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February 6, 2012

An Awakening

A pretty neat thing happened at work last week. I was writing up notes at lunch time in the rehab gym while eating my lunch. Out in the hallway, a young man was playing the piano brought out from the solarium and several patients and staff were listening to him play. Inside the gym, a gentleman was working at the upper body ergometer.

Having music in the gym is not untypical; often a gym will have a system playing music from the radio. But what we heard this day was classical music played live and rich, resonating throughout the rehab floor. This is a good thing, because music is found to have a calming effect. Not only that, music, unlike speech, is a whole brain activity. This will become important in a moment.

As I'm writing up my notes, I hear the gentleman at the ergometer say, "I've had a stroke!" I look over at him, he pedaling away, in no apparent distress. I see no new symptoms of a stroke, in fact, the initiation of speech is new for this man. "oh wow! I've had a stroke!" I slide over to him, "you want to talk about it?" He exhibits word finding problems, stuttering and perseverating on one of the words he can grasp but I can tell it's not quite adequate to express what he really means.

A cerebral vascular accident (CVA or stroke) is a type of traumatic brain injury where blood supply is cut off from a portion of the brain, either due to a burst or blocked blood vessel. It is strongly related to heart disease. Following a CVA, affected tissue areas of the brain, like any part of the body that is injured, exhibit swelling. As that inflammation goes down, patients often begin to get function back that they had lost. Forcing the engagement of this process too early is found to have more detrimental effect upon recovery than if we allow the brain to rest 3-4 days.

For my friend in the gym, what I was likely witnessing was post-ischemic recovery of brain tissue. With music playing in the background, more areas of the brain were stimulated, which would increase blood supply to the cortex (or outer covering of the brain). This would allow alternate blood flow to reach affected areas of the brain, and with it memories, words, and capabilities that the brain may have lost.

I can only imagine for someone like this, what his recent experiences must be like. He's in the hospital and may not understand why? Amnesia of the event may lift like a veil, and memories of the precipitating event may flood in, along with the emotions surrounding the event. A realization of the extent of the loss of prior function or the gratefulness to realize that they have survived such a dangerous experience may be overwhelming. With it may come relief and a clearer insight as to the why people have been pushing, pulling, prodding, moving him from one place to another, along with a sense of purpose that these things will help with recovery.

It was a big moment and really neat to see. I informed the attending physician and the speech therapist regarding their patient's breakthrough. I think he'll be alright now. Rather than floating through his therapy as though he is lost, he will likely engage his therapy with vigor and purpose, speeding his recovery.

Posted by linda at February 6, 2012 6:19 AM