"Long before it's in the papers"
June 04, 2013

RETURN TO THE WORLD SCIENCE HOME PAGE


Can a mother’s voice spur coma recovery?

May 11, 2010
Courtesy Northwestern University
and World Science staff

Ka­ren Schroed­er’s recorded voice spoke to her son, Ryan, try­ing to re­mind him of the time he had de­cid­ed to raise pigs at age 10. “You bid on three beau­ti­ful squeal­ing black and white piglets at the auc­tion,” she said soft­ly. “We took them home in the trunk of our Lin­coln Town Car, be­cause we did­n’t have a truck.”

Record­ings from Ryan’s moth­er, fa­ther or sis­ter were played through head­phones for him four times a day in a Chi­ca­go hos­pi­tal. They were part of a new clin­i­cal tri­al in­ves­ti­gat­ing wheth­er re­peat­ed stimula­t­ion with fa­mil­iar voices can help re­pair a co­ma vic­tim’s in­jured brain net­works and spur re­cov­ery.

In Jan­u­ary 2009, Ryan, a 21-year-old col­lege stu­dent from Hunt­ley, Ill., was in a co­ma af­ter he had been flung from his snow­mo­bile in­to a tree dur­ing an ice storm. He had a trau­mat­ic brain in­ju­ry; the fibers of his brain had been twisted and stretched from the im­pact.

He re­gained con­scious­ness af­ter nearly one month in the tri­al and has made steady prog­ress dur­ing the past year. Re­search­ers, how­ev­er, won’t know for cer­tain if the ther­a­py helped his re­cov­ery un­til the study is over.

The tri­al is led by The­re­sa Pape, a re­searcher at North­west­ern Uni­vers­ity and Hines VA Hos­pi­tal in Chi­ca­go. Funded by the U.S. De­part­ment of Vet­er­an Af­fairs, the study may be use­ful to young peo­ple like Ryan as well as in­jured sol­diers. “Trau­matic brain in­ju­ry is a huge is­sue in our so­ci­ety,” Pape said. “Ev­ery 21 sec­onds, we have a new head in­ju­ry and about one-third of those will be se­vere.”

The most com­mon cause of se­vere head in­ju­ry among civil­ians is mo­tor ve­hi­cle ac­ci­dents, ac­cord­ing to Pape, and the highest-risk group is 16-to-24-year-old males. In the mil­i­tary, the risk of trau­mat­ic brain in­ju­ry is three times that of civil­ians, even in peace­time. While the ac­tu­al num­ber is not known, an es­ti­mat­ed 8,470 sol­diers were di­ag­nosed with trau­mat­ic brain in­ju­ry from Jan­u­ary 2003 through Sep­tem­ber 2008.

Pape hopes the study will help an­swer the ques­tion that fam­i­lies are des­per­ate to know when a loved one is in a co­ma: “Can he hear me?” She is es­pe­cially ea­ger to know if these family voices can fa­cil­i­tate re­pair of the brain to im­prove the sub­jec­t’s abil­ity to func­tion and pro­cess and un­der­stand in­forma­t­ion.

Pa­pe’s hy­poth­e­sis is that re­peat­ed ex­po­sure to fa­mil­iar voices could help re­pair the brain’s neu­ral net­works, some of which be­come sheared in trau­mat­ic brain in­ju­ry. In a pre­vi­ous small pi­lot stu­dy, Pape ob­served that sub­jects in a veg­e­ta­tive state re­sponded more to the voices of peo­ple who are fa­mil­iar to them com­pared with non-fa­mil­iar voices.

When those sub­jects heard voices of their family mem­bers, a brain scan using MRI (mag­netic res­o­nance im­ag­ing) showed that parts of their brain were ac­ti­vat­ed, ap­pear­ing as bright yel­low and red blobs of light scat­tered in an un­or­gan­ized pat­tern. With un­fa­mil­iar voices, there was lit­tle ac­tiva­t­ion.

“The ques­tion be­came, are the fa­mil­iar voices ther­a­peu­tic in some way?” Pape asked.

When a sub­ject is en­rolled in the tri­al, Pape does a base­line scan of their brain, ex­am­in­ing the re­ac­tion to fa­mil­iar ver­sus un­fa­mil­iar voices. In a healthy per­son, she would ex­pect to see a family mem­ber’s voice ac­tivate the tem­po­ral lobe, the site of mem­o­ry, and the front­al lobe, the part of the brain that pays at­ten­tion when your name is called aloud. She does­n’t see that in her sub­jects with new se­vere trau­mat­ic brain in­ju­ry.

“As they reco­ver, we want to see if these ar­eas be­come ac­ti­vat­ed in the way we’d ex­pect in a healthy per­son,” Pape said.

Pape al­so tracks the state of their ax­ons, the thick white fibers that com­prise the brain’s net­works and al­low dif­fer­ent parts of the brain to com­mu­ni­cate with each oth­er. In a trau­mat­ic brain in­ju­ry, the ax­ons can be­come ripped and twisted like in­ter­state high­ways in a Hol­ly­wood dis­as­ter mov­ie.

“In a healthy brain, the net­works func­tion in a very or­gan­ized man­ner, from front to back, for ex­am­ple,” Pape said. “The in­jured brain has a disor­gan­ized di­rec­tion we don’t un­der­stand. The ax­ons are sheared, torqued and twisted. We’re try­ing to fig­ure out how and if they work af­ter a se­vere brain in­ju­ry. May­be they zig­zag or con­nect with an un­ex­pected neu­ron.”

Research sub­jects are di­vid­ed in­to three groups: high dose, who hear 10 min­utes of sto­ries four times daily for six weeks; low dose, who hear five min­utes of sto­ries and 35 min­utes of si­lence four times a day; and the “sham” group who wear the head phones but don’t hear any sto­ries. Af­ter six weeks, Pape meas­ures how the sub­jec­t’s be­hav­ior­al con­di­tion com­pares to changes she sees in the brain on new MRI im­ages.

The tri­al is dou­ble blinded, mean­ing Pape will not know wheth­er sub­jects were in the high, low or sham dose group un­til the stu­dy, which will en­roll about 45 sub­jects, is com­plet­ed in 2011. The ear­li­er de­scrip­tion of Ka­ren Schroed­er’s voice be­ing played for Ryan oc­curred af­ter the in­i­tial dou­ble-blinded part of the stu­dy. Af­ter this part, all sub­jects re­ceive the high dose of sto­ries for six weeks to make sure that if there is a ben­e­fit, ever­yone has the same ad­van­tage.

Pa­pe’s im­ag­ing da­ta of a sub­jec­t’s brain be­fore and af­ter the voice treat­ment is meant to re­veal whether net­works are bet­ter con­nected as a re­sult of the ther­a­py, and whether that is linked to im­prove­ments in func­tion.

When Schroeder en­rolled her son in the tri­al, about a month af­ter his ac­ci­dent, he could not fol­low com­mands or make pur­pose­ful move­ments. His eyes were open, but he didn’t seem aware of his en­vi­ron­ment. At the time, a doc­tor sug­gested Schroed­er would have to put her son in a nurs­ing home.

But af­ter three weeks in the tri­al, Schroeder be­gan to no­tice changes in Ryan. First, she said, he be­gan to no­tice the lights out­side the win­dow of his room on the 10th floor of North­west­ern Me­mo­ri­al Hos­pi­tal. “I could tell he was start­ing to come around,” Schroeder said. “Be­fore, he would lay in the bed and a herd of cat­tle could walk through and he would not be aware that they were there.”

Then, he be­gan to slowly fol­low a com­mand to push a ball out of his hand. A lit­tle more than a year lat­er, Ryan now texts his friends, brushes his teeth and walks with a walk­er or a four-prong cane. He is prac­tic­ing walk­ing with­out a de­vice. While he strug­gles with poor bal­ance, he re­cently started eye ther­a­py, which may or may not help his bal­ance. A pal­ate lift sev­er­al months ago greatly im­proved his speech, ac­cord­ing to Schroeder.

“Given the ex­tent of his in­ju­ries, Ryan has reco­vered well,” Pape said. “But I can’t draw any con­clu­sions yet. We have to wait un­til we have all the study da­ta.”

In the meantime, Ryan helps at his fam­i­ly’s pav­ing busi­ness where he en­ters da­ta in­to the com­put­er. He does­n’t re­mem­ber his ac­ci­dent or hear­ing the tapes of his fam­i­ly. “He con­tin­ues to make prog­ress. It is truly a re­mark­a­ble re­cov­ery,” said Ka­ren Schroeder. “The good Lord keeps throw­ing us ropes. We got in­volved in this by the grace of God.”


* * *

Send us a comment on this story, or send it to a friend









 

Sign up for
e-newsletter
   
 
subscribe
 
cancel

On Home Page         

LATEST

  • Meet­ing on­line may lead to hap­pier mar­riages

  • Pov­erty re­duction, environ­mental safe­guards go hand in hand: UN re­port

EXCLUSIVES

  • Was black­mail essen­tial for marr­iage to evolve?

  • Plu­to has even cold­er “twin” of sim­ilar size, studies find

  • Could simple an­ger have taught people to coop­erate?

  • Diff­erent cul­tures’ mu­sic matches their spe­ech styles, study finds

MORE NEWS

  • F­rog said to de­scribe its home through song

  • Even r­ats will lend a help­ing paw: study

  • D­rug may undo aging-assoc­iated brain changes in ani­mals

Karen Schroeder’s recorded voice spoke to her son, Ryan, reminding him of a time when at age 10 he had decided to raise pigs. “You bid on three beautiful squealing black and white piglets at the auction,” she said softly. “We took them home in the trunk of our Lincoln Town Car, because we didn’t have a truck.” Recordings from Ryan’s mother, father or sister were played through headphones for him four times a day in a Chicago hospital. They were part of a new clinical trial investigating whether repeated stimulation with familiar voices can help repair a coma victim’s injured brain networks and spur his recovery. In January 2009, Ryan, a 21-year-old college student from Huntley, Ill., was in a coma after he had been flung from his snowmobile into a tree during an ice storm. He had a traumatic brain injury; the fibers of his brain had been twisted and stretched from the impact. He regained consciousness after nearly one month in the trial and has made steady progress during the past year. Researchers, however, won’t know for certain if the therapy helped his recovery until the study is over. The trial is being led by Theresa Pape, a research assistant professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine and a research health scientist at Hines VA Hospital in Chicago. Funded by the U.S. Department of Veteran Affairs, the research may be useful to young people like Ryan as well as soldiers injured in combat. “Traumatic brain injury is a huge issue in our society,” Pape said. “Every 21 seconds, we have a new head injury and about one-third of those will be severe.” The most common cause of severe head injury among civilians is motor vehicle accidents, according to Pape, and the highest-risk group is 16-to-24-year-old males. In the military, the risk of traumatic brain injury is three times that of civilians, even in peacetime. While the actual number is not known, an estimated 8,470 soldiers were diagnosed with traumatic brain injury from January 2003 through September 2008. Pape hopes the study will help answer the question that families are desperate to know when a loved one is in a coma: “Can he hear me?” She is especially eager to know if these family voices can facilitate repair of the brain to improve the subject’s ability to function and process and understand information. Pape’s hypothesis is that repeated exposure to familiar voices could help repair the brain’s neural networks, some of which become sheared in traumatic brain injury. In a previous small pilot study, Pape observed that subjects in a vegetative state responded more to the voices of people who are familiar to them compared with non-familiar voices. When those subjects heard voices of their family members, an MRI scan showed that parts of their brain were activated, appearing as bright yellow and red blobs of light scattered in an unorganized pattern. With unfamiliar voices, there was little activation. “The question became are the familiar voices therapeutic in some way?” Pape asked. “Will they spur an improvement in behavior?” When a subject is enrolled in the trial, Pape does a baseline functional MRI scan of his brain, examining the reaction to familiar versus unfamiliar voices. In a healthy person, she would expect to see a family member’s voice activate the temporal lobe, the site of memory, and the frontal lobe, the part of the brain that pays attention when your name is called aloud. She doesn’t see that in her subjects with new severe traumatic brain injury. “As they recover, we want to see if these areas become activated in the way we’d expect in a healthy person,” Pape said. Pape also tracks the state of their axons, the thick white fibers that comprise the brain’s networks and allow different parts of the brain to communicate with each other. In a traumatic brain injury, the axons can become ripped and twisted like interstate highways in a Hollywood disaster movie. “In a healthy brain, the networks function in a very organized manner, from front to back, for example,” Pape said. “The injured brain has a disorganized direction we don’t understand. The axons are sheared, torqued and twisted. We’re trying to figure out how and if they work after a severe brain injury. Maybe they zigzag or connect with an unexpected neuron.” For the trial, subjects are divided into three groups: high dose, who hear 10 minutes of stories daily four times a day for six weeks; low dose, who hear five minutes of stories and 35 minutes of silence four times a day; and the “sham” group who wear the head phones but don’t hear any stories. After six weeks, Pape measures how the subject’s behavioral condition compares to changes she sees in the brain on new MRI images. The trial is double blinded, meaning Pape will not know whether subjects were in the high, low or sham dose group until the study, which will enroll about 45 subjects, is completed in 2011. The earlier description of Karen Schroeder’s voice being played for Ryan occurred after the initial double-blinded part of the study. After this part, all subjects receive the high dose of stories for six weeks to make sure that if there is a benefit, everyone has the same advantage. Pape’s imaging data of a subject’s brain before and after the voice treatment will reveal if networks are better connected as a result of the therapy, and if that is linked to improvement in the subject’s functioning. When Schroeder enrolled her son in the trial in late February 2009, about a month after his accident, he could not follow commands or make purposeful movements. His eyes were open, but he did not seem to be aware of his environment. At the time, a doctor had told Schroeder to make arrangements to place her son in a nursing home. But after three weeks in the trial, Schroeder began to notice changes in her son. First, she said, Ryan began to notice the lights outside the window of his room in the Northwestern University Clinical Research Unit on the 10th floor of Northwestern Memorial Hospital, the location where he received the voice therapy. “I could tell he was starting to come around,” Schroeder said. “Before, he would lay in the bed and a herd of cattle could walk through and he would not be aware that they were there. Now, little by little he would start to respond. Then, he began to slowly follow a command to push a ball out of his hand. A little more than a year later, Ryan now texts his friends, brushes his teeth and walks with a walker or a four-prong cane. He is practicing walking without a device. While he struggles with poor balance, he recently started eye therapy, which may or may not help his balance. A palate lift several months ago greatly improved his speech, according to Schroeder. Ryan continues with physical, occupational and speech therapies at the Rehabilitation Institute of Chicago in Wheeling. “Given the extent of his injuries, Ryan has recovered well,” Pape said. “But I can’t draw any conclusions yet. We have to wait until we have all the study data.” In the meantime, Ryan helps at his family’s asphalt paving business where he enters data into the computer. He doesn’t remember his accident or hearing the tapes of his family. “He continues to make progress. It is truly a remarkable recovery,” said Karen Schroeder. “The good Lord keeps throwing us ropes. We got involved in this by the grace of God.”