Gabrielle Giffords Brain Injury: Doctors Work To Help Giffords' Brain Rewire Itself

The New York Times added a number of encouraging details on Sunday night, including Giffords beating one of her nurses at a game of tic-tac-toe and using music to recover her speech:
The New York Times added a number of encouraging details on Sunday night, including Giffords beating one of her nurses at a game of tic-tac-toe and using music to recover her speech:

AP/The Huffington Post 

First Posted: 02/14/11 02:26 AM Updated: 02/14/11 04:05 PM

 

NEW YORK -- Compared to a sleek new laptop, that three-pound mass of fatty tissue called the brain may not look like much. But when it's injured, it adapts and rewires its circuits in new ways.

 

That's the kind of flexibility that doctors and rehabilitation specialists hope to encourage in Gabrielle Giffords, the brain-injured Arizona congresswoman.

Details about her recovery have been thin. But members of her staff say she recently began speaking for the first time since the Jan. 8 attack by a gunman in Tucson. Brain injury patients who regain speech typically begin to do that about four to six weeks after the injury, experts say.

Last week, the Congresswoman asked for toast while while having breakfast, her chief of staff told the "CBS Evening News." That was within a month of being shot in the head. The Houston Chronicle noted that doctors at TIRR Memorial Hermann have used the phrase "lightning speed" to describe her recovery thus far.

 

With a group of friends and family members acting as a backup chorus, Ms. Giffords has been mouthing the lyrics to "Twinkle, Twinkle, Little Star" and "I Can't Give You Anything but Love, Baby." And as a surprise for her husband, who is celebrating his birthday this month, a longtime friend who has been helping her through her rehabilitation videotaped her mouthing the words to "Happy Birthday to You."

 

Giffords also briefly spoke with her brother-in-law Scott Kelly by telephone Sunday afternoon as he orbited aboard the International Space Station, The New York Times reported on its website.

 

"She said, hi, I'm good," her chief of staff, Pia Carusone, told the paper. He is the brother of Giffords' husband, astronaut Mark Kelly.

 

She has also been receiving bedside briefings from aides on the recent uprising in Egypt and on last week's decision by Republican Sen. Jon Kyl of Arizona not to seek re-election.

 

"We tell her everything that's going on," Carusone said. "Don't get the idea she's speaking in paragraphs, but she definitely understands what we're saying and she's verbalizing."

 

Still, recovery for the 40-year-old Giffords will be a long, tough journey, as it is for anyone with a significant brain injury. Patients can make remarkable progress. But experts caution that they shouldn't expect to return to exactly the way they were before.

 

Too little has been revealed and it's too early to say if Giffords might be able to return to her job in Congress. One expert questioned whether that would be the best thing for her to do.

 

Most people with such injuries have some level of impairment for the rest of their lives.

 

Scientists are still unraveling just how the brain works to recover from traumatic injury and how to help it repair as much as possible.

 

They're dealing with an organ about the consistency of cold porridge. It contains maybe 100 billion densely packed nerve cells, each of which is connected to 1,000 or so other nerve cells, called neurons. Those connections form circuits that are the foundation of the brain's activity.

Brain injuries can disrupt that in several ways. A car accident can smash a head, stretching and tearing brain tissue across a wide area. A penetrating injury like a bullet causes more localized damage, but the force of the impact can also damage neuron connections some distance away from the projectile's path.

 

Either way, brain injury produces an "utter quagmire" of specific disruptions in brain functioning that doctors have only blunt tools to fix, said Dr. Jonathan Fellus, director of the brain injury program at the Kessler Institute for Rehabilitation in West Orange, N.J.

 

What all this disruption means to the patient depends on what brain circuits have been affected. People might have trouble reasoning, finding words, remembering things, organizing priorities, recognizing faces, understanding what's said to them, or doing multiple things at once. Or they could have problems walking, reaching, getting dressed or feeding themselves.

So how can the brain get better?

 

In some cases, brain cells that were impaired or stunned but not killed by the initial injury get back on track. Another surprising factor is that the brain's wiring is not fixed. In response to an injury, neurons can alter their patterns of connections.

 

For example, if the damaged part of the brain is small enough, new connections might bring in neighboring neurons to stand in for dead ones. Or existing connections can be strengthened, allowing neurons to work together more efficiently than they had to before.

 

Rewiring can bring in a whole different brain circuit to compensate for a damaged one.

 

So a person who used to find his way to work just by instinct may come to rely on memorizing the route more formally. Or somebody who struggles to find words may emphasize facial expressions more than before. A patient who has trouble remembering what he sees may compensate by telling himself what he's looking at, bringing in his verbal memory circuitry.

Patients may develop compensation strategies on their own, though more typically they're guided by doctors and therapists, said Dr. Bruce Dobkin, director of the neurologic rehabilitation and research program at the University of California, Los Angeles.

 

Fellus compares brain rewiring after injury to taking back roads when an interstate highway is damaged. It's a less efficient way to get a job done, he said, and the added effort may help explain why brain injury patients often feel tired or simply fail to accomplish some tasks.

 

"They have to pace themselves, they have to do things in a more organized way," staying more focused on a task like memorizing a phone number than they had to before, he said.

 

That's certainly the case with Kim Towns, 47, of Chesapeake, Va., even 23 years after she was shot in the forehead.

 

"I can't really concentrate like I used to. I get tired really easily, I get depressed," she said. Rather than doing several things at once, "I have to really just sit down and concentrate on one particular subject."

 

In any case, brain rewiring - scientists call it plasticity - is driven by what a patient is learning and experiencing, said Jordan Grafman, director of the Traumatic Brain Injury Research Laboratory at the Kessler Foundation Research Center in West Orange.

 

That's why patients should get into rehabilitation as soon as possible, where "people are paid to stimulate you," providing skilled expertise as well as respite for exhausted caregivers, he said.

 

The time course of recovery can be long. It's most dramatic in the first year, with probably more than a third of patients who survive severe injuries showing improvement by the end of that time, said Dr. Alan Faden of the University of Maryland.

 

Grafman said progress often slows in the second six months of the first year, becoming perhaps not evident to those who see the patient every day, but noticeable to someone who drops by only every three months.

During the second year, gains are usually minimal but can sometimes be significant, said Grafman. After that, many people show no further improvement, but some do, he said.

 

The course of recovery depends on things like age - with patients from teens to 40 recovering better than those over 50 to 60 - and how motivated, young and healthy a patient is, the size and location of the injury and even a genetic predisposition to recovery.

 

But for the most part, brain injury patients will always have some degree of impairment, Grafman said.

 

That's not necessarily a recipe for misery; it just means people need to adjust, said Grafman, who has studied Vietnam veterans with brain injuries for 30 years.

 

"I'm always impressed ... at seeing how may of them have lived quite successful lives, having families and kids and working at jobs," he said. They "wind up living, in some sense, an ordinary life."

 

Giffords might have to make the same kind of adjustment.

Without knowing details of her progress it's impossible to say whether she could return to Congress, Grafman said. A supportive staff might make it possible, he said, but "would it be the best thing for her?"

 

Impairment can add stress for those who strive to return to a high-pressure job, Grafman said. And over a long period, that added stress could harm their mental abilities even more. Persistent stress kills neurons, he said, and can interfere with memory and decision-making beyond the long-term effects of the brain injury itself.

 

As it stands now, "Giffords will have strengths that remain. That's what you want to play into," he said, even if it leads to a productive life outside the halls of Congress.

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2014

The Case for Reparations

 

The Case for Reparations

 

Two hundred fifty years of slavery. Ninety years of Jim Crow. Sixty years of separate but equal. Thirty-five years of racist housing policy. Until we reckon with our compounding moral debts, America will never be whole.

 

By Ta-Nehisi Coates

May 21, 2014

 


Chapters

  1. I. “So That’s Just One Of My Losses”
  2. II.  “A Difference of Kind, Not Degree”
  3. III. “We Inherit Our Ample Patrimony”
  4. IV. “The Ills That Slavery Frees Us From”
  5. V. The Quiet Plunder
  6. VI. Making The Second Ghetto
  7. VII. “A Lot Of People Fell By The Way”
  8. VIII. “Negro Poverty is not White Poverty”
  9. IX. Toward A New Country
  10. X. “There Will Be No ‘Reparations’ From Germany”
0 Comments

Mon

02

Jun

2014

A Look At 19th Century Children In The USA

PHILADELPHIA — DINNER with your children in 19th-century America often required some self-control. Berry stains in your daughter’s hair? Good for her. Raccoon bites running up your boy’s arms? Bet he had an interesting day.

 

As this year’s summer vacation begins, many parents contemplate how to rein in their kids. But there was a time when Americans pushed in the opposite direction, preserved in Mark Twain’s cat-swinging scamps. Parents back then encouraged kids to get some wildness out of their system, to express the republic’s revolutionary values.

The New York Times

Sunday Review

By JON GRINSPAN MAY 31, 2014

 

A late 19th century family taking a stroll down a set of railroad tracks
A late 19th century family taking a stroll down a set of railroad tracks

American children of the 19th century had a reputation. Returning British visitors reported on American kids who showed no respect, who swore and fought, who appeared — at age 10 — “calling for liquor at the bar, or puffing a cigar in the streets,” as one wrote. There were really no children in 19th-century America, travelers often claimed, only “small stuck-up caricatures of men and women.”

 

This was not a “carefree” nation, too rough-hewed to teach proper manners; adults deliberately chose to express new values by raising “go-ahead” boys and girls. The result mixed democracy and mob rule, assertiveness and cruelty, sudden freedom and strict boundaries. Visitors noted how American fathers would brag that their disobedient children were actually “young republicans,” liberated from old hierarchies. Children were still expected to be deferential to elders, but many were trained to embody their nation’s revolutionary virtues. “The theory of the equality” was present at the ballot box, according to one sympathetic Englishman, but “rampant in the nursery.”

 

Boys, in particular, spent their childhoods in a rowdy outdoor subculture. After age 5 or so they needed little attention from their mothers, but were not big enough to help their fathers work. So until age 10 or 12 they spent much of their time playing or fighting.

 

The writer William Dean Howells recalled his ordinary, violent Ohio childhood, immersed in his loose gang of pals, rarely catching a “glimpse of life much higher than the middle of a man.” Howells’s peers were “always stoning something,” whether friends, rivals or stray dogs. They left a trail of maimed animals behind them, often hurt in sloppy attempts to domesticate wild pets.

 

And though we envision innocents playing with a hoop and a stick, many preferred “mumbletypeg” — a game where two players competed to see who could throw a knife closer to his own foot. Stabbing yourself meant a win by default.

 

Left to their own devices, boys learned an assertive style that shaped their futures. The story of every 19th-century empire builder — Carnegie, Rockefeller, Vanderbilt — seems to begin with a striving 10-year-old. “Boy culture” offered training for the challenges of American manhood and a reprieve before a life of labor.

 

But these unsupervised boys also formed gangs that harassed the mentally ill, the handicapped and racial and ethnic minorities. Boys played an outsize role in the anti-Irish pogroms in 1840s Philadelphia, the brutal New York City draft riots targeting African-Americans during the Civil War and attacks on Chinese laborers in Gilded Age California. These children did not invent the bigotry rampant in white America, but their unrestrained upbringing let them enact what their parents mostly muttered.

 

Their sisters followed a different path. Girls were usually assigned more of their mothers’ tasks. An 8-year-old girl would be expected to help with the wash or other physically demanding tasks, while her brother might simply be too small, too slow or too annoying to drive the plow with his father. But despite their drudgery, 19th-century American girls still found time for tree climbing, bonfire building and waterfall-jumping antics. There were few pretty pink princesses in 19th-century America: Girls were too rowdy and too republican for that.

 

So how did we get from “democratic sucklings” to helicopter parents? Though many point to a rise of parental worrying after the 1970s, this was an incremental change in a movement that began a hundred years earlier.

 

In the last quarter of the 19th century, middle-class parents launched a self-conscious project to protect children. Urban professionals began to focus on children’s vulnerabilities. Well-to-do worriers no longer needed to raise tough dairymaids or cunning newsboys; the changing economy demanded careful managers of businesses or households, and restrained company men, capable of navigating big institutions.

 

Demographics played a role as well: By 1900 American women had half as many children as they did in 1800, and those children were twice as likely to live through infancy as they were in 1850. Ironically, as their children faced fewer dangers, parents worried more about their protection.

 

Instead of seeing boys and girls as capable, clever, knockabout scamps, many reconceived children as vulnerable, weak and naïve. Reformers introduced child labor laws, divided kids by age in school and monitored their play. Jane Addams particularly worked to fit children into the new industrial order, condemning “this stupid experiment of organizing work and failing to organize play.”

 

There was good reason to tame the boys and girls of the 19th century, if only for stray cats’ sake. But somewhere between Jane Addams and Nancy Grace, Americans lost track of their larger goal. Earlier parents raised their kids to express values their society trumpeted.

 

“Precocious” 19th-century troublemakers asserted their parents’ democratic beliefs and fit into an economy that had little use for 8-year-olds but idealized striving, self-made men. Reformers designed their Boy Scouts to meet the demands of the 20th century, teaching organization and rebalancing the relationship between play and work. Both movements agreed, in their didactic ways, that playtime shaped future citizens.

 

Does the overprotected child articulate values we are proud of in 2014? Nothing is easier than judging other peoples’ parenting, but there is a side of contemporary American culture — fearful, litigious, controlling — that we do not brag about but that we reveal in our child rearing, and that runs contrary to our self-image as an open, optimistic nation. Maybe this is why sheltering parents come in for so much easy criticism: A visit to the playground exposes traits we would rather not recognize.

 

There is, however, a saving grace that parents will notice this summer. Kids are harder to guide and shape, as William Dean Howells put it, “than grown people are apt to think.” It is as true today as it was two centuries ago: “Everywhere and always the world of boys is outside of the laws that govern grown-up communities.” Somehow, they’ll manage to go their own way.

 

________________________________

 

A National Endowment for the Humanities fellow at the Massachusetts Historical Society who is writing a book on the role of young people in 19th-century American democracy.

0 Comments

Mon

21

Apr

2014

Investigating Family's Wealth, China's Leader Signals a Change

From The New York Times 

By CHRISTOPHER DREW and JAD MOUAWAD

APRIL 19, 2014

 

HONG KONG — His son landed contracts to sell equipment to state oil fields and thousands of filling stations across China. His son’s mother-in-law held stakes in pipelines and natural gas pumps from Sichuan Province in the west to the southern isle of Hainan. And his sister-in-law, working from one of Beijing’s most prestigious office buildings, invested in mines, property and energy projects.

 

In thousands of pages of corporate documents describing these ventures, the name that never appears is his own: Zhou Yongkang, the formidable Chinese Communist Party leader who served as China’s top security official and the de facto boss of its oil industry.





A visitor at the Zhou family's ancestral graves in Xiqliantou, eastern China.  Intrigue surrounds the family after a spate of arrests.  Sim Chi Yim for the New York Times
A visitor at the Zhou family's ancestral graves in Xiqliantou, eastern China. Intrigue surrounds the family after a spate of arrests. Sim Chi Yim for the New York Times

But President Xi Jinping has targeted Mr. Zhou in an extraordinary corruption inquiry, a first for a Chinese party leader of Mr. Zhou’s rank, and put his family’s extensive business interests in the cross hairs.

 

Even by the cutthroat standards of Chinese politics, it is a bold maneuver. The finances of the families of senior leaders are among the deepest and most politically delicate secrets in China. The party has for years followed a tacit rule that relatives of the elite could prosper from the country’s economic opening, which rewarded loyalty and helped avert rifts in the leadership.

Zhou Family Ties

1 Comments

Fri

13

Nov

2015

Are Languages Products of their Environment?


shutterstock_222422665_151112


DISCOVER MAGAZINE published this very interesting article: 


  Languages Are Products of Their Environments


The characteristics that make each language unique may actually be adaptations to the acoustics of different environments.

2 Comments

Tue

03

Jun

2014

The Case for Reparations

 

The Case for Reparations

 

Two hundred fifty years of slavery. Ninety years of Jim Crow. Sixty years of separate but equal. Thirty-five years of racist housing policy. Until we reckon with our compounding moral debts, America will never be whole.

 

By Ta-Nehisi Coates

May 21, 2014

 


Chapters

  1. I. “So That’s Just One Of My Losses”
  2. II.  “A Difference of Kind, Not Degree”
  3. III. “We Inherit Our Ample Patrimony”
  4. IV. “The Ills That Slavery Frees Us From”
  5. V. The Quiet Plunder
  6. VI. Making The Second Ghetto
  7. VII. “A Lot Of People Fell By The Way”
  8. VIII. “Negro Poverty is not White Poverty”
  9. IX. Toward A New Country
  10. X. “There Will Be No ‘Reparations’ From Germany”
0 Comments

Mon

02

Jun

2014

A Look At 19th Century Children In The USA

PHILADELPHIA — DINNER with your children in 19th-century America often required some self-control. Berry stains in your daughter’s hair? Good for her. Raccoon bites running up your boy’s arms? Bet he had an interesting day.

 

As this year’s summer vacation begins, many parents contemplate how to rein in their kids. But there was a time when Americans pushed in the opposite direction, preserved in Mark Twain’s cat-swinging scamps. Parents back then encouraged kids to get some wildness out of their system, to express the republic’s revolutionary values.

The New York Times

Sunday Review

By JON GRINSPAN MAY 31, 2014

 

A late 19th century family taking a stroll down a set of railroad tracks
A late 19th century family taking a stroll down a set of railroad tracks

Read More 0 Comments

Mon

21

Apr

2014

Investigating Family's Wealth, China's Leader Signals a Change

From The New York Times 

By CHRISTOPHER DREW and JAD MOUAWAD

APRIL 19, 2014

 

HONG KONG — His son landed contracts to sell equipment to state oil fields and thousands of filling stations across China. His son’s mother-in-law held stakes in pipelines and natural gas pumps from Sichuan Province in the west to the southern isle of Hainan. And his sister-in-law, working from one of Beijing’s most prestigious office buildings, invested in mines, property and energy projects.

 

In thousands of pages of corporate documents describing these ventures, the name that never appears is his own: Zhou Yongkang, the formidable Chinese Communist Party leader who served as China’s top security official and the de facto boss of its oil industry.





A visitor at the Zhou family's ancestral graves in Xiqliantou, eastern China.  Intrigue surrounds the family after a spate of arrests.  Sim Chi Yim for the New York Times
A visitor at the Zhou family's ancestral graves in Xiqliantou, eastern China. Intrigue surrounds the family after a spate of arrests. Sim Chi Yim for the New York Times

Read More 1 Comments