NY Times - Mute 19 Years, He Helps Reveal Brain's Mysteries

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( Binstock forwarded this)

Mute 19 Years, He Helps Reveal Brain's Mysteries

By BENEDICT CAREY

HARRIET, Ark., July 2 — Terry Wallis spends almost all of his waking hours in

bed, listening

to country-western music in a cramped, two-room bungalow down a gravel road off

State

Highway 263.

Mr. Wallis, 42, wears an open, curious expression and speaks in a slurred but

coherent

voice. He volleys a visitor's pleased-to-meet-you with, " Glad to be met, " and

can speak

haltingly of his family's plans to light fireworks at his brother's house

nearby.

For his family, each word is a miracle. For 19 years — until June 11, 2003 — Mr.

Wallis lay

mute and virtually unresponsive in a state of minimal consciousness, the result

of a head

injury suffered in a traffic accident. Since his abrupt recovery — his first

word was " Mom, "

uttered at the sight of his mother — he has continued to improve, speaking more,

remembering more.

But Mr. Wallis' return to the world, and the progress he has made, have also

been a kind of

miracle for scientists: an unprecedented opportunity to study, using advanced

scanning

technology, how the human brain can suddenly recover from such severe,

long-lasting

injury.

In a paper being published Monday, researchers are reporting that they have

found strong

evidence that Mr. Wallis's brain is healing itself by forming new neural

connections since

2003.

The paper, appearing in The Journal of Clinical Investigation, includes a series

of images of

Mr. Wallis's brain, the first such pictures ever taken from a late-recovering

patient.

The new findings raise the hope that doctors will eventually have the ability to

determine

which patients with severe brain damage have the best chance of recovering. They

might

also help settle disputes in cases like that of Terri Schiavo, the Florida woman

who was

removed from life support and died last year after a bitter national debate over

patients'

rights. Ms. Schiavo suffered more profound brain damage than Mr. Wallis and did

not

show signs of responsive awareness, according to neurologists who examined her.

" We read about these widely publicized cases of miraculous recovery every few

years, but

none of them — not one — has ever been followed up scientifically until now, "

said Dr.

Schiff, a neuroscientist at Weill Cornell Medical College in Manhattan

and the

senior author of the new imaging study.

An estimated 100,000 to 200,000 Americans subsist in states of partial or

minimal

consciousness, cut off from those around them.

On Saturday, Mr. Wallis said he felt good, but he showed no memory of the study.

After

prompting from his mother, he did remember the trip back from the researchers'

laboratory in New York.

" Gasoline, " he said, referring to a stop the airplane made to refuel. " We

stopped for

gasoline. "

His mother, Angilee Wallis, said: " He is starting to learn things now. That

right there is

new. "

In recent weeks, she said, he has also shown hints of self-awareness, alluding

to his

disabled condition for the first time.

Mrs. Wallis, 58, and her husband Jerry, 62, live with and care for their son in

a white

clapboard cabin, with a small concrete porch surrounded on all sides by acres of

trees.

Their house, between Harriet and Big Flat, is among a scattering of such hidden

homes,

sheds and dirt roads a couple of miles from a highway intersection anchored by

two liquor

stores. The nearest decent grocery store is 30 minutes away, in Mountain View,

Ark.

For the Wallis family, Terry's accident, his long years of mental absence and

his return

have been a story of celebrity as well as recovery, of how media attention can

strike like a

flash flood and just as quickly dry up, leaving families to figure out what all

the attention

meant, if anything — and whether it was worth it.

He was a lanky 19-year-old in 1984, with a gift for elaborate pranks and engine

work,

when he and two friends skidded off a small bridge in a pickup, landing upside

down in a

dry riverbed. The family never figured out exactly what happened. The crash left

their son

unresponsive, breathing but immobilized, there but not there, said his father.

Terry Wallis showed no improvement in the first year, and doctors soon

pronounced him

to be in a persistent vegetative state, and gave him virtually no chance of

recovery, his

parents said.

About 52 percent of people with traumatic wounds to the head, most often from

car

accidents, recover some awareness in the first year after the injury, studies

find; very few

do so afterward. Only 15 percent of people who suffer brain damage from oxygen

deprivation — like Terri Schiavo, whose heart stopped temporarily — recover some

awareness within the first three months. A 1994 review of more than 700

vegetative

patients found that none had done so after two years.

But at some point after his accident, probably within months, Mr. Wallis, a

mechanic

before his injury, entered what is called a minimally conscious state, Dr.

Schiff said. The

diagnosis, established formally in 2002, is given to people who are severely

brain

damaged but occasionally responsive. In their good moments, they can track

objects with

their eyes, respond to commands by blinking, grunting or making small movements.

They

may spend the rest of their lives in this condition, but it is a necessary

intermediate step if

they are ever to regain some awareness, neurologists say.

Mr. Wallis spent the second 19 years of his life at a nursing home in Mountain

View, and

family members who visited said they saw plenty of hints of awareness along the

way. He

seemed to brighten when they walked in his room. Something in his face would

tighten

when he was impatient or hungry.

None of which made the day he said " Mom " any less thrilling. Ms. Wallis, her

voice

unsteady, quickly put out the word to the extended family.

Later, the patient had another visitor, a striking blonde woman: his 19-year-old

daughter,

Amber, who had been 6 weeks old at the time of his accident. " I was so nervous

driving

over there, " she said. " I was looking in the rearview mirror to check my hair, I

swear, I was

so worried he wouldn't recognize me. "

When finally he did, she said, the first sentence he uttered was, " 'You're

beautiful,' and he

told me he loved me. "

He was suddenly speaking; it was a transformation. He was still disabled, barely

able to

move or speak, but he was recognizable as Terry.

The months that followed brought a swarm of other emotions. Mr. Wallis, now

considered

clinically recovered but still in need of around-the-clock attention, was moved

into his

parents' home, shifting much of the financial burden of his care from Medicaid

to them.

And the world came knocking. A camera crew from Japan arrived and spent two

weeks

doing daily interviews and filming. Another crew visited from England. There

were talk

show appearances, agents, documentary makers, forcing Mrs. Wallis to take time

away

from her job at a local shirt factory to help her husband, a mechanic and

farmer, play host.

But the attention soon dissipated, and a fund his parents established for their

son's care —

the Terry Wallis Special Needs Trust — attracted few substantial contributions,

they said.

Their son still needed to be fed, washed, exercised and turned in his bed every

two hours,

night and day. His daughter took two regular shifts a day to tend to him, and

another aide

began working with the family.

But in some ways it was like living with a child who never grows up or leaves

home: there,

out back in the trees, was his old gray Ford van, untouched since 1984; out

front was an

aluminum boat his father had bought for him, overturned, unused.

In 2004, Dr. Schiff contacted the family, asking if they would allow their son

to be studied.

He helped arrange to have the Wallises flown to New York in April of that year,

and again

18 months later, for brain scanning. A research team from New York, New Jersey

and New

Zealand spent more than a year analyzing the results, comparing them to images

from

healthy brains and from another minimally conscious patient who had not

recovered.

Using a novel technique, they saw evidence of new growth in the midline

cerebellum, an

area involved in motor control, as Mr. Wallis gained strength and range in his

limbs.

Another area of new growth, located along the back of the brain, is believed by

some

experts to be a central switching center for conscious awareness.

The daily exercises, the interactions with his parents, his regular dose of

antidepressant

medication: any or all of these might have spurred brain cells to grow more

connections,

the researchers said.

" The big missed opportunity is that we didn't know this guy would spontaneously

emerge,

and we didn't get to monitor him before then " to find out what preceded it, Dr.

Schiff said.

To answer that kind of question in a systematic way, researchers will need to

follow more

minimally conscious patients for longer periods, experts say. But there is no

national

system to track such patients, they say, no central database like that which

exists for other

diseases.

" We don't see these people. They exist outside of our gaze. We don't even know

where

they live, " said Dr. ph Fins, chief of the medical ethics division of New

York

Presbyterian Hospital-Weill Cornell Medical Center.

Mr. Wallis, it was clear over the weekend, continues to live for the day. He has

a

granddaughter now, Amber's child, , and the 2-year-old does not seem

bothered

by the pale man with the dark mustache and the inward-turned arms. He does not

feel any

physical pain, he told his parents, and he has no real sense of time. He also

said recently

that he was " proud " to be alive.

" It is good to know all that, " said his father, sitting on the porch on Saturday

evening.

" It's good to hear him say that, because if he didn't say so, you'd just have no

way to

know. "