Are a Few of My Favorite Things.
We were there at least four hours and she did not yell for the first time.
The second night we had a party and she seemed to enjoy it.
At Christmas we had a party here and she seemed so sad and uncomfortable I had decided not to have one again.
This time was different. ” E.A., Mother
This time she has had EEG training for one week in February, and Daily since 23 March 1998, 10 years after MVA.
FROM J’S MOTHER ON 5/6/98
Dear Dr. Von,
J is really changing. The computer data looks much the same to me. She, however, is not the same.
Her speech is clearer. Almost everyday she says something that shows there is change in her brain. She is a pleasure to talk to.
Sherry and she were looking at a catalogue, J told her to go back two pages. She counted the pages. She told her there was a good looking guy there. She loved every inch of him and she would take the clothes too.
She still gets angry with her father; but gets over it faster.
Yesterday she said to me I want to talk to you about me in that chair pointing to the wheel chair.
Three weeks ago she started looking out the Van wind shield. I mentioned it to her and she said “Yes look out the wind shield just like a regular person.” Then she said I want to start choosing where I sit, I do not like this and she put her hand on the wheel chair.
A few days later James was getting his truck serviced and mentioned he might trade the Van We tried a car out I can get her in and out as easy or easier than the van.. She sits up front and looks at herself in the mirror. She can open the door and take her seatbelt off.
She has asked to drive. She has asked to roller skate. She was very good at roller skating before the accident.
The last three days she started to look at the screen when we do the EEG for the first time.
We bought her a pool table for Christmas. We had tried her with it but she did not seem interested. Yesterday Sherry sat her beside it. She picked up the cue and started hitting at balls. She was smiling and enjoying herself. I got her to put her right hand on the stick. She held it loose so the stick could slide through her hand. We have tried several games this is the first time she has ever appeared to enjoy one. She even told me which balls she was trying to hit.
It is like she is waking up. She said that is how she feels, “Like it is waking me up”. A friend said, “it is like there is a real person there now.”
You should have Dr. Lambes report this week. He promised me.
Thanks and Love,
Please note that J’s “doseage” is high, she is trained several times every day. I do not think that an animal operant, or drug model can be applied to this history of treatment. EEG is fundamentally different from temperature, EMG, and heart rate; but similar to GSR – these are NOT the products of relaxation.
Remark as well that the 6 year old child born prematurely with a tiny birthweight, obtained complex new behaviors within a few days of initiating training.
This letter is from her mother. 12 Jun 1998
I sure have not been able to get as many sessions as I would like; I have been able to do three some days but mostly one or two equaling two to four hours of training every day.
We are also doing breathing and muscle exercises etc. She works 8 hrs.- well actually more.
There are so many improvements. The first social worker she ever had came to visit her last week. He had tears in his eyes. He said, “I never thought I would see her this well.” He also said, “you should go on Oprah or Sixty Minutes or somewhere and let people see what she has done.” I said, “maybe later, I still am expecting more.”
Her medical doctor also saw her. He told James, “I can believe that she is just so much more alert!”
J.A. told me last Saturday, “The telephone is ringing.” I told her to answer it. She answered it with no problem, the person was able to understand her. She answered all the questions. It was just a regular conversation.
This is the first time she has answered the telephone normally in 10 years.
It is just so much like old times to talk to her.
She can move her legs so much more normally now.
She asks me all the time if she can help me. I am trying to find things she can do.